What was the response to the point you raised at the debate?

The response I got was kind of weird. One conservative argued that the public option would be infinitely inferior to whatever the market could provide, and the way you could tell was that in European countries that provided government health care, people that could afford it were returning to private health insurance.

Which struck me as odd for two reasons:

1.) Most proponents of the public option see no problem with that. It’s fine if people have private coverage as long as the people who don’t have some level of basic coverage, and

2.) It contradicts a claim I heard repeated over and over during the debate, which is that a public option would bring down the private health care industry because it would be impossible to compete with.

The point you raised about profit incentive being in conflict with the interest of the consumer would apply to any type of business, anywhere. You didn’t so much make a point against private insurance as you did against capitalism in general.

I think the point you may have been trying to get at revolves around the private system’s failure to cover those who need coverage the most – the people who can’t qualify for Medicaid but can’t afford healthcare. it is probably not profitable to cover these people for a price they can afford, so the insurance companies simply don’t do it.

The real problem is that health insurance coverage has gone in the opposite direction that the free market has: as our economy has grown, the percentage of citizens not covered by insurance has tripled in the last twenty years. So really, the “inherently efficient market” has left behind the people it’s supposed to benefit.

Lukas, it’s true that businesses and consumers will always have differing incentives; but when we’re talking about, say, buying a hamburger, the consumer has a variety of other options. My point is that while the market works fine for providing a lot of different goods and services, I’m not convinced that our country benefits from leaving basic medical treatment solely up to a system like that with no government option. And from the rest of your comment, I gather that you see why.

I feel like there is so much I don’t know about the world of health care and business. But my question is this: if there is more than one private insurance company offering services to the consumer, why aren’t they competing with each other the way other businesses do by attempting to offer better services/lowering prices and thus attracting more consumers? Why does there seem to be such a monopoly?

@Annie: Because, in many places, it is essentially a monopoly. The most recent numbers I can find without investing too much energy are from 2006 (which is admittedly ancient), but at that time a study also showed that in 166 of 294 metropolitan areas, or 56 percent, a single insurer controls more than half the business.

I’ve heard more specific numbers — including a number of states that only do have one provider — thrown around in speeches and such, but I don’t recall the specifics.

Ned, you raise a lot of really good points about the divergent interests in the healthcare market between consumers of healthcare and insurance companies.

The problem isn’t that incentives aren’t working, it’s that the market itself breaks down when there is a start information asymmetry. In order for a free market to work, consumers and producers need to have near perfect information so that competition and investment stay efficient. This is what drives cost down.

The current system is reliant on health insurers because of an important facet of human nature. This is of course the very “human” inability to plan for the future. If there were no health insurance requirements for young people, most people would be able to survive relatively well into their 30s without ever needing to go to the doctor. The problem is that at a certain age every individual will require care and, if they function normally, probably hasn’t saved any money to put towards their own health costs. In order for an efficient market system to work, the consumers would need to know how much money they are going to need in the future, in order for them to be prepared to pay for themselves. This doesn’t happen because to most people, a dollar today is not the same as it is worth tomorrow. An example of this discounting of utility would be if I promised you $.75 or $1 in 3 months. Even though the dollar is 25% more money, most people would rather have the $.75 today because they don’t know where they will be in 3 months. For more information on this please look up “asymmetric information” “akerlof’s lemons” and “discount rates.”

The insurance companies found a way to solve this problem, by offering health insurance to consumers which seems to be easier than simply saving for a person’s own healthcare. The insurance company provides future benefits at a lower cost today, but a higher cost in the long run. Insurance doesn’t require people to have been saving their whole lives because they do their best to calculate the amount of money they will have to pay out for each individual they cover. If you take the cost people pay in insurance over their whole lives, on average, the consumer ends up paying %30 more than they actually need for their own healthcare. For some people that is worthwhile, for many, its far too expensive.

The problem with a government plan is it does away with the 30% being overpaid into insurance profits, but it increases cost because it doesn’t incentivize consumers to think proactively about their healthcare. If the government system is a one-time fee, it motivates people to go out and get as much healthcare as possible without any consideration to cost. This incentive will create huge inefficiencies within the system, as is already seen within Medicare’s “pay per procedure” system. In addition, it gives doctors no incentive to actually treat patients effectively, because they get paid for every test they run, there is no benefit to them in lowering the cost to the public.

