[pbleighton]

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1) The opportunity costs involved in your plan versus our present system. What are they and how did you measure them?

There will be more health care consumed under universal health care, reducing dollars spent elsewhere. This is the desired result for universal health care

The control will be that the policy is basic benefits. This is common under many universal health care systems.

Opportunity benefits are relevant here as well. They include:
1. A healthier and more productive work force.
2. Greater competitiveness of our companies abroad - see the U.S. auto industry.
3. Elimination of completely non-productive sales/marketing, underwriting, billing, profit, and (much of) claims processing. As I said before, private insurors take 15%-40% of premiums for non-claims items, versus 2% for Medicare. This is a huge opportunity cost of the present system, which can't be ignored in any rational analysis.

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2) How are you going to combat rent seeking behavior? What rent seeking behavior will come out of your plan and how will you fight it? I assume you will fight it.

This question is only relevant to the discussion if the plan nationalizes health care (the product) versus health insurance (the funding mechanism). My plan doesn't nationalize the product at all. So you see, the *details* are relevant, after all.

If you disagree with this, please give examples of significant costs arising from rent seeking behavior you think would be incurred under expanded Medicare versus the present system. Please note that claims fraud is equally an issue for private insurance than for Medicare.

Peter

[mike777]

1)Peter there will be massive opportunity costs under either method. Many many people will die and be harmed as a result of choosing either method. You talk as if it is zero or close to zero. What are your costs vs the present method?

2) This is just plain silly of course there will be massive rent seeking under Universal Health care.

Just as a tiny tiny example google medicare and rent seeking, you get over one million sites to check out.
This is only a small start.

You just seem to dismiss this stuff. Oh well nevermind.

[hrothgar]

mike777, on May 30 2007, 07:30 PM, said:

1)Peter there will be massive opportunity costs under either method. Many many people will die and be harmed as a result of choosing either method. You talk as if it is zero or close to zero. What are your costs vs the present method?

2) This is just plain silly of course there will be massive rent seeking under Universal Health care.

You just seem to dismiss this stuff. Oh well nevermind.

Mike, given the fact you are prone to use expressions that you don't actually understand, it might be useful for you to provide a definition for the term "opportunity cost". (I just want to make sure that we're talking about the same thing)

BTW, given that the crux of Peter's argument is that that the existing system in the US is highly inefficient compared to alternative implementations, it really doesn't make sense to be commenting on opportunity cost. If we are willing to bear the opportunity cost of the existing system, then we should be willing to bear the cost of a less expensive system.

[mike777]

hrothgar, on May 30 2007, 11:41 AM, said:

mike777, on May 30 2007, 07:30 PM, said:

1)Peter there will be massive opportunity costs under either method. Many many people will die and be harmed as a result of choosing either method. You talk as if it is zero or close to zero. What are your costs vs the present method?

2) This is just plain silly of course there will be massive rent seeking under Universal Health care.

You just seem to dismiss this stuff. Oh well nevermind.

Mike, given the fact you are prone to use expressions that you don't actually understand, it might be useful for you to provide a definition for the term "opportunity cost". (I just want to make sure that we're talking about the same thing)

BTW, given that the crux of Peter's argument is that that the existing system in the US is highly inefficient compared to alternative implementations, it really doesn't make sense to be commenting on opportunity cost. If we are willing to bear the opportunity cost of the existing system, then we should be willing to bear the cost of a less expensive system.

Absolutely,


Richard trust me I know what I am talking about, your poor examples in other posts, see genocide for example are just plan silly and wrong. In any event I hate the flame posts you are so prone too. Leave me out, please.

Just show me what the opportunity costs are compared to the present system and how you measured them. If less count me in!

[jtfanclub]

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Here in the Netherlands we used to have employer-payed health insurance. Fortunately we got rid of it a couple of years ago. It was a nightmare.
- Whenever I changed employer I had to reconsider my insurance plan.

I don't consider that a big problem.

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- Some employers had collective insurance plans for their employees which were more expensive than the cheapest individual plans. So those emplyees that were healthy enough to qualify for the cheapest individuals backed out, making the collective pool even more expensive. Eventualy that would lead to a situation in which almost everybody would back out and only those with really poor health would stay, and pay enoumously. They would then start looking for another job that could offer a cheaper insurance etc.

