Oooh, I could say little bits here and there about this whole topic since I'm working in the health insurance field. I'm all for universal health care with the option of supplementing it with some kind of private insurance, whether on an individual/family or group basis.
As things stand now, though, health insurance reform can be difficult since it's generally regulated on a state-by-state basis. The insurance business thinks that's a good thing because things can be addressed on a more local/regional level compared to a further removed bureaucracy that may not have the best perspective on a particular issue.
From what I hear has been happening in Massachusetts, I think it sounds pretty dumb. Forcing people through the law to get insurance or they face some kind of penalty sounds like some kind of fascism rather than anything close to socialism/communism. Lowering rates is good and all, but forcing people to do it. . ..
I will say, though, that the companies in Illinois have at least been coming out with some competitive yet good programs for younger, healthier people who probably won't really have to use it. Now for older, not so healthy people, that's a whole other issue. They might as well have their kidneys fail, get on Medicaid and probably get better care than they would with conditions not as bad.
Off the top of my head, I don't see the "regional" perspective as that useful. It seems like "as wide an umbrella as possible", both to cover the folks who really need it, and to cover folks who probably won't need it currently but can chip in.
I don't have a strong opinion on the MA initiative, in part because it hasn't been an issue for me personally. My gut feeling is it's a bit of a transitional kind of thing; elements would really like to have full-on single payer coverage, but it's not yet politically viable, so they try to get some element of universalness. The question is, what were the previously uninsured doing? You here some arguments that they tended to let problems go for longer, and then used the emergency room more often. So from a societal financial standpoint (in terms of ultimately being less expensive in all) and an individual standpoint (in terms of people getting more appropriate treatment earlier) , maybe mandatory coverage makes sense.
TANSTAAFL
Speaking as a Canadian, there are problem with the current publicly funded health care model.
1. Because many (_not_ all) things are "free", there's little incentive for hypocondriacs et.al. not to abuse the system. This drives up the cost (to the government) of the system.
2. Because not everything is covered, it can be a nasty shock (especially if you don't have supplemental insurance) when you have to pay. This includes things like vision and new (often very expensive) drugs which haven't been added to the national or provincial list.
3. Due to the rising cost of HC (both due to ever more costly diagnostics & treatments and general increases in population & aging) there's a continuing battle over funding - how much and for what.
4. Funding comes from personal income taxes. Increased funding means, you guessed it, higher taxes.
I could go on. But like most things, it ain't as simple as it sounds and the devil is in the details.
TANSTAAFL?
I've also heard that there can be long lines for certain procedures and such (which supplemental insurance can help to shorten) under universal healthcare.
If I weren't working right now, I'd love to get into a point for point discussion on this one, especially since I totally sit on the fence for this topic.
But since I've got a little time to let a program load on my computer, I think the real interesting part about any economic and health care conversation is how these things can come down to semantics, philosophy, psychology, theology, ideology, etc. etc. Otherwise, people can easily talk past each other until the end of time and not solve anything.
Regarding the regional stuff, too, that's probably looking at the more actuarial/statistical stuff. How prevalent are certain conditions, accidents, industries, costs of healthcare in a region, money flowing through an area, the demand, etc. etc. Then, of course, there's navigating the individual laws of each state, training customer service people to know those laws, etc. etc. Balancing the needs of the customers, people, laws, etc. etc. probably costs a lot less and is better for the clients, as it keeps costs down and would ideally provide better and more efficient service.
Unfortunately, as things stand now, the large health companies don't necessarily follow this model as well as the property & casualty (liability) companies.
I agree, Kirk, that the initial incentive for drug companies is to make guaranteed sellers, low-risk profit-making drugs, but it's those sorts of drugs that let them hire more expensively-educated biochemists and such and risk more money on avenues of research that they know might come to nothing, or come to a rare drug that treats a disease that only 2000 people on earth have, etc. As for marketing, so what? You say nothing of the massively expensive FDA-approval process that the company pays for, and then they have to get the drug into the doc's hands-- not every money-making drug is Viagra, that sells itself, and they have competing drugs and have to demonstrate their drug's superiority.
They also need guarantees that, when they sell their alotment to Canada's health system at a reduced, massively bulk price, it isn't going to get reimported at that low price; Americans pay a higher market price than Canadians, and their profit model counts on it-- sure, Americans won't be harmed if the companies decide that they'll make more money by stopping all sales of their drugs to Canada, but Canadians will suddenly be paying the full American price for drugs.
Drug companies should also get some protection from predatory, wealth-destroying lawsuits. They're an obvious target, but we should count on the medical community, not the trial lawyers community to determine whether new drugs have unexpected harmful effects.
As for the insurance deal, I can see some states going universal, but however universal health care gets, it must coexist with private care; I don't care about any Canadian-esque bitching about a two-tier system; a one-tier-system means rationing for everyone, while two-tiers means that everyone's covered and people who can pay will take a load off the system that serves people who can't.
At current, there ought to be a way for insurance companies to compete across state lines, and some incentive for them to negotiate with individuals instead of just jobsite-related groups. But groups seem to be their business, hmm.