The ideal system is one that gives patients an incentive to save for their own healthcare and make smart decisions regarding preventive care and treatment. It is immoral to allow the government or insurance companies to make decisions regarding any individual’s health. The individual must have their choice of doctor and procedure, of where, when, and how. A system where the decision lays with the patient incentivizes doctors to provide the best care for each patient to ensure that they return for care next time they get sick. And finally, it makes healthcare providers and drug companies compete for the business of sick people instead of the business of the FDA or Medicare.

For more information on a system that gives the power back to the consumer (instead of the government, the insurance company, or the employer) please take a look at Singapore’s mandatory savings system, not as a model for an American system, but as an insight in to possible alternatives.

Sorry in advance for any grammar problems Ned! I study economic analysis, not philosophy!

@Greg: I do intend to look into the mandatory savings system, but while your argument for that is fairly persuasive, I still find the one against the public option less so. One thing in particular stuck out to me:

The problem with a government plan is it does away with the 30% being overpaid into insurance profits, but it increases cost because it doesn’t incentivize consumers to think proactively about their healthcare. If the government system is a one-time fee, it motivates people to go out and get as much healthcare as possible without any consideration to cost.

Aside from hardcore hypochondriacs, how likely is that? People don’t like visiting the doctor, let alone undergoing complicated medical procedures. It seems to me motivating people to seek more preventive care is a bigger challenge than getting them to only undergo necessary procedures.

The problem with a government option is exactly that: It doesn’t fix the problem, just makes the current problem temporarily cheaper. Logical human beings would go out and get as much healthcare as possible, including unnecessary tests. There is no logical reason to expect costs to decrease, let alone remain at current levels. Simply assuming that people will be responsible under a system where the dollar doesn’t come directly from their pocket is not a sufficient reason to support a public option. We hear just as many complaints from countries with universal healthcare as those without it, if not more.

The government will have to make regulations to drive cost down. In the UK, a blind person that needs a kidney is bumped below a person who can see and also needs one because of the equation the government devised in order to calculate what procedures should be approved and which shouldn’t. Under a system where it is up to the consumer, the blind person and the person with sight can both vie for the kidney fairly, because under a consumer based system, they are equal.

It would be irresponsible of us to accept a plan that doesn’t fix the problem and only makes the problem easier to bear if a better plan exists. The debate last night was on a public option, and that is not the best way to fix the problem. It may be the best/only way being debated in congress, but the fatalistic thinking of the democrats (this or nothing) is not the way to approach problems from a theoretical level such as university debates.

PS. My comment last night about college graduation rates was simply to address Nate’s point that “because something is popular it is right” “democracy” etc. In hindsight I should have just pointed out that the war in Iraq was chosen by popular demand, as was Hitler, George W Bush, the patriot act, and numerous other autrocities of democratic choice.

Ask any average european, they’ll tell you they’re more than happy to have public health insurance and that they think it’s RIDICULOUS that the US does not.

Not to mention, when I worked in Madrid this summer, it was really nice to be able to go to the dr and not have to worry about how much it would cost me. Perscriptions are also included.

And I could care less if the private health insure companies would be unable to compete (which is untrue, look at private companies in Europe), health care should not be something that is on the free market system. It is a right that everyone should have and not have to worry about.

@Cooper Your argument has the following assumptions, for which you do not provide evidence:

1. That Healthcare is a right
2. That the Freemarket can NOT provide for rights
3. That the Government CAN provide for right better than the Market
4. That healthcare is DEPENDENT on insurance companies being able to compete

I’m sure there are more. But frankly, its exactly the type of freeloading you took advantage of in Madrid that I’m afraid of. Individuals getting more than they pay for and passing the cost on to everyone else. That is not virtuous, that is not a human right, and it is not the right choice.

Just because YOU think Europeans think we are ridiculous, doesnt mean they do. The Europeans that go to my mother (anesthesiolgist) and my father (internist) obviously have a problem with the care they get. My girlfriend’s grandparents, that are currently dying of treatable diseases in the UK don’t like it either. They have paid in to a system, and have no recourse when they want to take their money elsewhere.

@Greg: Forget about whether or not health care is a right for a minute. That was a point of contention in the debate, I recall, but I’m not sure you even need to go there to justify government involvement in health care. In order to justify a government program, you don’t need to demonstrate that it’s a basic right; you just need to demonstrate that it benefits the society as a whole without stomping on anyone else’s rights.