The plan I mentioned would encourage employers to pay up to $2000 a year in health insurance. Depending upon how you looked at it, the employees who took the cheapest individuals would end up paying an extra $1000 (the amount the employer would have to pay the government) or $2000 (the amount that they employer wouldn't be covering) a year for their individual insurance. It's almost impossible that that would be worth it.

However, this points out that, really, there are only two options:

-Everybody pays the same amount, no matter how sick they are. Healthy people will opt out of this if at all possible, which results in you forcing healthy people to stay in at gunpoint, and pay for something they don't need. It also makes the healthy people resent the sick people they have to pay for.

-Everybody pays based on how sick they are. This can get impossibly expensive for the sickest people.

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- Whenever I quit one job I had to apply for a temporary individual insurance until I found another employer. For a few weeks this wasn't worthwhile but once I had to renew my residence permit during a gap between two employers, and the imigration required me to show an insurance plan. So I applied for a plan (I knew they would turn me down because my health was too bad but the trick is to apply just a couple of days before the visit to the police so that my application hadn't been turned down yet).

We have COBRA here, which says basically that even after you're unemployed, you can keep your employer's insurance, although you have to pay for both sides now.

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- Some people have multiple employers and it has to be decided which of them organize the insurance thing.

Fifty cents an hour. Doesn't matter who organizes it. Heck, the employer doesn't even have to organize it at all. He can have you pick your HMO, and agree to pick up X amount of the tab.

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- What if you live in the U.S. and work in Mexico. Should your Mexican employer pay for your U.S. insurance? Or should you have a Mexican insurance? In the latter case, would you have to go to Mexico to get treated? Would any legal issue related to your insurance be settled by a Mexican or a U.S. court? Applying Mexican or U.S. law?

Immaterial. That problem crops up no matter what system you're using. If you live in the Netherlands but work in Mexico....

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Not everybody has an employer so there will have to be a system for those without an emplyer. Now you might as well extent that system to those who have an employer.

Right. After all, Not everybody has an employer, but they all need to eat. Therefore, we might as well have the government provide food for everybody....

My plan is paid for by employers, but care is based on insured/uninsured, not employed/unemployed. So that's a moot point. I don't need a program for unemployed insured people- they're handling it fine on their own.

[pbleighton]

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Peter there will be massive opportunity costs under either method. Many many people will die and be harmed as a result of choosing either method. You talk as if it is zero or close to zero. What are your costs vs the present method?

2) This is just plain silly of course there will be massive rent seeking under Universal Health care.

Just as a tiny tiny example google medicare and rent seeking, you get over one million sites to check out.

I understand what you are talking about, and gave you a reasoned response.

I also challenged you to come up with specific examples on rent seeking, which you didn't even attempt to do. I wonder why.

Oh well.

See Richard's

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BTW, given that the crux of Peter's argument is that that the existing system in the US is highly inefficient compared to alternative implementations, it really doesn't make sense to be commenting on opportunity cost. If we are willing to bear the opportunity cost of the existing system, then we should be willing to bear the cost of a less expensive system.

I worked in the insurance industry for a long time, and I know what I'm talking about. The opportunity costs are so huge (15%-40% versus 2%) that they overwhelm the costs of insuring the currently uninsured (about 15% of the population).

Peter

[mike777]

Peter in my line of work over the years I got to talk or work with many people in the Health insurance field at the top levels. Not a one had the faintest idea what the best guess was at what the opportunity costs where in the area of health delivery decisions for the country as a whole.

If you do, cool just tell me what they are and how you measured them. My bet is all you have is a random guess but.....

I bet not one person who presents a universal health care plan has any idea. That is the problem.

As for rent seeking I told you there are million hits just in one second, sigh did you look at them? If you prefer to just keep guessing and not do any work, forget it, this is silly.

[hrothgar]

mike777, on May 30 2007, 07:42 PM, said:

Richard trust me I know what I am talking about, your poor examples in other posts, see genocide for example are just plan silly and wrong.

You mean the thread I asked you to provide any kind of reasonable explanation how the Union army committed genocide in the Civil War or the Allied Armies committed genocide in WWI?

These are your examples / claims, not mine...

