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 glockman
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 Re: is health insurance a right or privilege?  [Re: johnm214]
#16129995 - 04/23/12 07:21 PM (11 years, 11 months ago) |
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Neither. The constitution says 0 about healthcare. A privilege someone can take away from you....which they can't as long as you pay them. The free market.
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 zannennagara
Found in Space
Registered: 09/25/08
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Re: is health insurance a right or privilege? [Re: johnm214]
#16130406 - 04/23/12 08:44 PM (11 years, 11 months ago) |
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Quote:
johnm214 said:
Quote:
Kickle said:
My question is why it turned from healthcare to health insurance? Why the middle-man who leeches money?
Because people consume more if they prepay and don't face direct penalties for their consumption- hence insurance dissociates the cost from the benefit and people consume more and more healthcare.
I'm not sure you can find any evidence for that claim. It satisfies a certain economic logic that does not apply the same way to healthcare as to, say, movie rentals. If there is no penalty for frequent visits to a doctor, regular preventive care can vastly attenuate the great costs of illnesses wrought by the fear (or miserliness) of spending the money to go to a doctor or by living an unchecked destructive lifestyle. If cancer is discovered early on in some free regular checkup, total healthcare "consumption" is greatly reduced by not having to use chemotherapy later on or stay bedridden and wires-strewn in the hospital.
Even with other goods that logic does not always apply. People prepay for lunch buffets and probably consume a larger quantity of food than they would if they were paying per dish, but when you think about total consumption of food preparation, a limited number of dishes need to be made and a lot of time is saved by focusing on a few in bulk, so there is obviously some incentive to the upfront payment. Analogously, if you want some special quick treatment, you can pay more for exclusive healthcare, just as you can still order your own dish if you really want to; most are satisfied with the buffet.
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johnm214
Registered: 05/31/07
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Loc: Americas
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Re: is health insurance a right or privilege? [Re: zannennagara]
#16132607 - 04/24/12 10:09 AM (11 years, 11 months ago) |
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Quote:
zannennagara said:
Quote:
johnm214 said:
Quote:
Kickle said:
My question is why it turned from healthcare to health insurance? Why the middle-man who leeches money?
Because people consume more if they prepay and don't face direct penalties for their consumption- hence insurance dissociates the cost from the benefit and people consume more and more healthcare.
I'm not sure you can find any evidence for that claim. It satisfies a certain economic logic that does not apply the same way to healthcare as to, say, movie rentals.
Nonsense. Go the ER and you'll get plenty of antecdotal evidence. Go up to the floors and you'll see even more examples: all sorts of people admitted just because they like the 'vacation', and without any particular need for skilled nursing care.
From a RAND review: http://www.rand.org/pubs/monograph_reports/2005/MR1355.pdf
- Theoretically, the effect of income on the demand for health care
should be small, if not zero, under full insurance. If consumers have
access to free care, changes in income should not affect their ability
to obtain medical services. The empirical estimates in the literature
are consistent with theory. Phelps (1992) calculated income elasticities
based on results from an HIE study (Keeler et al., 1988).
He found that the demand for health care was relatively insensitive to change in income. The calculations yielded elasticities of 0.2 or less. This can be interpreted to say that a 1 percent increase in income will lead to a 0.2 percent increase in the demand for health care. Results from a number of observational studies are consistent with the finding from data based on the HIE (for examples, see Taylor and Wilensky,
1983; Holmer, 1984)
pg 27
So, people who don't pay for their care in any practical way, directly, use it without regard to cost- basically they'll take whatever they can get. In many cases that I've seen, this includes malingering and "hospital vacations" where they demand backrubs and people clipping their toenails and shit while they bitch about the cable TV- all because some doctor decided their cellulitus needed observation or some bullshit like that. (never did find out how seeing the patient's funky thigh for once a day in the hospital was any improvement over the vastly cheaper office visits- especially when all medications were PO)
More here:
- The movement toward managed care in the MHS provides a natural
experiment to analyze the effect of price changes on use among DoD
beneficiaries. Goldman (1995) studied the CHAMPUS Reform Initiative
(CRI) and found differences in the use response between inpatient
and outpatient care. The CRI, a pilot test for TRICARE, covered 850,000
beneficiaries in California and Hawaii. The CRI offered MHS
beneficiaries the choice of enrolling in an HMO or in a PPO. Goldman
used a sophisticated statistical model to address self-selection
issues associated with the choice of enrolling in the HMO or PPO.