You’ve also mentioned the UK single-payer system a couple times, which strikes me as sort of a straw man. There is not a single proposal on the table that would bring us within 500 miles of the UK system; it’s on the totally opposite end of the spectrum from our current system. Still, if you put a gun to my head and asked me to pick between our current system and the UK one, I wouldn’t blink in picking the latter.

@ned”…you don’t need to demonstrate that it’s a basic right; you just need to demonstrate that it benefits the society as a whole without stomping on anyone else’s rights.”

Impossible. There is no such government institution. The power of government is derived from people’s rights being given away or taken. See Hobbes, Locke, Machiavelli, Rosseau, etc.

Furthermore, this assumes that society can benefit as a whole or even has a collective interest. This is false, there is no collective interest, see Macur Olsons “The Logic of Collective Action” or “An economic theory of democracy” by Downs, or “Classics in Voting Behaviour” by Niemi and Weisberg to start.

Given that there is no collective interest, you would have to justify, in the very least, that the majority has the right to force the minority to comply with its wishes. This is fundamentally unamerican, as promised by the bill of rights, the individual should retain the ability to make decisions regarding their own well being.

There is such a thing as “not for profit” private insurance in this country, it is the government that regulates and surpresses these organizations from being available to everyone in every state. A reduction of government barriers is always the way to promote individual choice.

“Individual rights are not subject to a public vote; a majority has no right to vote away the rights of a minority; the political function of rights is precisely to protect minorities from oppression by majorities (and the smallest minority on earth is the individual).”
Ayn Rand

“You’ve also mentioned the UK single-payer system a couple times, which strikes me as sort of a straw man. There is not a single proposal on the table that would bring us within 500 miles of the UK system; it’s on the totally opposite end of the spectrum from our current system. Still, if you put a gun to my head and asked me to pick between our current system and the UK one, I wouldn’t blink in picking the latter.”

Ignores the debate completely. If you want to debate the current state of crisis to the UK’s organized inferior system, then your answer would suffice. However, the choice is not between the current system and a public option. It is between a public option and “X.” If there are values of X that are > the Public Option, X should be chosen.

Before people rise up in arms calling for the government to enter the market of healthcare providers as a way to increase efficiency (the premises of which are severely flawed,) why don’t we consider a basic action which has been proven to increase efficiency through competition: reduce barriers.

Currently health insurance that is available to people of one state is not available to people of another state. By removing this legal barrier and allowing competition between health insurance providers of all 50 states as well as affording consumers the option to choose any health insurance program in the country, there will be an immediate shift in bargaining power in favor of the consumers, which will lower prices and/or increase the quality of service offered.

Let’s remember that our healthcare is an issue and it is an issue that requires a solution, not just a reaction. Therefore, we need to find solutions that address the core inefficiencies of the system. The government option does not address these core inefficiencies, all it will do is prop up an inefficient system in a slightly different way. The argument for the option that I heard at the PUR debate last night, is that if the government removes the profits from the companies that provide this “basic human right” then the consumers will benefit. 1. This is a dangerous line of thought. What will be next for the government to nationlize based on this premise? Airlines? Stock Exchanges? Media? 2. Government inefficiencies will increase cost in administration, so that assumed benefit to consumers will vanish. 3. Who is to say that the government won’t pass a law down the road allowing them to use healthcare as a profit center? Even if legislation is explicity written to forbid this, all it would take is a vote down the road to overturn previous legislation.

I keep hearing from the left all these hopes and dreams that the government solution will be the cure-all for our healthcare needs. The desired result (lower cost, increased care) sounds lovely, but the government “cure-all” will not achieve this desired result.

Also, the next time you are waiting in line at the DMV, at least be thankful that you aren’t bleeding and waiting to see a government approved doctor.

@ Greg:

You make some good points throughout the thread. Incentive problems plague the current system – doctors making money through pay-for-procedure mechanisms and consumers being largely uninformed about the true cost of their insurance (which is often seen as lost wages since their employer pays the bulk).

I also like the idea of Health Savings Accounts as one way of bringing down costs.

But you also misstep on a few points. One, the public option would not, as you say, encourage wild over-consumption of health care. There will be premiums and co-pays in a public option just as in private insurance. It’s not Medicare-for-all. (And there is evidence that moral hazard isn’t that big a problem in health care on the consumer side).

