Do You Support Commoditizing of Insurance And Forcing Americans to Pay For It?

Following the Reagan vision, The Clintons commoditized:

* "Energy markets"(Enron)

* Investment Banking (hedge funds; allowing banks to purchase FIRE cos.)

* Postal Service (privatization of the USPS)

* Telecommunications (marketization of ownership, bandwidth, public media)

* "Health Care markets" (HMOs; privatization of Blue Cross Blue Shield)

None of the leading Dem candidates wants these "advances" reversed.

They see them as positive legacies of the Clinton era that we must
actually safeguard from "wackos" on the left and right who wish
the government to stop subsidizing "managed competition" --
what used to be called mercantilism or cartel economies.

Do DUers support the leading Democratic candidates' common vision?

Yes everyone has to pay in. The costs have to be spread out between sick and healthy or the sick cannot afford treatment.

You need to grow up.

Apparently you think the uninsured 15% are more likely to get sick
and are a burden on society, driving up premiums.

What you fail to understand (paraphrasing Kunstler, it is
a "restricted viewpoint fallacy" -- you can't imagine life
without it) is that hugely expensive, unprecedented in the
history of the world, reliance on specialty care, and
insistence on the right to specialty care for all insured
Americans who can AFFORD the deductables, drives up the
cost for all Americans. You don't want to believe this
because you think the American upper-middle class lifestyle
is "non-negotiable". Wealthy hospitals survive on
bequest money, not because they serve less poor people.
Rich people are far more expensive to care for than poor
people under the present system.

You want to tax Americans and then ask them to choose among
a list of private, commoditized, marketized insurance
organizations which will recieve your automatic, guaranteed
payment under the universally understood economics of
demand inelasticity and cartel economics, as per the subject
and title of the OP?

universal healthcare that provides quality medical care for their citizens from birth to death, that is affordable, that provides a higher quality of service as measured by all standard measures of population health, and, more importantly, that healthcare is not a commodity it is a public good that needs to be paid for and organized through non-market institutions.

No I don't want to tax americans and then ask them to choiose among a list of private for profit insurance plans - that is my least favorite form of universal coverage. I prefer expanding medicare to everyone and paying for it through the payroll tax. As a second best I prefer Edward's plan which puts a public plan in competition with private health insurance plans.

Several of the European social democracies actually have a mix of public private plans, and they seem to be working out quite well.

that everyone should pay in. However a payroll tax mandatory system is about as a regressive tax system as can be engineered. The guy making $25,000 in wages is going to pay a much higher % of his income for mandatory health care than 6 figure salesman or manager. To get everyone to pay, the system has to be set up to collect medical taxes proportional to any and all source of income. Since everyone has to pay in, how do those that have no income suppose to pay their share?

any part of "the common", from roads to regulating food safety.

And your history lesson is lacking "truth" -

for example - just when did the Clinton's force HMO's on us?

Clearly you are not up on the concepts.

Commoditization, in and of itself, is a libertarian strategy.

Forcing people to purchase a commoditized (i.e. privately managed)
resource is fascism.

I could be completely off about the intent of the OP, but it seems to me that the OP's bias runs toward walling off about 45 million uninsured and another 35 million or so under-insured so they can’t over-stress the current supply of docs and medical facilities.

If those 80 million suddenly have access to quality medical care – which is to say, if they can finally get that weird lump looked at by a specialist, or have that painful scratched cornea treated, or get that CAT scan or blood test or MRI or tox screen or any of the other standard medical procedures that well-insured elitists take for granted while 80 million Americans go without – if that happens, they’ll quickly overwhelm existing medical resources and force some people to wait longer than they're used to.

So the answer -- rather than moving to a single-payer, universal-coverage model in which everybody's in, nobody's out, nobody has to worry about pre-existing conditions, there are no restrictions on seeing "in-plan or out-of-plan" doctors, there are no bills, copays, negotiated settlements, deductibles and all that other insane crap that curses the US with the most expensive health care system in the world per capita ($7,400 in 2006) while not even making the top 30 in overall effectiveness or quality of care...

And the answer is more goddamn insurance?

Hardly.

On the other hand, I may have misunderstood the OP, in which case I shouldn't be posting without the proper amount of caffeine.

wp

Thereby "solving the problem" of "deadbeats."

No scarequotes needed, actually. According to Edwards,

"Families without insurance will be enrolled in Medicare, Medicaid, SCHIP or another targeted plan or (else) be assigned a plan within new Health Care Markets.

