I'm no fan of John McCain but

[Doc]

he got this one correct. The real problem with the ACA is it is a hyperpartisian bill rammed down America's throat by the left. They made not bones they were doing it w/o the GOP and the GOP rightly bitched. The right had no input so why the shock they when they get in power they are going to try to repeal it? But we all know the Einstein's definition of insanity (doing the same thing over and over and expecting different results) except for congress. Now the GOP wants to RAM their stuff thru without any democratic input or support. Well, if successful, guess what happens when the democrats get control? Who would be shocked if they repealed and replaced the repeal and replace? Not me. So why not do something together that BOTH sides can live with. Of course Schumer is for his (if you believe the lying bastard)...... but there should be some reasonable moderate democrats that can get behind something that isn't either far left or far right. Even the democrats know that the ACA is destined to fail, although some want that so they can go to single payer. There are literally hundreds of other acceptable options which keep insurance in the hands of the individual and are reasonable and moderate. Instead the right feels they have to repeal the ACA (IMO in part because its called OBAMA-care, and we don't want anything "OBAMA") but then fixing a 1000 plus page monstorsity might be far more difficult that ripping it up and starting from scratch. Take what is good about the ACA like portability, pre-existing conditions, etc and get rid of the bad like all the requirments like forced birth control coverage, prenatal care, pediatric dentistry.... and regulations that are causing increased premiums. Instead republicans can't find their asses with both hands and a road map while democrats rejoice over the prolonging of this pile of #### that came out of their asses and is costing hard working families thousands of dollars a year.

And they wonder why people hate congress.

[PedroDaGr8]

In my view, the biggest problems with the ACA are not WHAT it covered. Neonatal coverage is in general a long-term cost saver, birth control coverage is a long term cost saver (and also, if you are pro-life, one GUARANTEED way to reduce the number of abortions). Whether you use it or not, on a macroeconomic scale, these saved costs. These small cost savings though were not enough. The issue was there was basically jack **** to reduce real medical costs and rein in the price increases, both from the insurance agencies and the medical providers. There was zero price transparency initiatives (to allow comparison shopping), zero incentives to reduce usage (such as maximum billing per day), zero incentives to increase health (or penalties for lifestyle markers of bad health), zero means to drive down prescription drug prices, etc. It only was designed to do half the job, getting insurance to the uninsured. It didn't, nor was it IMHO truly designed, to force real const reforms in health care.

[Doc]

In my view, the biggest problems with the ACA are not WHAT it covered. Neonatal coverage is in general a long-term cost saver, birth control coverage is a long term cost saver (and also, if you are pro-life, one GUARANTEED way to reduce the number of abortions). Whether you use it or not, on a macroeconomic scale, these saved costs. These small cost savings though were not enough. The issue was there was basically jack **** to reduce real medical costs and rein in the price increases, both from the insurance agencies and the medical providers. There was zero price transparency initiatives (to allow comparison shopping), zero incentives to reduce usage (such as maximum billing per day), zero incentives to increase health (or penalties for lifestyle markers of bad health), zero means to drive down prescription drug prices, etc. It only was designed to do half the job, getting insurance to the uninsured. It didn't, nor was it IMHO truly designed, to force real const reforms in health care.

I'm a 54 years old married man with a wife who had her tubes tide. Why in the hell do I need NEONATAL CARE or BIRTH CONTROL as part of MY insurance package? It might save other people money but it does not me. If you want Neonatal care or birth control in YOUR insurance then you are free to get it but don't FORCE me to purchase something I don't need and will never use. My macroeconomics stops on April 15 when I pay my tax bill. After that I've met my commitment to others. From that point on I'm looking out for myself and my family. So when my monthly insurance bill went up $600 a month, I don't give a #### about macroeconomics, its "DOC-e-nomics" that I care about. And as a PRO-CHOICE person, I still believe the requiring people who are PRO-LIFE to supplement abortions is wrong. But much of the cost increases you mention were in place before the ACA and the law does nothing to curb it. I'm tired of Medical Facility Directors making ridiculous salaries and getting ludicrous retirement and perk packages. I'm tired of waste in the medical field but I also realize that excessive testing is required due to our litegeous society which is why tort reform is needed. What cuts cost is competition. Its been shown time and time again to be the case in America. Portability and ability to sell across state line would do wonder to bring INSURANCE costs down. There are so many options that can be discussed and used. Instead the bull-headed on both sides don't want to find something that BOTH can live with. Instead the left wanted it THEIR way and got it. Now the right wants to undo that, and I don't blame them for that. However its short sighted. So why not work together so you don't pass some partisan bill by the skin of the teeth that is destined to be repealed?

[Darrell KSR]

"Tort reform" is the greatest myth perpetrated on the American public today.

Man, the American public has been duped.


“The greatest trick the Devil ever pulled was convincing the world he didn’t exist.”