Two, although you’re right about the public option not being a panacea, I don’t think anyone contends that it is. It’s not the most important aspect of health reform. You know that, I’m sure. In fact, the health insurance exchange and consumer protections that would be implemented are far more important than a public option.

Three, you cite the kidney example to show the dangers of government involvement. It’s a relevant libertarian point, but you don’t acknowledge that the rationing of kidneys (and medicine in general) has to happen somehow. Right now we ration by price – if you can’t afford health care, you’re often out of luck (or bankrupted or undertreated etc.). I would rather see us move to a system where EVERYONE be able to receive a minimum level of care (not in an emergency room) and we ration based on empirical evidence like comparative effectiveness review.

Thank Charlie, you raise a lot of good points.

If there are premiums and copays meant to discourage over consumption, that is an additional cost to the consumer and addition cost as a deterrent to waste is an inefficient means of reductions. Initial cost is the only direct way to ensure that waste is controlled. I know there is evidence to suggest that there is a reduced risk of moral hazard, however it doesn’t take universal dissent to make the system wildly expensive. Even a tiny % of consumers can throw the government’s system into a deficit.

I agree consumer protection is important and limits to exchange are devastating. However, the greatest form of consumer protection is the ability to choose in the first place. The consumer cannot be protected if they cannot even choose the coverage or plan they desire.

Third, the fairest way to ration any scarce resource is to give it to those who are most willing and able to pay for it. A blind person should be allowed to compete with the sighted person for the kidney, by offering more money, getting to the hospital first, or even seeking live persons willing to make the transplant! (Controversial I know, and I’m sort of kidding)

Everyone should receive a base level care, which is why under a mandatory savings system; the government should subsidize the poorest people who otherwise do not make enough money to save it themselves. This system is counter to libertarian thought, but it is the only way to make healthcare universal while driving down costs, improving efficiency, promoting innovation, and restoring personal choice.

@Greg And you’re making presumptions that it ISN’T a human right and that the free market CAN take care of people…

Universal Health Care IS a basic right. Otherwise it becomes something that only middle to upper class citizens can afford because it costs a hell of a lot of money for health insurance. Between having money to eat/pay bills/gas OR health insurance, most Americans choose the more tangible things. And what about the people who don’t even have the money for those basic needs?

And it’s not like jobs are just dolling out health insurance either. Companies will do whatever they can to cut out health care packages. Due to the free market system, companies try to make as much profit as possible, so when my brother was a full time employee for Vail Resorts, they cut his ours, and just about every other full time employee who wasn’t in the corporate end of it, to a part time level so that way Vail Resorts wouldn’t have to pay for the health insurance packages of all its employees. I can name several other examples of how the free market system does not take care of it’s citizens if you would like.

There was no free loading involved in my trip to the doctor. I was sick, I went to the doctor, they told me what to do/gave me prescriptions and then I got better. It’s pretty cut and dry. If anyone has a problem, they go to the dr! So you’re worried about sick people getting better? Is that freeloading to you?

And usually, if they go a lot, which you seem to have critiqued, that’s even better, because then it’s preventative measures which prevent things from turning into larger problems.

Again, peoples’ lives should not be something dictated by the “free market system”.

@ Cooper

The burden of proff is not on me to prove it is a right. You made the assertion, you provide the proof.

I’m not saying those people shouldn’t get healthcare, but there is no such thing as a free lunch.

The current system is not a free market system. It is a system plagued with market destroying forces and divergent incentives for a variety of reasons.

Please study more economics.

@Greg: Your way of looking at things is great but I take issue with a couple things:

The biggest one is your mandatory savings system, because compared to an insurance system with premiums and co-pay I fail to see how they’re different, aside from a bigger bill. I understand how that big bill can have psychological effects, but if you’re paying it from money that you wouldn’t be able to use anyway, the cost is the same to the consumer, except that they actually have to pay the copay from their disposable income. Theoretically, a public option insurance is nothing more than a typical governmental solution to a collective interest problem: instead of keeping your mandatory savings accounts for the individual, it pools those resources to allow a greater flexibility of coverage.

True, it opens the door to abuse by that small percentage you mention, but I don’t buy that everyone would suddenly abuse the system. Now, I assume you recognize the fallacy of stating, “Logical human beings would go out and get as much healthcare as possible, including unnecessary tests,” but more to the point, with a co-pay that is significant I don’t agree that this problem would be as rampant as you suggests. Moreover, even if it did occur with that small percentage of abusers you mention earlier, I think that crime is lesser than the crime of someone’s mandatory savings account running dry, as that case is bound to be more fatal than the former (the assumption here being that those who have the most life-threatening illnesses also have the most expensive illnesses).