[helene_t]

jtfanclub, on May 30 2007, 06:43 PM, said:

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- What if you live in the U.S. and work in Mexico. Should your Mexican employer pay for your U.S. insurance? Or should you have a Mexican insurance? In the latter case, would you have to go to Mexico to get treated? Would any legal issue related to your insurance be settled by a Mexican or a U.S. court? Applying Mexican or U.S. law?

Immaterial. That problem crops up no matter what system you're using. If you live in the Netherlands but work in Mexico....

No it does not since my Dutch health insurer doesn't care if I work in Mexico, Netherlands or not at all. Just like it doesn't care if I play on an American bridge site or a Ducth one. Employment is as irelevant as online bridge.

My point is that I don't see any added value of having employers involved in all this. You might as well give Fred and Uday tax insensitives to provide heatlh services for all of us, but I don't see why.

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Right. After all, Not everybody has an employer, but they all need to eat. Therefore, we might as well have the government provide food for everybody....

But the whole point of this discussion is that some people think that people are not resposible enough to insure themselves so either they must be forced to buy an insurance plan, or their employers (or bridge sites or whatever) must be forced or motivated to do so, or the goverment must provide the insurance, or the government must provide the health services.

You might disagree with those assumptions, but in that case health is just another comodity and politicians should not talk about health services at all but just leave it to the market.

On the other hand, if the government really should assure that everybody has a health insurance, then I see no reason why there should be different systems for emplyed and non-employed. Here in the Netherlands we used to have different systems for draftees, for students, for orphans and for refugees as well. Fortunately not anymore. (Edit: there probably are still some exceptions for orphans since minors are usually covered by their parent's insurance. I don't know how the current rules are in that respect).

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.... there are only two options:
-Everybody pays the same amount, no matter how sick they are. Healthy people will opt out of this if at all possible, which results in you forcing healthy people to stay in at gunpoint, and pay for something they don't need. It also makes the healthy people resent the sick people they have to pay for.

-Everybody pays based on how sick they are. This can get impossibly expensive for the sickest people.

That's an important discussion. Now if employees are at the mercy of employers so that the degree of solidarity between employees (=insurees) differ between employers and between insuree strata within each employer, it becomes really messed up. I have several times declined job offers on the basis of the poor health insurance that came with the offer. Now if health insurance was just another benefit emplyers could freely choose to offer or not to offer (like cars, phones, laptops and plain money) that would be ok. But the idiotic thing is that the employers have little control on the health insurance coverage and -prices they can offer because the actuaric calculations depend on things like the age and sex makeup of the employees. So I ended up declinig job offers because the age profile of prospective colleagues would prevent me from getting a decent health insurance plan. That's silly.

[pbleighton]

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Peter in my line of work over the years I got to talk or work with many people in the Health insurance field at the top levels. Not a one had the faintest idea what the best guess was at what the opportunity costs where in the area of health delivery decisions for the country as a whole.

If you do, cool just tell me what they are and how you measured them. My bet is all you have is a random guess but.....

Mike, do you actually read the posts you respond to?

The 15%-40% non-claims cost, which is certainly an opportunity cost, is common knowledge in the industry. I know this through the actuarial work I did. My claim is that this existing giant inefficiency outweighs the cost of insuring the 15% of the population which is uninsured. This is basic arithmetic. Too tough for you?

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As for rent seeking I told you there are million hits just in one second, sigh did you look at them? If you prefer to just keep guessing and not do any work, forget it, this is silly.

Yes, I know what rent seeking is, Mike. I gave you my explanation for why this won't be a big issue (I would nationalize the funding mechanism, not the health care industry). This is the third, and last, time I will challenge you to produce examples of the rent seeking behavior you claim would result from expanded Medicare, which would not exist in the present system. Just stating there will be huge amounts doesn't rise to the level of serious argument. Put up or shut up.

Peter

[helene_t]

I don't understand this "rent seeking" thing in this context. Are you talking about health service providers taking advantage of Medicare? Or about insurees taking advantage of it? In any case, there would be substantial evidence allready since Medicare allready exists, I supose?

A google on "medicare rent seeking" produces enormous amounts of crap.This one turned out to be relevant to this discussion but it's not about rent seeking.

[mike777]

I will let Economists in the forum discuss their view of rent seeking.

