Professionals in Economics/Medical Industry, I could use your help!

[nexalacer]

I have posted a couple of blogs recently at DailyKOS and of course they got blasted. I don't really care about that, as I know I'm right, I just gotta get my ideas condensed more. But if you have some free time I'd like you to take a look and tell me what major gaps I have in the economics or the realities of the medical industry. I'd really appreciate it, thanks!

Myspace Link (http://blog.myspace.com/index.cfm?fuseaction=blog.ListAll&friendID=4014187)

DailyKOS link (http://www.dailykos.com/user/nexalacer)

[fsk]

Maybe you should try blogger? Do they have a better UI than KOS?

[Corydoras]

I dunno if any of this helps, but here goes... and don't ask me for any citations...!!!

--Objection 1: "Sick or injured individuals are not about to bargain for a better deal when they are vomiting or bleeding."

Of course they do. That's how the Amish get their medical care done when they absolutely cannot avoid the hospital.

--Objection 2: "The practice of medicine is so absurdly complex and challenging that a classic "knowledge asymmetry" develops, making it impossible for patients to be effective bargaining partners."

False. The patient says, "I can't pay that much. Could you possibly reduce your fee?" Patients do this, particularly when paying out of pocket-- but few patients try, precisely because most of them are not paying out of pocket and thus have no incentive to reduce costs.

--Objection 3: "Classic business logic compels insurers to avoid risky customers— that is, the ill, the elderly, the poor; basically anyone who will actually need...you know, health care. Forcing individuals to seek care on their own renders them even more powerless."

There are physicians who do not accept Medicaid. There are physicians who do not accept any kind of insurance at all. And even the largest hospitals have a surprisingly small number of insurers they accept. But it is unheard-of for doctors or hospitals to refuse direct payment from the patient, and yet this situation puts the self-pay patient in the driver's seat, because they don't have to go to a provider they don't want, and so the provider is motivated to attract patients. And many patients gladly go "out of network" from an HMO and either self-pay or pay a much higher copayment to get the doctors they want. That is, in fact, one of the biggest complaints patients have about HMOs, that they do not have choice, and a wide number of participating providers is one of the biggest points HMOs advertise. This is how important it is to people to have liberty in selecting a provider.

--Objection 4: "Low perceived risk leads many healthy young people to go without coverage, even if they could afford it, leaving the remaining insured pool that much sicker and older. Soon it enters a death spiral where premiums rocket out of control trying to contend with a shrinking pool of sicker patients."

Wait, Objection 3 just said that insurers are rejecting the poorer and sicker patients in preference to the healthier and younger. But anyway, there is a fallacy, and there simply is no evidence that this occurs. There is a finite limit to how small the pool can become, as the young and healthy do age and become less healthy, and are motivated to enter the pool, while the sickest and oldest die and leave the pool. The pool does not shrink infinitely.

--Objection 5: "You are dead wrong about government bureaucracy in this case. Medicare is ruthlessly efficient and very well run; it has an overhead cost well under 3%, while providing a consistent working environment that rationalizes care for the elderly. Both private insurers and risk pools (like union health funds) are by comparison horrifically inefficient and even corrupt."

Medicare is beset by fraud as well, for example by companies billing extra for infusion equipment and supplies the patients do not use, or selling scooters to patients who do not need them. Many people who can buy medigap policies, thus turning the situation into an even more inefficient system of three-payor instead of single-payor: Medicare, medigap, and patient.

--Objection 6: "Self-insurance or self-directed health accounts invariably sound attractive to affluent, well-educated and motivate dilettantes who have the funds and think they are smarter than everyone else. When actually implemented, they are consistently disastrous."

Medical savings accounts have not been widely available enough for long enough for there to be any evidence for such a condescending view of patients. Where employers offer flex spending accounts, they tend to be widely used throughout the workforce.

[nexalacer]

Thanks, you definitely gave me some more things to think about.... and citations to find! :D

Anyone else?

[DocGrimes]

I actually read your diary there before I even found this thread.

One of the most fundamental things I think is to be strict in the philosophical basis of your arguments. Do not let them pull assumptions out of the air or use emotional pleas to derail you from a more factual basis of your argument.

First one must establish the proper role and responsibilities of the people and government.

If you are discussing these sorts of topics with folks that have a different view on such a fundamental level as the role of government then you are not likely going to reach any common ground.

I think before you can find much in the way of common ground you will need to define things of which you speak that way we as readers do not get to bring our assumptions of meanings.

You can share ideas of personal responsibility, free market, and limited government with them all day but until you confront the underlying factors of their views I doubt you will get much traction.

Try to bring forth your points via logic and critical thought and do not let them distract you with emotional arguments. In fact point out the flaw of such arguments.

For example, I recall comments about how the 'free market' has left thousands of children without healthcare. While most of us probably agree that it is a good and even moral thing to help these children what we see is a disagreement in how and who has the responsibility.

We of course think it should be done as locally as possible. And if the parents can not tend to the matter then voluntary charitable efforts are likely to be present.

Statist tend to think that it should be aid given through force. ie, forced to pay taxes which is then applied to give aid under some management other than the producer of the confiscated wealth.

They also seem to make the assumption that folks who want a free market are so selfish as to be uncharitable.

And we are not in much of a free market so to blame the lack of coverage and high costs on the free market is a flawed argument argument as well.

Bottom line so that I do not get too wordy and ramble is this... get to the philosophical basics underlying both sides of the argument.