The results from this analysis showed that the demand for outpatient
care was 16 percent higher in the HMO than in the baseline fee-forservice
(FFS) plan. The HMO option involved lower out-of-pocket costs
for civilian visits; however, MTF care remained free in all plans.
Most of this increase under the HMO can be attributed to a greater
probability of any use rather than an increase in the number of visits
per person. It is interesting to note that there does not appear to be
any difference in outpatient use between the PPO and FFS. The aggressive
use reviews in the HMO and PPO appear to have decreased inpatient
days relative to FFS. However, the CRI did not appear to deter
inpatient admissions
pgs 33-34
So, when people have to pay to go to the doctor for some stupid bullshit that they'll never be admitted for, they do so more (16%) when they don't have to pay than when they do. But, when the doctors have someone watching what they are doing, and don't get paid simply by virtue of having a body in a bed, admissions and admitted days go down in the hospitals- something the cash for service patient won't benefit from if they don't think for themselves and educate themselves.
What exactly are you basing your claims on that its doubtful I can find any evidence for this claim? Its obvious and is observed everywhere patients show up on their own volition.
Quote:
If there is no penalty for frequent visits to a doctor, regular preventive care can vastly attenuate the great costs of illnesses wrought by the fear (or miserliness) of spending the money to go to a doctor or by living an unchecked destructive lifestyle.
And this is based on what? I hear this crap all the time but it doesn't apply to things that aren't progressive and either curable or able to be treated with good results. If there's nothing that can be done for the patient in the first place it doesn't matter how many times they come back bitching about something or other that either doesn't exist or is untreatable.
This view seems to be almost entirely based on faith. What is this "preventative care" that I hear the politicians talk about- and now you? Seriously, what is it that you expect to be done in those 'frequent visits' that will reduce costs? What are they preventing and how?
Quote:
If cancer is discovered early on in some free regular checkup, total healthcare "consumption" is greatly reduced by not having to use chemotherapy later on or stay bedridden and wires-strewn in the hospital.
What regular checkups are going to discover what cancer? For a few cancers there is some evidence of increased detection by regular screenings, but this has nothing to do with regular physician visits. In fact, if we turned to a more fee-for-service kind of system without all sorts of government restriction patients could voluntarily elect to get these screenings without the middle men they so often have to go through.
But this seems like an issue that only applies to a few cancers where screening is already well-established: gynecological, prostate, Colon, breast, and I don't recall anything else.
Quote:
Even with other goods that logic does not always apply. People prepay for lunch buffets and probably consume a larger quantity of food than they would if they were paying per dish, but when you think about total consumption of food preparation, a limited number of dishes need to be made and a lot of time is saved by focusing on a few in bulk, so there is obviously some incentive to the upfront payment.
How does this apply? You still need a doctor to read those radiographs, dick around with the patient, run the endoscope. There's no greater efficiency- except for midlevel providers and alternative care providers which the government and physicians have done everything possible to stop. Things have only changed recently now that insurance companies and governments are sick of paying for physician's bullshit fees. Now you see changes- funny how that works. This wouldn't be a problem in the first place with a free market.
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Absent Minded
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Re: is health insurance a right or privilege? [Re: Symbols]
#16133558 - 04/24/12 02:25 PM (11 years, 11 months ago) |
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Quote:
Symbols said:
If we as citizens are going to pay lots of taxes, I'd really rather it not go to health care. I much prefer to nurture multiple wars, surveillance, and police state bureaucracy.
I like how you think.
As for me, I'm split. I don't have it right now (but I'm 20 - save for some horrific accident, I don't think I really need it at this time.)
I can't decide whether or not I want to get my head around Obama's plan or not. Right now I am leaning towards no, but his plan does, but on the other hand, I still don't know if I want it.
