NationStates Jolt Archive

So I lost posting privileges on NS many many fortnights ago. I've been lurking on and off for a long time, but now I'm back. Please don't shun me :)

The more I think about the business model of insurance companies, the more I think that they're nothing more than ponzi schemes and pyramid schemes. Health insurance companies, for instance, take in premiums, invest those premiums, and use the returns on those investments to pay out claims. Whatever is left over is profit. So, for a long time everything was going swimmingly, but when tough times roll around (a.k.a. stupid risk managers make bad investments that their models tell them are good), insurance companies have to bank on low interest rates, and now government bail outs. Relying on low interest rates to dodge the bullet that rolls around every few years as the vicious cycle repeats itself has worked out in the past, but not so much any more. This cycle also begets merging of smaller insurance companies into bigger ones to delay the consequences. So whether it be indirectly through interest rates (inflation) or directly through bail outs (new access to TARP money), aren't WE the ones really supporting this pyramid scheme? Is this really sustainable? How long before it just collapses on itself?

Anyway, since I think people are already tired of the moral arguments see Linda Peeno) about a single-payer health care (read: SOCIALISM), I thought I'd go with the practical argument. The only pyramid schemes that are sustainable are those backed by the government, like Social Security. Of course, Social Security is heading towards a crisis. A government-backed scheme is dependent on a rise in population, an increase in productivity, cutting benefits, or raising taxes (or inflating the currency). Productivity is really beyond the pale of government control, but increases naturally as technology advances. Cutting benefits and raising taxes are painful and insanely unpopular. Moreover, it's really just transferring the ills of society from one person back onto another. In my opinion, the simplest, easiest, and fastest way to fix the Social Security, is to reform our immigration laws and allow immigrants to work here and pay taxes (which Obama may do, supposedly he's about to propose comprehensive immigration reform).

We spend 14% of our GDP per capita on health care costs and we don't even offer universal health care, while Canada spends just 7% and DOES cover everyone. It's not like we're paying a whole bunch of money for a better system, we're paying MORE money for a WORSE system. So... am I just a crazy socialist pinko commie, or am I just being practical?

(sorry I can't post links or sources yet cause I need post count of four apparently)

*shuns*

Hm. I'll concur that private health care insurance is a fundamentally flawed concept, in that the company is interested in profiting off of your premiums, and actually paying out money when you get injured is a loss on their books, so they try to avoid giving you money as much as they can, while driving the premiums up as much as they can.

On the other hand, public health care does have one major flaw; waiting lists. Since there are never enough doctors to go around, you may end up waiting for years before you can get an appointment for surgery if it's not immediately life-threatening (cancer gets fast-tracked, of course). But you can always go private if you get sick of waiting ...

People (in the States, at least) seem to see this as an either/or debate. But there's no reason at all why you can't have public health and private hospitals and private health insurance.

Insurance per se isn't a ponzi scheme.

Health care doesn't work well under an insurance model tho'.

I doubt that the US will ever do the right thing about this however. It's just too much of a vested interest. I mean sure, I can see the dems hammering big pharma (not without cause) but they are never going to touch the insurance industry.

Government is a ponzi scheme. And Obama is not proposing anything "in the middle"

Government is a ponzi scheme. And Obama is not proposing anything "in the middle"

Obama is not proposing a single payer health care system. He is maintaining the current private health insurance industry.

Obama is not proposing a single payer health care system. He is maintaining the current private health insurance industry.
Yeah of course which is a completely free system, not one that is deeply intertwined with the state on both the economic and political levels.

Yeah of course which is a completely free system, not one that is deeply intertwined with the state on both the economic and political levels.

I understand you hate Obama and everything, but if a free market is at one end, and single-payer health care is at the other, then Obama is somewhere in the middle.

I understand you hate Obama and everything, but if a free market is at one end, and single-payer health care is at the other, then Obama is somewhere in the middle.
Its not Obama in particular, you could've named a whole swath of people but chose to name Obama.

I guess the current US gov. is "somewhere in the middle" as in "its not 100% forced totalitarian collectivism"

Its not Obama in particular, you could've named a whole swath of people but chose to name Obama.

I guess the current US gov. is "somewhere in the middle" as in "its not 100% forced totalitarian collectivism"

I can't tell if you're just ranting about the Obama administration or if you're talking about health care here. Do you consider Canada to be totalitarian?