LAN3 is right about the bulk of insurance health business being with the groups. Nonetheless, from what I've seen, for the young, healthy consumers, they're creating competitive products that would fit their needs.
As with any situation in the States, though, it's the people who need it (poor, old and unhealthy) that suffer because they carry more risk. That becomes a moral/ethical issue there. Who should carry the brunt of the unhealthy? A for-profit company or a non-profit/government/volunteer organization or taxed people?
Frankly, I'd be interested in seeing if there ever was a non-profit insurance company that ever existed. Something like that could really provide an interesting shake up to the world, as long as people actually donated to the company. Are there enough philanthropists to make it viable for such a non-profit?
Correct me if I'm wrong, but isn't one of the lesser known facts about the Insurance industry is how they make money: it's not simply insurance payments coming in minus health care paid for, but it gives the insurance companies a big hunk of money to invest in traditional financial ways.
ericball: all those issues apply in the US system, but instead of the government and taxes, its HMOs and premiums. (Which are technically optional in most of the country, but MA is experimenting with making them mandatory... but still)
LAN3, it's weird to think about marketing. I guess in one sense EVERYTHING is more expensive because its advertised. Maybe a useful metaphor would be it's a bit of oil to grease up the wheels of the market place that we all pay for.
Yeah, like any other business, insurance companies make money through investments. During good economic times, remember, rates generally go down because of income made through investments. On top of that, investments (at least in steady accounts like money markets and such) help to fund reserves that keep companies around and allow them to pay claims.
I should point out that increased funding does not equal higher taxes-- rather, it indicates a need for higher tax revenue, which can come from higher taxes paid by fewer people with jobs, etc., or lower taxes paid by many people with jobs.
The US, it turns out, is on the proper half of the Laffer Curve such that Bush's tax reductions, after a year to two take effect, gradually increased tax revenues because of the lower unemployment and increased financial risk-taking that comes lower taxes in an improving economy.
Lex: Who should carry the brunt of the unhealthy? Distribute the load; in my state and probably most states, car insurance companies are required to take on a certain percentage of bad drivers; so too might insurance companies. It's not an elegant solution, but one could call it the cost of doing business with that state, and the states can compete for the insurance companies by changing that rate.
The thing with drug marketing is that people often think it's about Claritin ads run during the evening news-- TV ads for drugs is still a relatively new thing. In fact, drug marketing means an army of booth-bozos at medical conferences, drug company reps taking loads of docs and nurses out to lunch and giving them drug-branded swag, distributing free samples, etc. You may think you're a target market for an anti-histamine, but people who control prescription pads are the real targets.
Yep. I took notes for a drug company marketing research interviews with doctors. They had varying interesting opinions, but it was very interesting that the focus was on doctors, even though the regular consumer does see some of these ads everywhere.
As for bearing the burden of the unhealthy. . .on an ideal level, I think the "community," society, nation or the rest of humankind should. On a realistic level, I think it's a philosophical and moral discussion that I have no basis for arguing that satisfies me.
With auto insurance companies taking on bad drivers, that's an easy argument. It's in the self-interest of all drivers. If they get hit by a bad driver, they want to get some kind of renumeration, which they can get from an insurance company easier and it would probably not cost as much, whether it's a little extra tax money or little more premium.
The_Lex - you need to read some more classic SF. There Ain't No Such Thing As A Free Lunch
LAN3 - since increased HC funding won't significantly increase the tax base, then taxes (for some segment of the population) will have to increase to support the increase.
In this world, no, there isn't a free lunch.
If we really tapped into the human potential, however, I think the possiblities are limitless. I don't think whether the lunch is free or not would be a problem.
Nonetheless, we live in this world of limits and massive human conflict without any real desire to resolve it without destroying the other side and making sure that we're RIGHT, so you're right, ericball. In this world, there's no free lunch, mainly because the majority of the people are so self-centered (and some of them NEED to be because of their bad conditions) that they're not concerned about REALLY making the world a better place. They just want to make it better for themselves and, essentially, their tribe.
I've come to terms that the world will be like that for my lifetime. Nonetheless, that doesn't stop me from trying to plant the seeds for a better world in the future.
ericball-- Increased HC funding could have a net positive effect on the tax-base, but only in the same sense that increased child-care spending would-- people could get back to earning. However, increased spending on HC could come from somewhere else, like Federal education dollars, which support something primarily funded by the states. Or we could get our damn congressmen to stop spending money on their best friends. Or, we could lower taxes again, which could increase the tax revenues to pay for the increased HC spending. heh.
Lex: It's easy to see that liability coverage for bad drivers benefits the people they run into-- it's a direct effect. But the parallel case with medical insurance has the same benefit, but indirectly-- the X-ray you get doesn't actually cost $80, but it subsidizes the indigent who have pneumonia or broken bones who need a diagnostic x-ray.
The classic SF book, by the way, is one I haven't read either, but I've got enough nerd fandom friends to know the reference: Heinlein's "The Moon is a Harsh Mistress."