Verbal (Kevin Spacey) in The Usual Suspects

The second greatest trick may be the insurance industry’s success in getting more than half the states to implement “tort reform.” That achievement was based on the promise that restricting victims’ ability to bring medical malpractice suits would improve healthcare and reduce its cost. Those myths have now been completely dispelled.

https://www.forbes.com/sites/steveco.../#27db913663ea

The Rand Institute for Civil Justice, one of the most respected think tanks in the nation, found that only 10 percent of injured people seek compensation and only 2 percent of them file lawsuits. The Rand Institute also found that since 1991, tort cases reflected only six percent of all cases filed. Other reports have shown that:

While populations have grown nationwide, personal injury lawsuits have decreased by 21 percent.
Personal injury lawsuits represent only 1.3 percent of all civil dispositions.
From 1992 to 2005, jury trials in personal injury cases have seen a 52 percent decrease.
A survey of judges in Texas, where tort reform support runs high, found that 86 percent of them felt there was no need for legislation to limit lawsuits.
The frivolous lawsuit myth is an invention of big business. Corporations and insurance companies, though selective and sometimes entirely false reports, have framed several legitimate lawsuits as frivolous and an abuse of our courts. Through a relentless and well-funded public relations campaign, big business has transformed civil cases into urban myths that propagate the frivolous lawsuit myth. Frivolous lawsuits are just another bogey man trotted out by corporate interests to scare us into giving up our rights.



http://tortreformtruth.com/fact-vs-fiction/



Tort reform," which is usually billed as the answer to "frivolous malpractice lawsuits," has been a central plank in the Republican program for healthcare reform for decades.

The notion has lived on despite copious evidence that that the so-called defensive medicine practiced by doctors merely to stave off lawsuits accounts for, at best, 2% to 3% of U.S. healthcare costs. As for "frivolous lawsuits," they're a problem that exists mostly in the minds of conservatives and the medical establishment.

http://www.latimes.com/business/hilt...19-column.html

Tort reform is an absolute fraud on America. I've only read thousands of pages on this crap.

And full disclosure--I don't practice law in this area at all. I am of counsel with a defense firm, but I don't practice in that area at all, either. My opinion is solely mine, but it is unbiased, as I have no pecuniary interest in it at all.

Our "litigious society" ain't one bit to blame for this.

[Doc]

I have no issue with doctors being sued for malpractice however when the focus of their diagnostic workup is to prevent law suits as much as diagnosing the patient, its an issue. I run into this frequently and I'm only a vet. At times I run tests to cover my ass, tests that cost somebody money and raise bills so its easy for a lawyer to claim law suits/tort reform are a red herring but they are not because most Drs do cover their asses. And yet you still get the outrageous settlements where the Dr is not at fault. Its why malpractice insurance is so expensive.

That said, it is only a small segment of the reason for high costs. Tort reform won't solve the problem, but i never stated that it alone would. But addressing many small factors results in a larger result. Do that along with portability, competition, controlling executiven salaries and perks to reasonable level, as well as letting individuals decide what they do and dont want covered based on their personal financial situations and you get a cumulative result. Combined it makes a difference

[Darrell KSR]

The studies show that they perform the same tests in states with no possibility of them being sued. An absolute lie that it's caused by litigation.

Easter Bunny is more real than tort reform being responsible for our health insurance premiums. Absolute crock of crap.

Edit - before I go to bed, I wanted to make clear your opinion isn't a crock of crap. In fact, as usual, there's a lot of great stuff in it. The position that litigation is affecting our health insurance premiums isn't correlative. That's where I'm going. I'm a numbers guy. There's another debate on whether medical providers should be sued for substandard care, or consequences for improperly being sued for normal care, etc. To me, that debate isn't nearly as clear.

[Doc]

Anecdotally, for being "the greatest myth perpetrated on the American people", there sure are an awful lot of medical malpractice lawyer. Nowhere near the number of personal injury ones, but then there is cross over between medical malpractice and personal injury.

No doubt its overblown but its a factor. Addressing it wont solve the health cost issue but would help. Personally I've been affected and continue to be affected by preventative medicine (preventative in the sense of legal action rather than patient preventation of disease). I stopped seeing one back doctor who require an MRI every 6 months for legal reasons. My current requires them every 24 months as that is his malpractice carriers requirement. My last back attack it cost me an extra month of agony waiting for the MRI and results which have not changed in 10 years (5 scans) plus the $500 copay on the MRI to show my disc was still not there. Neither the Dr or myself was shocked the disc had not grown back. Additionally when I have my back done, requirements are such that only one side done at a time despite my problem being bilateral. This a result of regulations to minimize lawsuits, but it double my and the insurance costs since i have 2 anesthesias and 2 hospital visit rather than one. So while law suit might be rare, they are rare because excessive testing. That might be a good thing because is no such thing as too much testing but to claim it has no relevance in health care costs makes no sense. When verdicts in the millions are handed down, somebody pays. Ultimately it is the lowest person on the totum pole, the one who does not have the ability to pass on the cost. Insurance companies pay but pass those costs on to those they insure. In 2012 that was $3.5 billion. Those all might be valid but with numbers like that believing that Drs don't alter how they treat and insurance carriers do not regulate and require to minimize their exposure seems unreasonable. And lets not forget to mention the drug companies exposure in side effects, or more correctly termed adverse reactions, that often delay drug use or have them pull or get drug companies sued...and add to the cost of medication.....probably as much as the pharmaceutical companies' greed.

