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29 June 2012 @ 10:20 am
I think I just realized something  
So I follow Joe Bethancourt on Facebook, because I like his music and am willing to overlook his politics. And he posts lots of things about, "What part of my property do you think you have the right to steal?" in response to the Affordable Care Act.

I haven't been able to formulate an answer.

I think I've figured it out. From my perspective, he's asking the wrong question, and that's why I can't answer it.

The question *I* ask is, "We live in a society that conveys many advantages. How can we most fairly distribute those advantages while not constraining personal incentive and creativity?"

I have no problem with people who invent really cool things, or provide really cool services, being fabulously wealthy. I have no problem with the idea that a job requiring 25 years of training pays more than a job that doesn't require that kind of investment.

I do have a problem with a society and culture that treats people who do the day-to-day work of maintaining the infrastructure (by which I mean both public infrastructure like road builders and forest rangers and police and teachers and firefighters, and private infrastructure like custodians and secretaries and house builders and factory workers) -- or who are unable to work because of disability, or who are able to work but cannot find a job because the economy is broken -- as disposable and worthless.
Johnjohnpalmer on June 29th, 2012 06:37 pm (UTC)
I would rather have gone to a single payer system, but an insurance company can certainly increase availability of health insurance (through obvious means) and can provide intelligent negotiations (increasing affordability) that an individual has neither the ability (due to lack of medical training) nor the bargaining power to provide.

"You cannot improve the availability and affordability of health care..." is not obviously true, and I strongly suspect is entirely false. Is there any place in the world where there's just medical consumers, and doctors and other service and product providers, who provide better affordability and availability with no one "siphoning off ever more money"?
Gnome: Pupgnomentum on June 29th, 2012 06:51 pm (UTC)
Try the UK. Well, at least for the next few months until it gets totally screwed over.

The government pays for the NHS. The doctors are on fixed wages. Drugs and other supplies are bought through bulk purchase, driving costs down. The weak links in the system are the over-supply of administrators and under-supply of medical staff.. though I'd class that as poor management, rather than wilful syphoning of money.
Johnjohnpalmer on June 29th, 2012 08:36 pm (UTC)
In the UK, I assume there are government bureaucrats or officials who make decisions about payment and availability, even if it's only "here's what we will pay our doctors" and "here's how much we'll pay for these drugs." These people aren't working for free - they're between patient and doctor, and since it's not free, they're siphoning off money - just like an insurance company would. (It should be more efficient - just as the VA is more efficient than private health insurance in the US. But the cost is probably still present. But obviously, I can't speak authoritatively.)

In single payer, the government would act as an insurance company - and siphoning off money (but just expenses for the employees running the system, not showing a profit).

You could have a system where people only get the health care they can pay for out of pocket (or via credit card/bank loan/etc.), and costs would be lower, but outcomes would suck diarrheatic donkey ass for all but the very wealthy.
Gnome: Packmatesgnomentum on July 1st, 2012 06:09 pm (UTC)
Fair point.
The Renaissance Manunixronin on June 29th, 2012 08:53 pm (UTC)
The thing is, bargaining power SHOULDN'T MATTER. In fact, it's one of the ways in which the current system actively makes matters worse. The insurance companies use their huge bargaining power to force contracted rates on healthcare providers that frequently don't even cover the provider's cost. The provider has to make that up somewhere, and they can't do it from the patients covered by insurance company contracts, so they make it up from the patients NOT covered by contracts. Which is to say, the uninsured ones.

So now you have a situation, created by medical insurance, in which patients who can't afford medical insurance are subsidizing the medical insurance of those who can. And that is just completely barking insane.

The ACA COULD have addressed this, by the very simple expedient of declaring, "One facility, one procedure, one price." If you provide a given treatment at a given price to a patient covered by one insurer for a certain price, you have to charge the same price for that treatment to a patient covered by any other insurer, or to an uninsured patient. But they didn't, because the insurance companies would never have gone along with that.