With that said, I suggest you all read Richard Posner’s take (as well as Becker’s) on the Swiss healthcare system that was covered in the New York Times not too far back:
http://www.becker-posner-blog.com/archives/2009/10/should_the_swis.html

This is not the solution, but it is an example of a model that works. Americanizing it is the answer.

http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model

In light of reading the posted article…
“The state’s role is to provide a safety net for the few people unable to save enough to pay their way…”
I take back that lesser of two crimes comparison.

This is a really interesting comment section. Keep it up. I think the quarrel between Charlie and Greg about whether “money” or “government” should ration health-care is especially interesting, and important. You should both explain those positions more, in my opinion…

But Cooper, this isn’t directed as a personal attack, but your example is probably a perfect example of ‘freeloading’, for lack of a better word. I’m willing to bet you didn’t pay taxes while you stayed in Madrid, or in any way substantially contribute to the government of Spain in order to “deserve” the value of the medical care you received. If you actually did, you can at least imagine that it would be quite possible, and common, that someone could receive health-care for free without having contributed anything to Spanish society.

@Lukas: Finally, we should all keep in mind that the “safety net” is only a band-aid for a more pressing problem of much greater importance. We should be working towards solutions that enable everyone to actually pay for their health-care…off their own dime.

Any health-care solution devised is just one more facet of a growing welfare state that has become increasingly pervasive in our society. Welfare, whether in the form of social security, unemployment benefits, or health-care should be a continual reminder that there is a growing demographic of Americans who are failing to support themselves. Fault does not lie with productive members of society for failing to support the poor. You might think altruism is great, and that’s fine, but band-aids in the form of welfare ignore the greater problems in our society that a greater altruist would be more concerned with.

@Chris I was working in Madrid, teaching English, I was giving back to the Spanish society. I paid bills and taxes. I was therefore entitled to that health care. And would the actual Spanish citizens who go in for health care be free loaders?

Yes, the actual citizens who are below the poverty line, or who don’t have a job, and thus don’t pay taxes, yet who still receive health-care would be “freeloading.”

And is working and paying taxes the only way to give back to society? And what if you’re still working and below the poverty line, you’re freeloading? So then you have to be rich in order to not be a freeloader, because then you can pay for everything yourself then, eh?

I”m still standing on what i said, Health care is a right.

@cooper

free·load (frē’lōd’)
intr.v. free·load·ed, free·load·ing, free·loads Slang
To take advantage of the charity, generosity, or hospitality of others.
free’load’er n.

free rider
 
Use free rider in a Sentence
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–noun
1. Informal. a person who obtains something without effort or cost.

@Greg The informal definition is the only one that seems to works, but again, if you’re talking about being productive and contributing to society there are many more ways to do it then just working and paying taxes. I think this whole “freeloading” and “deserving quality” is crap. It’s a right, everyone deserves the best care possible.

We’re just going to have to agree to disagree, let it be noted that I, just happen to be a better person than you and Chris for willing to help pay for Universal Healthcare, for all those freeloaders out there.

@Chris, I’m not exactly sure what your point is. If it’s to support the idea of mandatory savings so that each member can pay “off their own dime” I didn’t see a refutation of my point that mandatory savings and a public option get you to the same place using only slightly different methods. If you were just speaking to the idea that people should just have to pay for their own healthcare, I appreciate the sentiment but realistically that’s ludicrous. There is no system in the world where someone pays for healthcare solely by themselves.

Also, your statement that “Fault does not lie with productive members of society for failing to support the poor,” I think demonstrates a fundamental misunderstanding of social contract theory that conservatives commonly make. It’s not that productive members are “at fault” but rather that they agree as being a part of that society that we have a responsibility to those our society leaves behind. To think that we can somehow magically make the poor productive is silly and ignores basic macroeconomic theory. There will always be unemployment, and there will always be a view that judges our society based on how we treat the worst off among us. This legitimate view of societal purpose is what leads to your welfare state, not some misguided notion that the rich are “at fault” for the poor’s situation.

@ Lukas if you still can’t see the difference between a manditory savings plan and a government run plan you are either extremely short sighted or you lack proper prospective.