[Doc]

Last post concerning tort reform, promise.

Putting on a lawyer hat, or frock, let's say a parent with a 2 yr old child walks into your firm. Child suffered a fractured RIGHT hip mid April after falling off the bed. No evidence of abuse, no bruising, etc. Doctor repairs the hip and child does fine. End of July the child can't walk and goes to ER where radiographs reveal a fractured LEFT hip where the bone is dissolving. After HHS is called, not making the parents happy, and determining there is no child abuse, the Dr reviews previous films from April, has them reread to confirm he did not miss a fracture in the other hip, he runs extensive bloodworm including thyroid and parathyroid panels, as well as full body radiographs and consults with orthopedic surgeons and internal medicine specialists. All is normal in bloods, films etc. Child needs second surgery to fix left hip.

The above is not a hypothetical, other than the species. This occurred to me and I'm repairing the left leg on the cat this afternoon. But let's go back to our hypothetical parents and their lawyer. What is your recommendation? Or better yet, what is the recommendation of a lawyer who specializes in medical malpractice who has expert witnesses willing to testify the the Dr should have fully work the child up the first time with parathyroid and Calcium panels, all hefty priced tests. Does it go to trial or does they settle out of court? No doubt the child went through pain and suffering, surely a jury sees that. How much is that worth?

But now to me and my cat. Seems there is a condition called Spontaneous capital physeal fracture

https://www.ncbi.nlm.nih.gov/pubmed/12494971

26 case retrospective study. My cat makes 27, I THINK. But do I now run parathyroids and bound/unbound Calcium's on all the young cats I see with physeal fractures? If I'm a human Dr where the insurance company pays, absolutely. Its good medicine and keeps me from being hauled into court. In full disclosure, none of those tests confirm the diagnosis. There is no test to confirm but that does not prevent a lawsuit, only protects me from the accusation of malpractice.

I'm often accused of running tests to pad my bills when its actually good medicine. Wisely I document declined procedures which has saved my bacon more than once. But at times I do practice defensive medicine out of necessity.

Bottom line is we won't agree and hence agree to disagree. You see it from a lawyer standpoint, I from a medical provider. I have no issue with just and fair settlement such as a wrong leg being amputated or wrong drugs/doses. In fact the payouts listed in the last post at be 90% correct and just. But not every baby born with a defect is the OBs fault. Not every failed surgery is the surgeons fault. Finding fault or blame after an event is 1000 x easier then predicting and preventing.

But to claim this myth is the greatest, greater than Lee Harvey acted alone or global warming or Russia changed the election results, or that Bill Clinton did not have sexual relations with Monica, will always get an argument from me

[Catonahottinroof]

Finding fault or blame after an event is 1000 x easier then predicting and preventing.

In politics this has been sport for years. In the legal profession this has morphed from a cottage industry to something more vast, even sinister in some aspects and we all pay the price at the end of it.

[jazyd]

Morgan and Morgan...for the people law firm who wants to sue every Dr, every hospital. Every business they can. And I know for a fact the Feds got his firm for not paying his employees and paid a huge fine.

And frivolous lawsuits hmmmmmm. Before tort reform in Mississippi. The town of Port Gibson had more lawsuits pending than population. Lawyers from all over filed in that town knowing they would win because Latasha knew if she voted for Lakeisha to get lots of money then ole Lakeisha would vote for her to get money.

Lawyer John...One Call That's All never knew where a courtroom was but knew how to get in touch with every insurance company



moneyhttp://www.townhallmail.com/rllfcsqkfftpckfkpkcnqphvvlpvvklqwwnsbctltntrlw_zfs mmzwlpwz.html?a=&b=

[Doc]

Oh, and while I despise the ACA because it as un-American as they come with its forced compliance and government intrusion into my life, I still believe Mccain did the right thing by forcing a bipartisan approach even though it resulted in a failure to pass the partial repeal

[KeithKSR]

Oh, and while I despise the ACA because it as un-American as they come with its forced compliance and government intrusion into my life, I still believe Mccain did the right thing by forcing a bipartisan approach even though it resulted in a failure to pass the partial repeal

McCain didn't force a bipartisan approach. The left wants single payer and a full bailout of ACA. Repealing ACA would have come closer to forcing bipartisanship.