Families who lose coverage will be expected to enroll in another plan or be assigned one. For the few people who refuse to pay, the government will help collect back premiums with interest and collection costs by using tools like the ones it uses for student loans and taxes, including collection agencies and wage garnishment.

"The government will help collect back premiums with interest and collection costs..."

So the feds now want to be in the shylock biz? They're going to act as a collection agency for private insurers? Jesus Christ! How much more fucked up can this place get?

I realize that none of the corporate candidates has any intention whatsoever of kicking the for-profit vampires out of the mix, but you've got to be a little twisted to volunteer to do debt collection work for them.

Then again, the numbers don't lie. According to campaign finance figures submitted to the Federal Elections Commission and reported by Opensecrets.org, through the first nine months of 2007 Hillary Clinton leads all presidential candidates, Democrats and Republicans, in money accepted from the insurance industry ($2.675M). She also leads the pack in money accepted from hospitals and nursing homes ($375K); from HMOs ($247K); from pharmaceutical companies ($274K); and from medical industry lobbyists ($570K). Obama is either second or third on most of those lists.

This kind of crap absolutely floors me, and it reinforces my opinion that we live in a country dominated by compliant, unquestioning, ill-informed, politically illiterate chowder heads content to consume their quotas of goods, services and ideologies with an equally uncritical eye.

Look what the French do whenever some pipsqueak like Sarkozy threatens the social safety net: general strikes, riots in the streets, no backing down, no negotiations, the union way or the highway. And look at the results: The finest health care system in the world according to the World Health Organization; shorter work weeks with no loss of wages or benefits (although Sarkozy's fucking with that these days); five weeks vacation per year mandated BY LAW... That's how you deal with corporatists looking to bump their stock price by squeezing their workforce.

And here... well, just give an American a car that starts and stops, a job with the illusion of upward mobility (but without the reality), an affordable mortgage, 1.8 blonde moppets and a despised group to shit on, and he'll be your boy ever after.

No benefits? One week vacation? Unpaid overtime? Obscene commutes? No problem. He'll take anything the massuhs dish out as long as there's some Miller Lite in the fridge and a fresh bag of Doritos waiting on the counter.

Hopeless.


wp

This, plus the opposition to public housing by half of DU, causes me
to realize that the political change (not just this or that candidate
but the political ideal),

which at least half of all DUers and a majority of voting Democrats are fighting for,

marketization, commoditization, managed competition, deprivation of
civil rights (including the implied right to freedom of contract
under Anglo-Saxon law) and replacement with consumer entitlements,

is fundamentally opposed to my beliefs,

and to the beliefs of all civil libertarians.

This includes many of those on the so-called "anti-corporate left",
already marginalized alongside us here on DU, who share nothing in
common with us civil libertarians (some of whom are also anti-corporate
but we share nothing else in common).

They support marketization, commoditization and market libertarianism so long as their favored (Dem friendly) corporations benefit.

They support privatization of public housing, mandatory ID checks, and
turning the citizen into a "consumer" of government mandated privately
owned commodities ranging from "smart roads" to health insurance.
They support the Kelo case.

If this is what most DUers believe (that marketization and mandatory purchases of commoditized goods -- the sort of thing we fought a Revolution to escape), then perhaps I don't belong here on DU or in the Democratic party??

(falsely or truthfully) with "blue state liberalism"
of the elitist, nanny state, "let them buy insurance"
variety.

The bad news is they have no political alternative
to corporate fascism.

The right-libertarians don't want to solve anyones'
problems and believe in corporate citizenship rights
(i.e. corporations have more rights than people).

The left-libertarians don't vote.

The Reaganites have corrupted populism into a racist,
false consciousness philosophy of fundamentalist
religion-infused promotion of greed and Horatio Alger lies.

The leading democratic candidates and big-gov't Wall Street
fascists have adopted National Socialism. If elected, they
have absolutely no intention of abandoning:

commoditized health insurance

mandated purchase of commodities

mandated national id cards (credit cards acceptable)

mandated credit rating evaluation to live in public housing

marketization of roads, transit construction,
public housing, energy, toll tracking and security systems, etc.

I am sick of paying for something and getting nothing in return.I am forced to buy liability insurance for my vehicles.I have never costed them one thin dime in 34 years no speeding ticket in 32 years yet my rates go up every year!If we are forced to buy health insurance the same thing will happen.Peoples health can not be for proffit.Ever been ripped off by crooked mechanic or car salesman?Doctors are just as bad if not worse.

how's it workin' for ya?