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sheekle: fuck peace love and unity
sheekle: death despair and misery
sheekle: is where it's at
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zappaisgod
horrid asshole
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Re: is health insurance a right or privilege? [Re: dogwood] 1
#16134550 - 04/24/12 06:16 PM (11 years, 11 months ago) |
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Quote:
dogwood said:
i have to write a paper for medical ethics. just wondering everyone's opinion.
neither
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Freedom
Pigment of your imagination
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Re: is health insurance a right or privilege? [Re: zappaisgod] 1
#16134641 - 04/24/12 06:35 PM (11 years, 11 months ago) |
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yeah, it sounds like the teacher doesn't understand the definition of the word privilege.
Edited by Freedom (04/24/12 06:36 PM)
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zannennagara
Found in Space
Registered: 09/25/08
Posts: 433
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Re: is health insurance a right or privilege? [Re: johnm214]
#16134690 - 04/24/12 06:45 PM (11 years, 11 months ago) |
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Nonsense? Whatever anecdotal extremities you wish to conjure up do not support an axiomatic claim. No doubt people do visit ERs for frivolous reasons, some perhaps because they "like the 'vacation,'" but a great deal others because they have no other means of medical contact - including mental health, which assuredly plays a factor in many cases of this tourism you describe.
The first quote you furnished has very little relevance to the discussion. It is referring to income elasticity of demand and merely stating that an increase in income will not increase demand for healthcare - which is obvious when the person already has "full insurance," and makes sense otherwise, in that it's not generally some luxury people only splurge on when they get a raise. How you are jumping from this to people taking "whatever they can get" does not really follow. There are certainly sensational examples to be found of ER misuse, but this quote is comparing people already on insurance plans with different levels of income.
Your second quote undercuts your own conclusion. Demand for outpatient care may have increased, sensibly enough, but note at the end that the HMOs actually decreased inpatient days/use. There's a comparison of per capita costs in Colorado between HMOs and FFS plans here that shows HMOs have slightly lower overall costs for every year studied (p. 19). Rand themselves have research demonstrating HMOs cost 5-15% less per capita, with "fewer particularly expensive procedures, tests, and treatments" (pp. 17-18).
What is this "preventative care" that you hear the politicians talk about- and now me? The report you linked to mentions preventive care about thirty times, including: Quote:
preventive medical services may be seen more as a luxury than a necessity and, thus, may be put off when the price of such care increases. Further, the opportunity cost of obtaining preventive care is much higher than it is when the patient is sick, particularly if the illness keeps the individual out of work. It is also likely, that since the benefits of preventive care accrue in the long-term, they are heavily discounted.
There's also Wikipedia and US Preventive Medicine. Obviously much can be accomplished with personal management of behavior, and other treatments like vaccinations and tests can be done at clinics. Whether people are visiting an MD or not - and for many things I agree they don't need to - not requiring payment for the service encourages more to use it, which obviously reduces overall health care costs if people don't get STDs or polio.
There is overregulation that drives up medical costs - if you're saying that health care is overly restricted to expensive physicians and hospitals, you're right. But providing low-cost access to health care - including basic checkups and screenings that can be performed at clinics - does not necessarily increase the total cost of the health care system, although there may be more frequent use of services, and a few may exploit that access, because it catches and stops many things before they become more expensive. Education is extremely important also.
You can say we wouldn't be here with a free market, but this is where the free market has brought us, infiltrating regulators and anticompetitively making itself less free for the benefit of its self-appointed adherents.
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zannennagara
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Re: is health insurance a right or privilege? [Re: zannennagara]
#16134925 - 04/24/12 07:33 PM (11 years, 11 months ago) |
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Also, I find anecdotes relating to the denial of insurance coverage to the sick - whereby someone with a treatable disease may have to defer treatment while awaiting a claim review which hopefully for the company is rejected - far more disturbing and undesirable than stories about people asking for massages in emergency rooms.
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No debe haber separación, no puede haber definición.