[Doc]

McCain didn't force a bipartisan approach. The left wants single payer and a full bailout of ACA. Repealing ACA would have come closer to forcing bipartisanship.

Repealing it was a 100% partisan move. Not a single democrat has been involved in solving the mess they created. The reason the original ACA is a mess is because the GOP was shut out of the process. Mccain stated one of the reasons he voted no was to reach across the aisle. Repealing it would have open up the GOP to do exactly what the left did, force something on a 100% partisan tract that the other side of the aisle could not and would not tolerate. Sorry but with the GOP in charge there is no way to bring about a single payer that the far left wants because they would have to flip at least 3 GOPers into voting for it. That isn't going to happen, no way, no how. More likely would be if the bill had passed and repeal occurred then when the left gains control of congress and the WH (which will eventually happen), they would repeal what the right forced thru and then put in single payer. Better approach is to work together NOW and find something that works for BOTH sides. Otherwise its just a game of pass until you lose control and then they repeal.

[CitizenBBN]

Better approach is to work together NOW and find something that works for BOTH sides. Otherwise its just a game of pass until you lose control and then they repeal.

There is nothing that works for both sides.

[Doc]

There is nothing that works for both sides.

Then its jist going to be a never ending repeal and replace.

[CitizenBBN]

Then its jist going to be a never ending repeal and replace.

Yes it is.

No way around it. Dems won't be happy till it's 100% government health care, gop has no idea what to do but they don't want that or their base will abandon them.

There's no compromising left. This is a to the death struggle for individual liberty or socialism.

[Catonahottinroof]

I think that was the original end game...single payer.

Yes it is.

No way around it. Dems won't be happy till it's 100% government health care, gop has no idea what to do but they don't want that or their base will abandon them.

There's no compromising left. This is a to the death struggle for individual liberty or socialism.

[Doc]

I think that was the original end game...single payer.

And they will get it unless the GOP comes up with something that at least SOME democrats, the more moderate ones, can get on board. A strictly partisian bill will get repealed because it has unilateral support. The other side won't want it because they had no input, which is ONE of the reasons the ACA was destined to fail. Of course when you have idiots like McConnell in charge of the Republicans, its no wonder that he can't get them together.

[dan_bgblue]

It appears as if the liberals are afraid that their recalcitrance and bull headed attitude may be working against them in the court of public votes in future elections. If they are seen by John and Jane Doe as being the party that is killing any opportunity for positive change then they may not win the next election against the party that "appears" to be trying to make improvements all by themselves.

I hope this is a good sign for the possibility of bipartisan cooperation

[Doc]

It appears as if the liberals are afraid that their recalcitrance and bull headed attitude may be working against them in the court of public votes in future elections. If they are seen by John and Jane Doe as being the party that is killing any opportunity for positive change then they may not win the next election against the party that "appears" to be trying to make improvements all by themselves.

I hope this is a good sign for the possibility of bipartisan cooperation

Exactly whichnis why it pisses me off if the GOP wastes the opportunity to do the right thing and come with a bipartisan moderate accaptable bill over something that is ultraconservatuve and destined to fail. Learn from the stupid approach the left took by jamming a unilateral bill hmthat had zero right support and was destined to be repealed as soon as the right can.

[CitizenBBN]

Exactly whichnis why it pisses me off if the GOP wastes the opportunity to do the right thing and come with a bipartisan moderate accaptable bill over something that is ultraconservatuve and destined to fail. Learn from the stupid approach the left took by jamming a unilateral bill hmthat had zero right support and was destined to be repealed as soon as the right can.

Except the bills the GOP has come up with are far from ultraconservative. Hell, if we just changed the monikers on the names from (R) to (D) we'd all be railing about socialized medicine.

What they needed to do was pivot completely, and instead of debating repeals or replaces, just go take a big trip to Singapore, learn how to do a real free market based health care system that still protects those without means, come back and vote for the damned free market for a change.

The closest notion of it has come from Rand Paul, but since that wouldn't please all the lobbyists for any group that thing was DOA. It wasn't perfect but it was the right direction in some ways.

What we have now is just a debate between completely socialized government run health care or government run health care provided by a few large well connected companies who get rich with their government overlord contracts.

that's it, those are the choices on the table. It's why the GOP base disowned them, held their nose and voted for trump, and why the Democrat base not vested in identity politics did the same thing to their party. Because the only two choices on any issue being offered by the two parties is either a 100% government solution or a government mandated solution installed by corporations with their noses so far up the government's backside they are all but the same thing.

[KeithKSR]

There can't be a bipartisan bill when one side refuses to participate.

[Doc]

There can't be a bipartisan bill when one side refuses to participate.