A government run plan means the government pays for and regulates healthcare. This means that the government is in charge of human bodies. Even if everyone were altruistic, and a government plan worked perfectly, it still wouldnt be ideal, because the individual does not choose.

A savings plan does work perfectly because there is no bureaucratic waste, no administrative lag, no pay per procedure healthcare, free competition between doctors for patients, and the patients retain the ability to choose for themselves. A savings plan would require that the poorest in society be given money to go to the doctor, not given a doctor to go to. Everyone else just goes as they normally would.

And as for it not working anywhere in the world?

http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model

http://healthcare-economist.com/2008/01/14/singapores-health-care-system/

“The government pays for “basic healthcare services… subject to tight expenditure control.” Bottom line: The government pays 80% of “basic public healthcare services.”

So you’ve decided that government paying for MOST of the cost versus ALL of the cost wipes away all bureaucratic waste and lag. I don’t know how you’ve managed to reach that conclusion

However, the Singaporean system is interesting. Thanks for providing info about it.

@peter your statement is misleading. technically the government pays for 100% of PUBLIC healthcare. That’s because its public healthcare.

“The World Health Organization’s most recent full report on global health statistics says the United States spends 15.4 percent of its GDP on healthcare, while Singapore spends just 3.7 percent.

What’s the reason for Singapore’s success? It’s not government spending. The state, using taxes, funds only about one-fourth of Singapore’s total health costs. Individuals and their employers pay for the rest. In fact, the latest figures show that Singapore’s government spends only $381 (all dollars in this article are U.S.) per capita on health—or one-seventh what the U.S. government spends.

Singapore’s system requires individuals to take responsibility for their own health, and for much of their own spending on medical care. As the Health Ministry puts it, “Patients are expected to co-pay part of their medical expenses and to pay more when they demand a higher level of service. At the same time, government subsidies help to keep basic healthcare affordable.” ” (http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model)

the difference is Singapore provides healthcare rather than subsidizing it and giving money to the poorest of its people. As i said, the system is not perfect for America, but it gives insights on other possibilities.

@Lukas: “It’s not that productive members are “at fault” but rather that they agree as being a part of that society that we have a responsibility to those our society leaves behind.”

I agree. Being a part of society does entail some sort of responsibility to those least-well off. To you, this responsibility means that we should provide sustenance in the form of basic health-care, unemployment welfare checks, and social security for instance.

To me, this responsibility means that society should works towards providing the opportunity for those least-well off to improve themselves and their life.

The problem I have with your version of responsibility is that it is short-sighted and merely guises the underlying problems in society so that the more-advantaged in society might feel better about the advantages they have received, yet do not deserve.

If you were truly concerned with the well-being of those “society leaves behind”, you would be less concerned with forms of welfare, and more concerned with why those who can’t support themselves are in that situation.

If it is a contest of virtue that pro-public option people want to make this debate… I think you find yourself far behind.

[...] Tuesday I asked our readers whether or not they supported the public option. In the comments thread that ensued we learned, [...]

@Greg, it seems to me that when you’re talking about a government run plan you’re imagining a single-payer system, which is not the public option that is the original impetus for the debate. The public option is simply a publicly run, nationally available insurance company, into which citizens pay premiums and deductibles. It’s interesting that you champion Singapore, and it would seem that you misunderstand their system, because the article you’ve repeatedly point to actually explicitly says there is a “national insurance plan” called Medisheild. In light of this, I stand by my statement that there is no system in the world where the consumer bears all of the costs of healthcare, at least directly.

@Chris, I fail to see how this is short-sighted as you claim. I’ve heard this “opportunity” argument before, and I buy it less now than I did then, because as I see it, and you may disagree, health is a fundamental part of providing that opportunity. It’s impossible for a man to open a business if he is hampered by tens of thousands of dollars in heath expenses for his child. Or a 30 year old inventor who is too afraid to leave his job to pursue his passion because he would loose his heath benefits and a pre-existing condition would prevent him from gaining new insurance.

You and I both want to provide people an opportunity to succeed, the only difference is that I’m providing a concrete solution to a problem that is plaguing millions of Americans (including the millions more that have lost health coverage in the last 20 years, despite significant economic growth), where you are simply waving your hand and talking about how if you can’t support yourself you don’t deserve to. The fact is that in our economic system of choice fundamentally creates a lower class, I am simply asking that the opportunities provided them keep pace with the advancement of our society. I think we’ve reached a point where that requires access to healthcare despite socioeconomic class.