Just cut health care off when people reach 65.

Hm. I'll concur that private health care insurance is a fundamentally flawed concept, in that the company is interested in profiting off of your premiums, and actually paying out money when you get injured is a loss on their books, so they try to avoid giving you money as much as they can, while driving the premiums up as much as they can.

On the other hand, public health care does have one major flaw; waiting lists. Since there are never enough doctors to go around, you may end up waiting for years before you can get an appointment for surgery if it's not immediately life-threatening (cancer gets fast-tracked, of course). But you can always go private if you get sick of waiting ...

People (in the States, at least) seem to see this as an either/or debate. But there's no reason at all why you can't have public health and private hospitals and private health insurance.
Are you under the impression that Americans don't have to wait to get time with doctors? Why, some Americans with things like cancer, die while waiting for their insurers to decide whether to cover their care (or else just wait until they die).

I can't tell if you're just ranting about the Obama administration or if you're talking about health care here. Do you consider Canada to be totalitarian?
Yes, I am talking about health care and not trolling about Obama. Yes I do consider that Canada has got quite a bit of tyranny in it, as almost everyplace does.

Are you under the impression that Americans don't have to wait to get time with doctors?

Comparatively they don't. Especially the insured ones. The insured ones also have far better access to pharmaceuticals. (Though we could argue what benefit that really is).

Health care is always going to be rationed. There just isn't any way that everyone can receive the best available treatment.

So the real question is how is it going to be rationed, and americans really don't want to have a proper debate about that. So the whole thing is stuck in fantasy land.

Personally, I think it is time to suck it up and adopt an NHS style system (warts and all, though with stricter management about hygiene). But it's not going to happen.

Yes, I am talking about health care and not trolling about Obama. Yes I do consider that Canada has got quite a bit of tyranny in it, as almost everyplace does.

As a Canadian, I know I find it tyrannical to know that I can get some of the best medical treatment in the world for free for my children. I'm sorry, I meant to say cost-effective and convenient.

Comparatively they don't. ...

Personally, I think it is time to suck it up and adopt an NHS style system (warts and all, though with stricter management about hygiene). But it's not going to happen.

The Commonwealth fund makes many international comparisons. The USA sits somewhere in the middle in terms of wait times. Germany and New Zealand have the best wait times in the developed world, and both have public healthcare. Linky. (http://www.commonwealthfund.org/Content/Performance-Snapshots/International-Comparisons/International-Comparison--Access---Timeliness.aspx)

In a 2005 survey of sicker patients conducted in six developed countries, the United States ranked last on four measures of continuity of care and access problems reported by patients. The U.S. patients reported relatively longer waiting times for doctor appointments when they were sick, but relatively shorter waiting times to be seen at the emergency department, see a specialist, and have elective surgery.

Comparatively they don't. Especially the insured ones. The insured ones also have far better access to pharmaceuticals. (Though we could argue what benefit that really is).

Health care is always going to be rationed. There just isn't any way that everyone can receive the best available treatment.

So the real question is how is it going to be rationed, and americans really don't want to have a proper debate about that. So the whole thing is stuck in fantasy land.

Personally, I think it is time to suck it up and adopt an NHS style system (warts and all, though with stricter management about hygiene). But it's not going to happen.
I disagree about the ability of people to rely on having insurance to get the care they need, especially when they really need it and it's really expensive and there is no one the insurance company can sue to get the money back. I think the reliability of private insurers depends entirely upon who and what the patient is, what their condition and prognosis are, and a cost/benefit analysis of the insurer. And if that cost/benefit analysis does not break down in their favor, they will try as much as possible to deny coverage -- and screw how much you have been paying in premiums.

However, I completely agree that it is time for Americans to grow the hell up and go for an NHS already. I am a little more positive about NHS itself than you might be, but that might be because I have no problem at all with rationing public health care and giving priority to life-threatening conditions and contagious diseases, and letting people either wait or pay out of pocket for their own elective procedures or not strictly absolutely necessary treatments.

I do agree with Tsaraine that a mix of public and private insurance would probably suit most Americans. Use an NHS to provide a national standard of health care, and allow those who want more to privately purchase additional insurance from private carriers.