The far left.is refusing to participate, instead going for the Russia offensive to derail Teump, however theee are.some moderates, moderates in the democratic party who are more republican than the.like of Mckaskil, McCain. Swing a.few.of those, thats all im suggesting because then you have some concensus. But.to do that you have to get their input on any bill. Thus far.there has no seeking democratic involvement, just like the left shutout the GOP in the creation of Obama care

[PedroDaGr8]

What they needed to do was pivot completely, and instead of debating repeals or replaces, just go take a big trip to Singapore, learn how to do a real free market based health care system that still protects those without means, come back and vote for the damned free market for a change.

Singapore is far far far from a free real market system. It is in fact a highly government regulated and controlled system, much more so than even many European countries, enhanced by a small layer of free market veneer layered on top to keep out of control spending in check. The part that is a free market veneer does do a good job at this one role. Try to apply the Singaporean system without the additional drastic price regulations (both services and drugs are highly price regulated) and availability controls (once against what services and drugs are available are highly regulated) would result in a system which would collapse under its own weight negating any and all savings brought about by the free market aspect. The free market keeps the spending/utilization down when coupled with very tight controls, but unfortunately it does not bring the costs down on its own. Even the upper level, catastrophic plan which functions like insurance here is government regulated. It makes use of the highly regulated and subsidized government hospitals, has forced enrollment (though you can opt out), etc. Cost along is not why Singapore is successful, Americans already spend dramatically more out of pocket, than Singaporeans do (and their average Incomes and Cost of Living are higher than ours!). In the long run, there are just too many externalities and necessities for healthcare to function like a 100% free market while also keeping the costs reasonable AND covering everyone with at least basic healthcare. Too many places were need of a drug or service negates the free market functionalities, too many places where someone is too poor and as such must be covered by the tax payer. Whether disabled, elderly, too young, etc. there are all cases where the consumer will take out more than they put in. Additionally, part of the reason that it can work so well is that Singapore also almost authoricratically controls the health outcomes via other aspects of their citizens lives as well. Drug use and gun crime are almost non-existent (dealers get executed), people are forced to walk or take public transit everywhere which results in a more mobile populace, smoking and alcohol have taxes that would make California, Washington and NYC blush. Imagine a USA where people walked everywhere, didn't smoke, didn't do drugs, barely drank, etc. and already you would have huge reductions in the cost of healthcare in the USA. Additionally, much of Singapore's system which deals with the poor has been aided by monumental explosive growth of the Singaporean economy. Should this growth stop or reverse, many of the structures that cover the most vulnerable would outright collapse plunging their "ideal" healthcare system into chaos. Likely resulting in them converting over to a system resembling some of the strongest and most intrusive European style socialist systems, while still leaving some of the aspects of the old "free market" system in where they can to control costs.

[CitizenBBN]

I'm OK with executing drug dealers and whipping thieves, etc. You're right, start rounding them up and shooting them in the head would dramatically reduce our nation's health care burden.

You've talked me into it.

I haven't been to Singapore so I can't argue it either way, but I absolutely know that the health care system is built around consumers having no decision making basis based on either cost or quality of the product, and if you have a market where consumers do not make decisions based on cost or quality, you're going to have a truly horrid situation with rampant costs and horrible quality.

the only way to fix it is to have people vested in their health care decisions financially, and pushing as many decisions as possible down to the individual consumer level. The only way to do that is a system where the government subsidizes people but where it does not make decisions about care. We would actually do a lot to fix it to ban insurance altogether, but while that's not possible it is possible to move away from centralized decisions and rationing (which is inherently the way government allocates resources), and pushing decision making down and forcing providers to attract those consumers directly.

It's not a panacea, there are still a lot of problems facing the system, from rampant drug use to the notion that we should spend millions to keep someone alive just a little bit longer regardless of their quality of life and that other people should be forced to pay for it, but it's the right road to take. Won't happen, but its the right road if you really want to see dramatic lowering of costs and improvements in quality.

[PedroDaGr8]

I'm OK with executing drug dealers and whipping thieves, etc. You're right, start rounding them up and shooting them in the head would dramatically reduce our nation's health care burden.

You've talked me into it.

Hah, it is just as much that as the fact that you walk everywhere there and the city and subsidized public transit encourage more mobile lifestyles. I know QUITE a few Americans who couldn't tolerate that life. Personally, I found Bangkok to be an amazing city for livability without a car. They had multiple tiers of public transit, all affordable to the various groups of the population. As well as things like taxis, Uber/Grab, etc. to fill in the gaps. It worked very very very well. In the times I have stayed there, I never once felt like I needed a car and I actually enjoyed the freedom of NOT needing one. It also encourages cities to build themselves more densely and efficiently instead of sprawling into large neighborhoods with enormous yards.

I haven't been to Singapore so I can't argue it either way, but I absolutely know that the health care system is built around consumers having no decision making basis based on either cost or quality of the product, and if you have a market where consumers do not make decisions based on cost or quality, you're going to have a truly horrid situation with rampant costs and horrible quality.