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johnm214
Registered: 05/31/07
Posts: 17,582
Loc: Americas
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Re: is health insurance a right or privilege? [Re: zannennagara]
#16135010 - 04/24/12 07:49 PM (11 years, 11 months ago) |
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Quote:
zannennagara said:
Nonsense? Whatever anecdotal extremities you wish to conjure up do not support an axiomatic claim. No doubt people do visit ERs for frivolous reasons, some perhaps because they "like the 'vacation,'" but a great deal others because they have no other means of medical contact - including mental health, which assuredly plays a factor in many cases of this tourism you describe.
The first quote you furnished has very little relevance to the discussion. It is referring to income elasticity of demand and merely stating that an increase in income will not increase demand for healthcare - which is obvious when the person already has "full insurance," and makes sense otherwise, in that it's not generally some luxury people only splurge on when they get a raise. How you are jumping from this to people taking "whatever they can get" does not really follow. There are certainly sensational examples to be found of ER misuse, but this quote is comparing people already on insurance plans with different levels of income.
You misrepresent the first refrence (which reviews others) by depicting it as "merely stating that an increase in income will not increase demand for healthcare". What the study found from its rather large sample was that there was practically no relation at all between income and healthcare demand- the direction in change of the income variable was irrelevant.
This, along with the other information available, tends to show percisely what you challenged:
"Because people consume more if they prepay and don't face direct penalties for their consumption- hence insurance dissociates the cost from the benefit and people consume more and more healthcare."
Quote:
Your second quote undercuts your own conclusion.
I'd love the hear how you think so, but you don't provide any clear explanation. The study showed percisely what I claimed: demand for healthcare increases when there is no direct perceived cost. Patients will go to the doctor and demand appointments more often when they face no costs.
You claim there's some difference in outcome evidenced by the HMO's restrictions on hospital treatment, but have failed to show any evidence this is correct- and I rather doubt it is. The obvious conclusion is that when doctors know they will get reimbursement from the insurance company and the patient will do what they tell them, that they'll keep in the hospital when its not necessary (or when the patients demand it).
Either way, you show no evidence the difference in length of stay was a result of patient demand rather than, say, the fact that the HMO was refusing to pay for the care past a given number of days and thus the patient would need to come up with a thousand bucks plus (in today's market and dollars anyways) for the room.
Quote:
What is this "preventative care" that you hear the politicians talk about- and now me?
Yes, what is it? Far as I can tell you still haven't answered that question- nor shown your claims of reduced cost are correct. The only thing you mention is vaccines and 'tests', neither of which require a physician or any sort of medical care at all, neccesarily. Again, what is this "preventative care" that if only we had we'd save so much money in the long run?
The only clear definitions I've heard are regarding stuff that is rather obvious, patients allready know, and which are utterly unrelated to the availability of doctors: things like loosing weight, stop eating crap that makes you sick, stop using dirty needles, stop using chainsaws while drunk, and so on. Those are the big ones that I've seen that would help, but I fail to see what a doctor is supposed to do about that.
Quote:
Education is extremely important also.
Perhaps, but that's more an individual responsibility, and of course the doctors treat people as fools by default in most cases. Medicine is somewhat unique in the amount of fear that exists amongst practitioners of educating the public or their patients- no other profession seems to suffer this debilitating notion of loosing your license cuz some idiot decided your off hand remarks entitled him to home-treat his diabetes.
Even information provided by a pharmacy or doctor's office is almost always written to what seems like the educational level of an elementary school student, and is so full of caveats and disclaimers to make it impossible for anyone to know what's going on. Of course if it didn't cost $250 to get an extra ten minutes to ask the doctor what's wrong with you and have it explained, that wouldn't be such a problem, but such is the world we're in now (due to issues previously mentioned).
Quote:
You can say we wouldn't be here with a free market, but this is where the free market has brought us, infiltrating regulators and anticompetitively making itself less free for the benefit of its self-appointed adherents.
Really? What's free about prohibiting osteopathic school graduates from being licensed (as was the case in many doctors lifetimes)? What's free about the AMA's acredation wing getting government fiat to determine whether an allopathic school opens at all and how many seats it can have? What's free about forcing people to pay into a collectivized treatment plan that accounts for maybe half the income of many doctors/facilities and thus skews the treatments available to what the politicians want? What's free about banning me from getting treatment from the practitioner of my choice?