As a Canadian, I know I find it tyrannical to know that I can get some of the best medical treatment in the world for free for my children. I'm sorry, I meant to say cost-effective and convenient
I lived in Canada actually, you had a nice time getting free treatment off others work?

The Commonwealth fund makes many international comparisons. The USA sits somewhere in the middle in terms of wait times. Germany and New Zealand have the best wait times in the developed world, and both have public healthcare. Linky. (http://www.commonwealthfund.org/Content/Performance-Snapshots/International-Comparisons/International-Comparison--Access---Timeliness.aspx)

But ... we have terrible waiting times! People have to wait months or years! ... Or do we just not know how lucky we are? *recalls that he was born three months prematurely, and would be dead if not for public health care*

I do agree with Tsaraine that a mix of public and private insurance would probably suit most Americans. Use an NHS to provide a national standard of health care, and allow those who want more to privately purchase additional insurance from private carriers.

Well, the thing is that providing public health care does not automatically mean that private health care can't function; it functions perfectly well as an adjunct. For it to be a binary choice the government would have to actually *outlaw* private health care, which is both stupid and political suicide.

The Commonwealth fund makes many international comparisons. The USA sits somewhere in the middle in terms of wait times. Germany and New Zealand have the best wait times in the developed world, and both have public healthcare.

Probably if you take everybody into consideration that is true. But I bet if you pull it apart it's because there are a large %ge of people with little or no access to primary care. (There are also large parts of the US that a chronically poor, thinly populated, and therefore completely underserved in respect of medical services).

But my point was rather, if, if, you have either the insurance or the money, then in the US there is far better access to specialists, complex surgery, expensive tests and expensive drugs than elsewhere.

I'm not defending it. Just pointing out that someone with decent health insurance in the US probably won't face the same barriers to treatment as a similarly situated person in the UK, for example. It's part of the reason there is still a fair bit of medical tourism to the US.

It goes back to rationing.

Just cut health care off when people reach 65.

i don't know about cutting off entirely, but yeah, ultimately we are going to have to ration care for those who have already lived full lives. unless we somehow figure some other way to make their healthcare costs come down by about 98%...

i don't know about cutting off entirely, but yeah, ultimately we are going to have to ration care for those who have already lived full lives.
Yeah we should start to ration oxygen as well.

I lived in Canada actually, you had a nice time getting free treatment off others work?

Cheap witticisms are no substitute for a rational argument.

Unless you can somehow provide evidence of me not paying taxes, which would be impossible due to the GST, you cannot claim that it was 'free' for me in comparison to others.

And yes, I did enjoy that I did not have to pay anything beyond my taxes.

Probably if you take everybody into consideration that is true. But I bet if you pull it apart it's because there are a large %ge of people with little or no access to primary care. (There are also large parts of the US that a chronically poor, thinly populated, and therefore completely underserved in respect of medical services).

But my point was rather, if, if, you have either the insurance or the money, then in the US there is far better access to specialists, complex surgery, expensive tests and expensive drugs than elsewhere.

I'm not defending it. Just pointing out that someone with decent health insurance in the US probably won't face the same barriers to treatment as a similarly situated person in the UK, for example. It's part of the reason there is still a fair bit of medical tourism to the US.

It goes back to rationing.

Actually, the study loks at access and timeliness separately. So the percentage of those who have no access to primary care has already been pulled out, as you say. By the way. The USA ranks worst among developed nations in terms of access to healthcare. See the same link from my previous post.

I lived in Canada actually, you had a nice time getting free treatment off others work?

I don't know about you, but I very much enjoy using free roads, free police protection, and free military.

I don't know about you, but I very much enjoy using free roads, free police protection, and free military.
I sure enjoy the free transportation network to move around repressive forces, the free information network and the free state-ordered elements of repression that all of society has been forced to pay.

Taxes are really sweet when they're paying for death flights aren't they?

Unless you can somehow provide evidence of me not paying taxes, which would be impossible due to the GST, you cannot claim that it was 'free' for me in comparison to others.
You can dodge GST, of course you can work, don't strike me as the type. Maybe I should've said something along the lines of advocating stealing and forceful seizure.

I sure enjoy the free transportation network to move around repressive forces, the free information network and the free state-ordered elements of repression that all of society has been forced to pay.