Somewhat agree with you here. A system which doesn't create incentives to not abuse the provided services by overutilization or by choosing the most expensive options rather than what is necessary is doomed to fail, collapsing under itself in out of control costs.

the only way to fix it is to have people vested in their health care decisions financially, and pushing as many decisions as possible down to the individual consumer level. The only way to do that is a system where the government subsidizes people but where it does not make decisions about care. We would actually do a lot to fix it to ban insurance altogether, but while that's not possible it is possible to move away from centralized decisions and rationing (which is inherently the way government allocates resources), and pushing decision making down and forcing providers to attract those consumers directly.

Here is where we diverge. If you want to provide all people with at least a bare minimum of healthcare, something which I consider humane and just, there is an inherent upwards pressure on prices due to their necessity. Even in the most individual controlled and incentivized system, the poor need doctors visits, they need hosiptal stays (sometimes expensive ones), etc. The fact that these are a need which MUST be purchased generates a continuous upwards force on market prices. They might grow more slowly than now but without fail either some will do without even essential care or prices will rise in the free market. Those are the only two logical outcomes of this scenario. Additionally, anything which is a must have and have it right now kind of treatment will not experience the price reductions that the free market offers. For example, cancer care or a heart attack, you can't wait to search and find the best most logical and affordable option. You need the care you need right now and the market will exploit that by extracting as much as they can from it. Either insuring that the poor can not afford it and die from their ailments (because once again the optimal cost from a Supply/Demand perspective always results in a small percentage of those that can't afford) OR you subsidize these costs to ensure they can afford it and the costs again continue to rise. As such, there has to be at least some degree of government intervention and at minimum setting prices. From there, the industry can decide how it wants to ration, but without the mandatory price controls, the structure of a for-profit healthcare system will ALWAYS and WITHOUT FAIL rise and rise dramatically until the poor and for certain things even chunks of the middle class are left unable to afford it.

It's not a panacea, there are still a lot of problems facing the system, from rampant drug use to the notion that we should spend millions to keep someone alive just a little bit longer regardless of their quality of life and that other people should be forced to pay for it, but it's the right road to take. Won't happen, but its the right road if you really want to see dramatic lowering of costs and improvements in quality.

Don't entirely disagree with a lot of this either. Treating addiction as a mental health disorder, rather than a criminal one would save this country uncountable amounts of money. Increasing taxes on goods which negatively affect the health outcome (as was done with smoking) will pay dramatic dividends down the road as well. Your other example about controlling the costs of sustaining life sucks but it also in essence a necessity if you want the system to work.

[CitizenBBN]

Here is where we diverge. If you want to provide all people with at least a bare minimum of healthcare, something which I consider humane and just, there is an inherent upwards pressure on prices due to their necessity. Even in the most individual controlled and incentivized system, the poor need doctors visits, they need hosiptal stays (sometimes expensive ones), etc. The fact that these are a need which MUST be purchased generates a continuous upwards force on market prices.

Going to hit this in pieces, still at the office.

IMO this notion is empirically disproven across a wide range of markets and time. Is there a constant upward pressure on food? Not counting inflation, no there isn't. Microeconomics proves that there is no such thing, no real difference between goods that are necessary and goods that are not.

Why? B/c demand is shaped the same to a point, and the point where we would reach any difference (i.e. a Giffin good type situation) simply doesn't exist in reality b/c there is profit to be made by producers well beyond that point. Even the most classic example of such a force, the Irish potato famine, has been proven to be false.

Obviously we would have to subsidize purchases for those who can't afford care, up to a point, but that won't put pressure on prices b/c what it does is change the level of supply. You simply are moving along both curves, but the shape of those curves is basically the same for all markets.

Food, housing, etc. are no different from cell phones and such. Let's say cell phones were a vital necessity. Rather than paying $10K for one, you'd see other producers enter the market to try to get in on the higher profits being had by current producers, thus driving down price. It's how markets work, and why they work.

Producers constantly enter and exit markets, when they are free of course, in response to those changes in demand, so you never see the situation you describe for very long, determined as a function of the inherent structural barriers to entry (like making new factories or in this case hospitals and training more nurses and doctors).

[CitizenBBN]

I will add that what is creating that pressure in health care is very different. It's the very fact there is no market, and no limit on the expectations of what we should spend on anyone for any reason, that creates it.

Show me a market with nearly unlimited amounts of money to be spent by consumers and again I'll show you a very high cost market.

I'm sorry grandma has terminal conditions which means she will never, ever, no matter what we do, return home and have a normal life, and you want to just keep her on life support for 2 more months at the cost of $30K a day. If you have that kind of money and want to basically waste it on that indulgence then fine, but there is no moral, ethical or Constitutional requirement for me to have my hard earned money taken from me so you can do that. We cannot cheat death, and there comes a point where it is no longer "saving a life" b/c the quality of what we save simply makes no sense for anyone.