As a noneconomist rent seeking for me occurs when parties try to capture profits by transferring wealth from one party to another. It is often studied in the field of public economics, a field where economists anaylze government decision making. Governments of all types, although some are more susceptible than others-possess the power to grant special prvileges to well whomever they can get away with granting these privileges to. Dictators may grant privileges to almost anyone, but in representative democracies politicians tend to give special favors to those who support their reelection campaigns. The type of favors politicians may grant include privileges to promote the interests of the lobbying company, such as subsidies for a product, favoritism in winning government contracts, or loopholes in regulations. Others may indirectly such as harming competitors by taxing competing productsor adopting strict regulatory standards.

What wrong with rent seeking is not the transfer of wealth from one party to another. It may be morally repugnant in many cases but it does not make society poorer, it just shuffles dollars around.

The transfer of wealth is not the problem. The problem is that the effort that went into transferring the wealth is effort that could have been devoted to something productive.

Politicians are well aware that helping one group necessarily hurts another group. Thus convincing politicians to dole out favors is not a simple task. Interest groups spend large amounts of moeny. Rent seeking requires putting on a happy face for the public.

All of these expenses are the costs of rent seeking. Rent seeking is the attempt to get more pie by taking pieces from others. Profit seeking, individuals seek to generate profits by innovating to create new low-cost production techniques.


The ability of governments to grant special privileges creates incentive for rent seeking,which is why public economists spend so much time try to design and advocate for political rules and institutions to discourage rent seeking.

If health care related companies, owners, patients, and agents are in front of Congress on a frequent basis for the hundreds of health care related issues some posturing may affect some rent seeking privileges by the many parties with a stake in the business of health care.

BUT THAT'S ALL JUST POLITICS.

See Professor Gordon Tullock for more on this subject.

[mike777]

Since this thread is about health care reform I wanted to get back to the subject of scalability. I posted some sites on imaging since that was one area where I could see scalability. Forum posters may have other, better ideas for scalability.\\

I do not want to get too hung up on the issue of a single payer system. How to combat overusage or the issues of some bureaucrat in DC setting prices sounds like it may have problems but maybe someone has a plan.

The current system is going with perverse incentives, and yes incentives matter, big time. With the current system of self-referral it's not clear if new technology will actually save money. Doctors can prescribe tests all day long and then perform them for fat fees. They can run and get reimbursed for tests galore while Medicare and DRG's Diagnostic related groups help limit payments. The procedures are spelled out in excruciating detail at the Department of Health and Human Services Center for Medicare and Medicaid Services with prices set by who knows.


Dr. laurence Baker at Stanford says new tech and increased medical spending is interrelated. You invent a new scanner and medical spending goes up. Health is better, but costs are not down. New technology drives more spending. It's hard to quantify better health.

Since the expense is in the catastrophic end of the curve, heart, stroke and cancer the real answer's got to be there somewhere.

[pbleighton]

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I will let Economists in the forum discuss their view of rent seeking.

As a noneconomist rent seeking for me occurs when parties try to capture profits by transferring wealth from one party to another. It is often studied in the field of public economics, a field where economists anaylze government decision making. Governments of all types, although some are more susceptible than others-possess the power to grant special prvileges to well whomever they can get away with granting these privileges to. Dictators may grant privileges to almost anyone, but in representative democracies politicians tend to give special favors to those who support their reelection campaigns. The type of favors politicians may grant include privileges to promote the interests of the lobbying company, such as subsidies for a product, favoritism in winning government contracts, or loopholes in regulations. Others may indirectly such as harming competitors by taxing competing productsor adopting strict regulatory standards.

What wrong with rent seeking is not the transfer of wealth from one party to another. It may be morally repugnant in many cases but it does not make society poorer, it just shuffles dollars around.

The transfer of wealth is not the problem. The problem is that the effort that went into transferring the wealth is effort that could have been devoted to something productive.

Politicians are well aware that helping one group necessarily hurts another group. Thus convincing politicians to dole out favors is not a simple task. Interest groups spend large amounts of moeny. Rent seeking requires putting on a happy face for the public.

All of these expenses are the costs of rent seeking. Rent seeking is the attempt to get more pie by taking pieces from others. Profit seeking, individuals seek to generate profits by innovating to create new low-cost production techniques.


The ability of governments to grant special privileges creates incentive for rent seeking,which is why public economists spend so much time try to design and advocate for political rules and institutions to discourage rent seeking.