Taxes are really sweet when they're paying for death flights aren't they?


You can dodge GST, of course you can work, don't strike me as the type. Maybe I should've said something along the lines of advocating stealing and forceful seizure.

Other than rhetoric, do you have anything to add to the debate?

I disagree about the ability of people to rely on having insurance to get the care they need, especially when they really need it and it's really expensive and there is no one the insurance company can sue to get the money back. I think the reliability of private insurers depends entirely upon who and what the patient is, what their condition and prognosis are, and a cost/benefit analysis of the insurer. And if that cost/benefit analysis does not break down in their favor, they will try as much as possible to deny coverage -- and screw how much you have been paying in premiums.

I'm not going to deny that sort of thing happens. But I think if you look at the availability of things like heart bypasses and hip replacements (routine, yet expensive specialist type things) the insured american does better than counterparts in other countries.

The other aspect is that at the end of the day insurance companies don't care how much stuff really costs. In fact it's actually to their benefit that medical costs increase ahead of the rate of inflation because they take their skim off the top, so as long as they can keep chipping the premiums up, they don't have any incentive to control spending. Which is why HMOs (where the insurance company had more say in treatment) have been complete failures in that regard.

It's a bit of a moot point, since in most regards the US system is such a failure it is actually threatening the economy in many respects.

However, I completely agree that it is time for Americans to grow the hell up and go for an NHS already. I am a little more positive about NHitself than you might be, but that might be because I have no problem at all with rationing public health care and giving priority to life-threatening conditions and contagious diseases, and letting people either wait or pay out of pocket for their own elective procedures or not strictly absolutely necessary treatments.

Well, I have elderly relatives in the UK, so I see a lot more of the NHS than most americans. Though I do agree that the US spends far too much on people who only have six months to live, and far too little on things like pre-and post natal care &c. which could yield real benefits.

I do agree with Tsaraine that a mix of public and private insurance would probably suit most Americans. Use an NHS to provide a national standard of health care, and allow those who want more to privately purchase additional insurance from private carriers.

I wouldn't ban private insurance. I'd just take away the tax benefit. People would be free to use it instead of a national system if they wanted though.

Other than rhetoric, do you have anything to add to the debate?
Ah, the art of persuasion. I'd say thats essential to a debate would you not?

Yeah we should start to ration oxygen as well.

no need in our present circumstances, though it is clearly imaginable that in certain circumstances we would have to.

no need in our present circumstances, though it is clearly imaginable that in certain circumstances we would have to.
you have bested me nsg

;__;

<snip>

It's a bit of a moot point, since in most regards the US system is such a failure it is actually threatening the economy in many respects.

<snip>
We can quibble about details and what we should do in the future forever, but on this we agree completely, and this, I think, is the heart of the matter. When Americans lose sight of this -- of the obvious and demonstrable failure of our current system -- we get lost in a maze of arguments over tactics and (worst of all) ideologies.

Actually, the study loks at access and timeliness separately. So the percentage of those who have no access to primary care has already been pulled out, as you say. By the way. The USA ranks worst among developed nations in terms of access to healthcare. See the same link from my previous post.

I don't disagree that healthcare access is terrible. All I am saying is that if you have the money i.e. you are in the top 20%, you have better access to care than anywhere else. I don't think that's a particularly controversial viewpoint.

I lived in Canada actually, you had a nice time getting free treatment off others work?

In most countries people enjoy the free enforcenment of property rights odd others work.

When Americans lose sight of this -- of the obvious and demonstrable failure of our current system -- we get lost in a maze of arguments over tactics and (worst of all) ideologies.

I think it's the lack of easy answers (for both sides). Nobody wants to confront reality.

Also, it's good cover for the entrenched interest who have a big interest in maintaining the status quo.

Ah, the art of persuasion. I'd say thats essential to a debate would you not?

Not really. Especially if you're only using it in place of actual arguments.

Tell me, do you have any historical examples of completely private healthcare systems offering a large population a level of service equivalent to the current healthcare system in Canada?

But ... we have terrible waiting times! People have to wait months or years! ... Or do we just not know how lucky we are? *recalls that he was born three months prematurely, and would be dead if not for public health care*

Regardless if your parents had insurance birth is taken care of in US hospitals regardless if one can pay or not. By the way I was born early too and I think it makes me tough. :tongue:

Well, the thing is that providing public health care does not automatically mean that private health care can't function; it functions perfectly well as an adjunct. For it to be a binary choice the government would have to actually *outlaw* private health care, which is both stupid and political suicide.