Now that's only part of the cost inflation we are seeing, but it is a part of it. Treating people for their 40th overdose is a big part of it too, and there are many other factors. But those factors only exist b/c we have destroyed the free market process where people have to make decisions within their means, and prioritize based on their money and not just spend money the government is borrowing from our grandchildren without their approval.

[PedroDaGr8]

Going to hit this in pieces, still at the office.

IMO this notion is empirically disproven across a wide range of markets and time. Is there a constant upward pressure on food? Not counting inflation, no there isn't. Microeconomics proves that there is no such thing, no real difference between goods that are necessary and goods that are not.

Why? B/c demand is shaped the same to a point, and the point where we would reach any difference (i.e. a Giffin good type situation) simply doesn't exist in reality b/c there is profit to be made by producers well beyond that point. Even the most classic example of such a force, the Irish potato famine, has been proven to be false.

Food is a very ill fitting comparison despite its necessity. If I can't afford a tomato, I can choose to eat a potato, or a carrot, or lettuce...there are a plethora of alternative options in which I can partake. Each of these competes against the other, on top of internal competition between providers of specific vegetables. This is why despite its necessity, it actually functions very well as a free market. The number of options and competitors for the most part are quite substantial. When I need a specific medical procedure, I need that procedure. At most I have a very limited set of options to chose from, most of the time I have that one. I can't make massive changes from a cornucopia of options like I can with food. I can't substitute a leg cast for a chemotherapy treatment. This particular aspect alone hamstrings (I'm just full of puns today) the competition that is necessary in a fully free market to provide wide access. Additionally, in comparison with other industries, the barrier to entry for food production and ease of moving up and down the scale is remarkably low. This does NOT apply to markets like medicine. The barrier to entry for medicine is stunningly high, at minimum a hundred thousand dollars to bring a SINGLE new provider into the market. This provider can only serve a limited number of people in a relatively small geographic area. Additionally, the provider is in essence limited to one category of medicine, to change fields would require a huge additional outlay of both time and money. To handwave away barriers to entry in medicine, is very similar to hand-waving away the last mile in IT. You are handwaving away one of the primary reasons that the costs are so high. Getting back to medicine, the costs are astronomical and only going to get higher and higher as more of the boomer generation enter the later (and much more medically costly) stages of their lives.

Obviously we would have to subsidize purchases for those who can't afford care, up to a point, but that won't put pressure on prices b/c what it does is change the level of supply. You simply are moving along both curves, but the shape of those curves is basically the same for all markets.

If this were a normal demand situation to some degree you would be correct. Demand for many medical procedures is essence highly inelastic. Huge changes in price do very little to quell demand. Increasing the supply sounds great, but as mentioned before. The barriers to entry have gotten so high (and are getting dramatically higher every year with rising tuition costs and other associated costs) that supply side is highly constrained by said barrier to entry. This isn't implying that the market isn't working here, it is. Just within the constraints that it currently functions, based around human needs, the cost of getting doctors up to speed to provide quality care, etc. the optimal position for the supply/demand curves is just going to get higher and higher leaving more in the dust. Due to the inelastic demand and highly constrained supply, subsidization is either going to be absorbed by the market and a point will be reached where the low end is priced out of the market.

Food, housing, etc. are no different from cell phones and such. Let's say cell phones were a vital necessity. Rather than paying $10K for one, you'd see other producers enter the market to try to get in on the higher profits being had by current producers, thus driving down price. It's how markets work, and why they work.

Housing is a prime example of a market where the optimal position of the supply/demand curve often leaves a huge percentage of the market entirely unable to participate. If you look at Seattle, where I live, demand is ENTIRELY outstripping supply; it isn't even close. The market is such now that the average sale price last year increased over $100,000 from the year before. I make low six figures and I would have to purchase in a VERY rural area, around an hour commute each way from my place of work if I wanted to own a house (assuming it went for asking price, good luck); many people I know have commutes worse than that. For people making below what I do, which is a very reasonable salary, home ownership is entirely impossible. The is literally almost nothing being built to satisfy their demand, over 90% of all new construction was to build homes with asking prices between $1.5-$4 million, with most of the rest well in the $1 mil to $1.5mil range. Most of the time on land with a home that was purchased for $450,000. Since these investors pay straight cash, sight unseen, no inspection, no care about the house that used to be there; they can out compete almost everyone and are essentially sucking up all of the affordable housing in the areas to convert it into housing which serves the upper wage earners. My point isn't to throw shade on the upper wage earners, its just that the market has found its optimal. That optimal is such that a huge portion of the population will NEVER be home owners. This is my point about medicine, a significant percentage of the population will die from treatable medical issues simply because they can't afford it (are priced out). The supply/demand market model left on its own in essence demands this.