If health care related companies, owners, patients, and agents are in front of Congress on a frequent basis for the hundreds of health care related issues some posturing may affect some rent seeking privileges by the many parties with a stake in the business of health care.

Still no specifics.

Unless, of course, you are willing to say that *all of health care* under a single-payor system is rent seeking. This is, of course, true at some level, but it is so broad as to be meaningless.

Now, as to your other red herring, opportunity cost:

Well, you've consistently ignored the 15%-40% non-claims cost issue (and neither of your links on the French system address it either, not that it would because I'm not proposing the French system) - well OK, I guess this qualifies as an inconvenient truth.

But let's get back to your question:

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Just tell me two things about it:
1) The opportunity costs involved in your plan versus our present system. What are they and how did you measure them?

Then your later quote:

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Peter in my line of work over the years I got to talk or work with many people in the Health insurance field at the top levels. Not a one had the faintest idea what the best guess was at what the opportunity costs where in the area of health delivery decisions for the country as a whole.

So, according to you, your question is effectively unanswerable (BTW I agree with you). In other words, a red herring. We can, of course, look at specifics of contrasting systems, but you understandably prefer not to.

Oh, well.

Peter

[pbleighton]

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The current system is going with perverse incentives, and yes incentives matter, big time.  With the current system of self-referral it's not clear if new technology will actually save money. Doctors can prescribe tests all day long and then perform them for fat fees. They can run and get reimbursed for tests galore while Medicare and DRG's Diagnostic related groups help limit payments. The procedures are spelled out in excruciating detail at the Department of Health and Human Services Center for Medicare and Medicaid Services with prices set by who knows.

Dr. laurence Baker at Stanford says new tech and increased medical spending is interrelated. You invent a new scanner and medical spending goes up. Health is better, but costs are not down. New technology drives more spending. It's hard to quantify better health.

Since the expense is in the catastrophic end of the curve, heart, stroke and cancer the real answer's got to be there somewhere.

This may surprise you, Mike, but I agree with you on this.

The government spent almost a million dollars caring for my grandmother after she had lost the ability to recognize anyone.

The mother of a friend died a terrible, very expensive private insuror-sponsored death in a very low chance of success treatment for her advanced lung cancer.

Meanwhile our infant mortality rate is more than 50% higher than the rate in the Czech Republic. That's over 80,000 extra dead babies every year.

Nice priorities we have.

But as you say, that's politics.

Peter

[mike777]

Peter you have this backwards but nevermind this is silly.

You are presenting a new plan. Fine. I am not defending the current system I am asking you, not me, to do the work in answering these issues and questions. If you make a proposal you need to defend it. I am not defending your proposal.

I am to repeat I am not attacking your plan I am asking about costs.

If you plan is more efficient, great, prove it. If the opportunity costs are lower, fine prove it or at least give some argument other than babies are dying now and your best friend died.

I think the answer is in scalabilty, in attacking the big 3 killers. If your single payer system is the answer great.

[pbleighton]

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I am to repeat I am not attacking your plan I am asking about costs.

Why do you never acknowledge my point about non-claims costs?

Why do you never acknowledge my point about differentials in our general and infant mortality versus other countries, especially in light of our spending twice as much per capita on health care (and no, your links don't address them either).

These are real numbers, real arguments, and you continue to ignore them.

Why?

Peter

[pbleighton]

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I think the answer is in scalabilty, in attacking the big 3 killers. If your single payer system is the answer great.

The two are not mutually exclusive at all. Why do you think they are?

Peter

[helene_t]

mike777, on May 30 2007, 09:18 PM, said:

If you plan is more efficient, great, prove it. If the opportunity costs are lower, fine prove it or at least give some argument other than babies are dying now and your best friend died.

Peter has mentioned several times that the Medicare non-claim overhead is 2%, compared to some 15-40% for commercial insurance plans. What more do you need?

[mike777]

pbleighton, on May 30 2007, 02:19 PM, said:

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I am to repeat I am not attacking your plan I am asking about costs.

Why do you never acknowledge my point about non-claims costs?

Peter

My answer is whatever you like it to be. I have no idea what you are talking about and I am not arguing with you. As I said I have no interest in the details.

I cannot even understand the details in my own health care plan or choices which I said ages ago in my previous post.
How am I going to understand the details in a single payer plan for 300 million people.

If you got a good pricing plan solution or overusage solution, great. I do not know one.