Even forgetting the mid level providers, we'd have a ton more physicians if the government stopped their interference, and both availability and prices would plummet as a result. Along with this, you'd be free to go to your local church for an excorcism or to the homeopath to drink distilled water for every single maledy you might ever need to be treated for. The choices would rise and people could do what they wanted- all at much cheaper rates.
The notion that medicine as it is now is a free market (or that the ills are attributed thereto) seems absurd. What could make you think that?
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dogwood
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Re: is health insurance a right or privilege? [Re: johnm214]
#16135096 - 04/24/12 08:07 PM (11 years, 11 months ago) |
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Quote:
johnm214 said:
Quote:
dogwood said:
it seems like a single payer system would be best. i would like to think that a libertarian approach to healthcare would work best but i don't know if that's true in this case. if healthcare is a right (not insurance, but the care itself), then wouldnt this be the best way to cover everyone?
That's a pretty big presumption- who owes you this right of healthcare? The doctor? Me?
A libertarian model would not allow the AMA to strangle the field of physicians and mid level practitioners, and you'd get much more people practicing medicine with a coincident reduction in cost. People seem to presume that doctors naturally deserve the money they get for some reason- nonsense. They don't deserve anything more than what people are willing to pay them, and people with similar schooling in this and other countries make far less proportionately.
well, maybe the word "right" isn't correct to describe healthcare. but my point is that anyone who walks into an emergency room will be treated as far as I know
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zannennagara
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Re: is health insurance a right or privilege? [Re: johnm214]
#16135489 - 04/24/12 09:32 PM (11 years, 11 months ago) |
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Please explain how changes in income in either direction and their lack of impact on demand for care do anything to prove that people consume more when they prepay. Please demonstrate where in the article there is a net increase in overall health care costs when everyone is covered as opposed to paying individually for insurance. The article does show that demand and visits increase with coverage, which is not disputed, but it does not show how these increased visits impact the total cost or efficiency of health care because it does not compare the nature of these visits.
Quote:
The study showed percisely what I claimed: demand for healthcare increases when there is no direct perceived cost. Patients will go to the doctor and demand appointments more often when they face no costs.
As explained above it does not precisely show that demand for healthcare increases. More appointments, yes, but the translation of that care into total cost and efficiency - the issue under discussion - by the resulting need to hospitalize fewer of those patients favors the prepaid HMOs, as the links I gave you show. And it's not because of poorer treatment or outcomes, as this shows:
Quote:
The HMO patients received more prediagnostic care but did not receive definitive surgical treatment as quickly as the FFS group. There were few differences in care, however, once diagnosis was made; there were no differences in access to care, rates of definitive surgery, chemotherapy, radiation therapy, length of hospitalization, number of follow-up physician visits, and most measures of satisfaction with care. No differences in outcome, including 4-year survival and 1-year health status, were found. HMO patients expressed significantly less concern about the cost of their care. These findings suggest an initial hesitancy to provide definitive care by the HMO but no significant differences in either the process or outcome of care once definitive care is begun.
Lower costs, but no differences in outcome, which favors the prepaid option.
I don't really see why I have to define preventive care for you, when the very article you cited mentions it extensively - as well as saying that it has long-term benefits that are discounted excessively - and I gave you links anyway. I already agreed that most of it - vaccinations, education, consultations - does not need to be the exclusive purview of accredited physicians, but obviously in the cases when it is for whatever reasons it will still diminish ultimate health costs to allow for a perhaps frequent usage as opposed to dissuasive upfront costs that lead to problems going unnoticed.
Furthermore I agree that the notion that healthcare is a free market is absurd - but free market advocates at least as far back as Adam Smith have understood that refusing to regulate merchants (such as insurance companies, or doctors) creates markets that are extremely far from free. Regulatory boards and companies are just the tools and extensions of these unregulated markets to drive up their own monetary gains. Undoubtedly the AMA and the government are driving up health care costs, just as the insurance companies are - because all are composed of people only accountable to private financial interests.
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