@ Lukas At the debate I pointed out that disaster insurance would be required for all citizens in order to protect people from freak accidents like cancer at a young age, genetic diseases etc.

You are missing the point. A public option does not fix the problem. It is just a bandaid. Under a public option we are stuck with the same system we have, just extended over the entire population, and it is way more expensive on the tax payer. (not to go in to all of the rights it tramples).

A manditory savings, coupled with disaster insurance to cover statistical anomalies (or the ’sob stories’” and a small redistribution of wealth from the wealthiest tax payers to the poorest people ( like medicare for the poor instead of the old and in the form of cash for medical expenses) covers 100% of society.

If you are against a system that is cheaper, fairer, promotes innovation, and covers everyone, then you are immoral.

[...] option, co-ops would avoid some of the pitfalls of the private insurance companies which, remember, are in the business of maximizing input (the premiums you pay) and minimizing output (the care you r…. Since co-ops don’t share this goal, they can offer lower premiums for similar care, [...]

@Greg, Hahahaha, as much as I want to be offended by your implication that I’m immoral, the fact is I don’t buy your argument for a few reasons:

1) Government spending on heath in Singapore is a helluva lot more than just intervening in “statistical anomalies” It involves Medishield (the aforementioned public option), Medifund (think Medicaid), Eldershield (government subsidized private Medicare), as well as about 74% of hospital beds used being entirely publicly funded. Moreover, the government does regulate the type of procedures the account can pay for, as well as the doctors you can see. In short, your system with strictly mandatory savings and a little “disaster insurance” exists purely in fantasy.

2) It’s not hard to believe that Singapore spends less than we do because of significant lifestyle differences between our two societies. Even setting aside vast differences in diet, they have a far more paternalistic state that heavily discourages unhealthy behavior like smoking etc, (as well as discouraging free speech, but that’s another discussion), so to think their control of costs is simply because of their healthcare system is ignoring a lot of the factors that ultimately determine health.

Ultimately though, I am inclined to like your idea. Setting aside political impossibility, I think it’s somewhat of a great idea, but even Singapore has a “public-private” mix of a system that helps regulate and control costs. Even your favorite model would suggest that a public option has a far bigger role to play other than “bandaid.” The public option is necessary to not only cover those that the private system won’t, but also to help control costs and be true competition to private insurance just as it is in Singapore. A MSA would really more replace our current private insurance providers than bridge the gap that keeps the low-middle class from being insured.

I agree that a public option does not fix the problem completely, but it is an important step to doing so.

Lukas, I proposed that rather than have the government cover costs, they simply take some of their tax revenue and pay it to the poorest people as a health subsidy rather than create a wasteful bureacratic system that infringes on peoples liberties. A Savings plan does require the government to do something, but it doesnt need to be a public option.

I am not saying we should be singapore, for the last time, it is a model from which we can learn.

My point: There is a better way than a public option. One may be a manditory savings plan. Under no circumstance should the right to a regular person’s own health care be vested in someone other than themselves. Never to an insurance company, employer, or government.

The whole of the Bill [of Rights] is a declaration of the right of the people at large or considered as individuals … It establishes some rights of the individual as unalienable and which consequently, no majority has a right to deprive them of. – Albert Gallatin (1789)

Honey, your argument has many virtues, but rights is not one of them. People already have the right you speak in defense of, but we voluntarily forfeit a part of it because it makes more economical sense. Your system, while possibly providing more choice in healthcare, actually strips the right of the citizen to choose how to pay for it. I mean, you can’t argue that a system with the name “mandatory” in it preserves rights. Part of the very reason that Singapore can get away with something like that is because their citizenry has far fewer rights than ours does. I suspect that this is the same reason that mandatory savings hasn’t really been part of the national discussion.

Really, the best way to preserve rights is a public option, seeing as it is, after all, an option. No citizen will be forced into it. They may choose to because it’s cheaper, but that’s kind of the point. No system, Singapore included, has been able to control costs without some sort of public involvement in the healthcare market.

As I said before, a MSA would be an interesting supplement to a public option, not a replacement.

And I realize that you’re not pinning yourself to Singapore, but seeing as it’s the only example of the type of system you advocate, and that example can’t exist without a public option – in a state that is far smaller and far more controlled than ours is – I honestly think it helps my point far more than it does yours.