Private health care works in the UK. I know we had a choice for the co I worked at in the UK of taking the private or taking public with a bit more pay. I took the public however really never needed major things done while living there for a year and a half.

Comparatively they don't. Especially the insured ones. The insured ones also have far better access to pharmaceuticals. (Though we could argue what benefit that really is).

Health care is always going to be rationed. There just isn't any way that everyone can receive the best available treatment.

So the real question is how is it going to be rationed, and americans really don't want to have a proper debate about that. So the whole thing is stuck in fantasy land.

Personally, I think it is time to suck it up and adopt an NHS style system (warts and all, though with stricter management about hygiene). But it's not going to happen.


I agree with the rationing bit. People just don't realize it. As for our current system I do think without major changes it will collapse under massive costs. I think it will start with one or more major providers going under.

Not really. Especially if you're only using it in place of actual arguments.
But what is argument?


Tell me, do you have any historical examples of completely private healthcare systems offering a large population a level of service equivalent to the current healthcare system in Canada?
Yes, (http://mises.org/freemarket_detail.aspx?control=279) I do. (http://mises.org/story/1239) Does this count as an argument? Or is there not enough stealing involved.

But what is argument?


Yes, (http://mises.org/freemarket_detail.aspx?control=279) I do. (http://mises.org/story/1239) Does this count as an argument? Or is there not enough stealing involved.

Neither of those are historical examples of free market health care systems. By historical example, I mean an example of a free market healthcare system actually working at sometime in human history.

Though the second link does allude to the fact that the free market has really no idea how to put togther a viable healthcare system.

The weakness in many free market arguments is that the folly of government intervention is ably pointed out, but the solution to the problem is always less detailed. Then free-market advocates are accused of just doing nothing. But we don't really know what might evolve when markets are free to operate unfettered.

Neither of those are historical examples of free market health care systems. By historical example, I mean an example of a free market healthcare system actually working at sometime in human history.
Yeah I guess that no doctors or medicine existed before Marx wrote the communist manifesto right?

Out of curiosity have you ever read Mafalda?

Yeah I guess that no doctors or medicine existed before Marx wrote the communist manifesto right?

Out of curiosity have you ever read Mafalda?

I am not discussing Marxism. Please do not try to change the subject.

I am going to assume that you concede the fact that the free market has never provided a level of care equivalent to current public healthcare systems.

Let me guess, you identify with Manolito.

I am going to assume that you concede the fact that the free market has never provided a level of care equivalent to current public healthcare systems.

Let me guess, you identify with Manolito.
Manolito was a genius. I assume you identify with the crazy screaming V.C. and the US Marine characters at the same time.

I'm not conceding anything, a free market would provide better care. You would do well to note (and I'm actually going to flatter your desire and point to some evidence) that private charity or religious charity (oh no the church!) are the best some people can get in a lot of places, most of these are places run by centralist governments. Of course the examples of centralists that prohibit even this kind of free aid are limitless.

I'll just remember all the time I've heard of or seen people wait incredible times in the Canadian healthcare (even emergency rooms) with my own eyes, or lack of doctors, or whatever else you want.

I'm not conceding anything, a free market would provide better care.

You have yet to provide anything to support this claim except the vaguest theoretical evidence. If you want theoretical economic rationales for why the free market can not adequately provide a decent level of healthcare, you can go here:

http://www.oheschools.org/

It's meant for those with some understanding of economics, but even beginners should be able to understand after looking over the first few pages.

You would do well to note (and I'm actually going to flatter your desire and point to some evidence) that private charity or religious charity (oh no the church!) are the best some people can get in a lot of places, most of these are places run by centralist governments.

Please provide evidence that this is so.

Of course the examples of centralists that prohibit even this kind of free aid are limitless.

Then it should be easy to find an example as evidence.

I'll just remember all the time I've heard of or seen people wait incredible times in the Canadian healthcare (even emergency rooms) with my own eyes, or lack of doctors, or whatever else you want.