Producers constantly enter and exit markets, when they are free of course, in response to those changes in demand, so you never see the situation you describe for very long, determined as a function of the inherent structural barriers to entry (like making new factories or in this case hospitals and training more nurses and doctors).

Producers in this market ARE NOT free to enter and leave as they please, we have licensing and schooling for doctors. These are expensive and time consuming barriers to entry, most medical schools are already 100% full, we just can't produce doctors fast enough. Also, the "for very long" is an even bigger issue here. Most medical procedures do not have this luxury, people will die waiting for the market to correct itself. This is part of the reason for the inelastic demand, when I have cancer I need treatment now! I can't wait for Joe's Assault Rifle emporium to see this need in the market and open up Joe's Cancer and Assault Rifle Emporium slogan "We shoot cancer dead!". I need treatment TODAY! Which means that I have no option but to pay through the nose.

I will add that what is creating that pressure in health care is very different. It's the very fact there is no market, and no limit on the expectations of what we should spend on anyone for any reason, that creates it.

Show me a market with nearly unlimited amounts of money to be spent by consumers and again I'll show you a very high cost market.

I 100% agree that competition is necessary. The healthcare market we have right now LITERALLY combines the WORST aspects of a free market with the worse aspects of a managed and controlled market. In essence, we have a market that from day 1 is designed to create out of control spending, hyperutilization of advanced services, etc. We have a market that treats illness at the highest cost possible, instead of promoting and incentivizing healthy outcomes and attempting to minimize overall spending. So we can reduce the pressures, to slow down the astronomical levels of inflation we are seeing in healthcare, but there are so many market externalities which are driving the costs higher, many which are directly due to the free market.

I'm sorry grandma has terminal conditions which means she will never, ever, no matter what we do, return home and have a normal life, and you want to just keep her on life support for 2 more months at the cost of $30K a day. If you have that kind of money and want to basically waste it on that indulgence then fine, but there is no moral, ethical or Constitutional requirement for me to have my hard earned money taken from me so you can do that. We cannot cheat death, and there comes a point where it is no longer "saving a life" b/c the quality of what we save simply makes no sense for anyone.

100% agree here, as cold as it sounds. There is a time in life where spending more to pro-long suffering is a fools errand. No matter what anyone wants to admit.

Now that's only part of the cost inflation we are seeing, but it is a part of it. Treating people for their 40th overdose is a big part of it too, and there are many other factors. But those factors only exist b/c we have destroyed the free market process where people have to make decisions within their means, and prioritize based on their money and not just spend money the government is borrowing from our grandchildren without their approval.

Treating someone for the 40th overdose is an example of our failed drug policy. That's another issue for another day. But your point remains and I partially agree with it. That essentially eliminating the free market from what it does best is partially responsible for the cost increases. Where we disagree is the word 'only', as I have explained above. The market in and of itself is a badly structured market for achieving an optimal public outcome. There are many things we can do to help encourage the free market. Things like limiting treatment options (fewer kinds of treatment, means more doctors performing said treatment), structured and controlled spending/pricing, etc. Then as Singapore has done, let the free market ride on top of that to prevent people from abusing the structures put in place. Without doing it though, the free market will function as expected. It will just reach an optimal settling and price point MUCH MUCH higher than I think you realize. You believe that the market will somehow settle into serving everyone. I see a market that will settle at a price point in which the poor and a chunk of the middle class will die from treatable illnesses.

[CitizenBBN]

But Pedro, when you talk about constraints to entry, most of those are government imposed, and in my model yes many have to be removed.

An oft debated area that's a good example is mid-wifery. IN the past you didn't have to have a doctor even to deliver a baby, but now you have to have a referral from your general doctor just to talk to the specialist doctor, and no one else can dispense any help at all. Those are not market rules, those are government rules.

So it's not the free market working just with constraints, it's a massive government rule set that began in the 1960s with the beginning of Medicare/Medicaid and it has created these constraints on supply.

As for inelasticity of demand, yes it's less elastic than some things, but it is not completely inelastic. Not at all. I know people who run to the doctor every time they have a sniffle. If they had to pay that bill themselves they'd opt for some chicken soup and go on. True there are procedures where it's "do this or die" that are very inelastic, but as a percentage of total health care costs there is really a lot more room.

If we factor in places where we agree, that maybe grandma doesn't get $300K worth of health care just to keep her alive another month when she already doesn't know her own name, and you can cut out a lot of the most inelastic expenditures too. A sizeable chunk even if not a majority.

I have thoughts on the substitution issue too, but honestly I have to go to bed. I'll pick it up tomorrow though.

Just remember, there has never been a free market where the necessity of the good in question forced constantly rising prices. IN a free market the supply curve can move to compensate and yes substitues and such do develop such that the market can function properly. Now that's not even close to what we have in this country, b/c we're not even close to a free market, but if we had one we wouldn't be facing a constant movement up in costs, but rather the typical ups and downs of market adjustment.