Anecdotal evidence is not considered very strong evidence. If you want to seriously compare wait times, I suggest looking at international comparisons by respected institutions. I linked to one above. You wil find that the wait times in Canada, bad as they are, are not much worse than in the US.

You would do well to note (and I'm actually going to flatter your desire and point to some evidence) that private charity or religious charity (oh no the church!) are the best some people can get in a lot of places, most of these are places run by centralist governments.

Please provide sources to said charities in nations with publically funded healthcare systems that do not receive any public funds.

Now, while I certainly feel the US healthcare system is drastically flawed and badly overpriced, especially given the comparative level of health in the United States (even when other countries have "lifestyle factors" that are as prevalent or even "worse" than us), the insurance industry is not a Ponzi scheme. They earn revenue and incur expenses...that's the fundamental structure of any business model.

Ponzi scheme - eh? Well then I am getting pretty hozed. I spend $5000/year to cover my family and so far we are averaging about $600/year in claims - so I am spending $5000 for $600 benefit..... Not exactly an investment.

However if you consider that I also enjoy the peace of mind knowing that if I had a major claim I would be covered then you have another subject completely....

If you want to compare it to a Ponzi scheme you should consider whole life insurance - since it is certain that eventually every policy owner will die - and the benefit will be larger than the premiums paid in all cases. It would be an invalid comparison - but still closer than your attempt with health insurance.

Now, while I certainly feel the US healthcare system is drastically flawed and badly overpriced, especially given the comparative level of health in the United States (even when other countries have "lifestyle factors" that are as prevalent or even "worse" than us), the insurance industry is not a Ponzi scheme. They earn revenue and incur expenses...that's the fundamental structure of any business model.

Here is one major reason why;
http://www.cbsnews.com/stories/2009/04/02/eveningnews/main4915011.shtml?source=RSSattr=Health_4915011
9 Patients Made Over 2,600 Hospital Visits
"...And since the overusers can't pay for their care, emergency care costs more for all of us. "


IMHO part of the reason we have many social problems (homelessness, medical abuse, drug abuse, crime, ugly babies, etc.) can be traced to the cuts in mental heath which led to people who should be institutionalized and/or receiving treatment being cast out into society. We've saved a few million on mental health costs and ended up spending ten times more in other expenses...

I think it's the lack of easy answers (for both sides). Nobody wants to confront reality.

Also, it's good cover for the entrenched interest who have a big interest in maintaining the status quo.
My inner cynic (who is even more cynical than my outer cynic) is betting that your second sentence is the big clue about why it's so hard to get Americans to face the truth. Liver pills and snake oil will pay for a lot of propaganda.

Now, while I certainly feel the US healthcare system is drastically flawed and badly overpriced, especially given the comparative level of health in the United States (even when other countries have "lifestyle factors" that are as prevalent or even "worse" than us), the insurance industry is not a Ponzi scheme. They earn revenue and incur expenses...that's the fundamental structure of any business model.

It's also the fundamental structure of any ponzi scheme. In any ponzi scheme, you take in money from new participants to pay money to the old ones. Health insurance companies do EXACTLY this, but they invest that money in the interim to generate a profit. As long as your investments are generating that profit, everybody is happy. The executives say, "See, we're freaking geniuses making all this money," but when they make bad investments and lose money, they say, "Oh, that's not my fault, it's the MARKETS fault. I can't possibly be held accountable for screwing up, in fact, I have no responsibilities whatsoever!"

Insurance companies are supposed to transfer risk away from individuals, but what good does that do when you just end up gambling with that money a few days later? There will always be risk in the markets, there's no way to make it disappear.

Here is one major reason why;
http://www.cbsnews.com/stories/2009/04/02/eveningnews/main4915011.shtml?source=RSSattr=Health_4915011
9 Patients Made Over 2,600 Hospital Visits
"...And since the overusers can't pay for their care, emergency care costs more for all of us."

i'd rank that rather low on the source of our troubles. the real problem is the rate of increase of healthcare costs, and that has to do mainly with the way we care for the elderly. a couple overusers are a drain, but are going to ultimately be a fixed sort of cost - the number of them should be fairly constant as a portion of population and dealing with them just takes time rather than increasingly expensive procedures.

Psh, youre talking to a Katrina survivor...I hope all Insurance companies Rot in Hell, and State Farm in particular is chewed by Satan himself...