The problem is now insurance companies are legally allowed, and required by shareholders in the interests of showing a profit, to whittle down the pool of insured people to whom they respond. Remember the primary way a corporation achieves a profit is through managing and minimizing risk. Sick people are a drain, therefore a risk, to the insurance company. So they make a point to let go of those clients or forestall payment for as long as possible.

No job? No problem, you're out of the system totally and insurance companies need not worry their pretty little heads about you.

Chronic condition that requires maintenance meds and follow up care for life? They fix that be capping lifetime benefits that you will use up in about five years' time, so again they don't have a pesky unlimited payout to worry about down the line when they know they have to report a profit THIS quarter.

Pre-existing condition that the insurance company openly says they have no responsibility to cover the cost of treatment? Again, they are lucky and SAVE MONEY --to their way of thinking -- because you are out of the picture totally.

Don't you get it? Anyone who needs treatment doesn't get it under this system because it means the insurance company loses money. It's in the insurance company's best interest to get rid of sick people and attract healthy, premium paying people whom the insurance company bets will never actually have to make the insurance company pay for anything.

The only thing that will work is if all Americans, both sick and well, are in the same risk pool. That will bring down costs because the will be spread over a much larger pool of people.

Universal, nonprofit healthcare now!

What it was supposed to be was insurance companies competing on price and services, driving prices down to what people are willing to pay.

Then we had a few things added that poisoned the mix - actions against adverse selection, and demand inelasticity.

When I talk about actions against adverse selection, it started off mundanely enough - charging smokers higher premiums and such. Now, if you have any sort of medical condition that might cost them money, they'll jack your premiums sky-high, assuming you aren't denied coverage altogether. We can also throw in the notorious murder-by-spreadsheet tactics as seen with Nataline Sarkisyan. If they can't keep the expensive cases off the rolls entirely, they can jerk them around, delay, deny, deceive, in hopes that a cheaper solution (aka death) emerges.

With demand elasticity, we throw a monkey-wrench in the normal supply-demand curve dynamic that ensures that when prices are too high, demand falls. No. It's inelastic demand, meaning people will want roughly the same amount of health care whether it's cheap or expensive. That means health care providers and insurers will charge high prices, because they can.

My prescription:

Ideally, single-payer tax-funded health care for every human being on U.S. soil. Start with Kucinich's bill to expand Medicare. It's the most humane, and makes the most economic sense.

The problem is that with all the asshats in DC, pushing that through is nearly impossible.

So then we go for mandatory insurance schemes, like Hillary Clinton proposes.

We may be stuck living with that, but that doesn't mean we can't demand a price for allowing the insurance companies to remain in business.

That price is heavy, heavy regulation and extensive financial aid for those who can't afford to pay for insurance.

Since everyone will be required to be insured, we've solved the adverse selection problem. So now we can demand regulations that insurance companies charge the same premiums to all comers, sick and healthy, meaning the transplant patient pays exactly the same as the healthy 25-year-old. We can demand regulations that state insurance companies are prohibited from turning anyone away for medical reasons - if the guy in the wheelchair with cerebral palsy, needing a million dollars of surgery comes in and wants insurance and has the money to pay the premium, the insurer's required to take him and fork over the money for his bills. Regulation should be put in place mandating a minimum level of coverage, which should consist of every medical treatment the doctor orders, barring only a few things like cosmetic surgery (that isn't reconstructive surgery to repair disfiguring injuries & such.)

While we're at it, take the power away from the HMOs. No more preapprovals allowed - only the doctors treating and the patient receiving treatment (or his proxies such as family members if he can't make the decisions himself) get to choose the treatments. The insurers do not get a voice. Doctor and patient make decisions on treatment, the insurers are stuck with the bill, and if they don't like it, they can suck it.

And yes, extensive financial aid for those who can't afford it. Start by reducing the number of people who can't afford it by requiring all employers, no exceptions, to provide health insurance for their employees. Doesn't matter if they're McJobs for minimum wage, doesn't matter if they're part timers only doing 15 hours a week. If you're employed, you get insurance. If you're unemployed and collecting unemployment, Social Security or don't have means to support yourself, you get Medicare. In other words close the economic chasms that prevent millions of people from getting decent medical care.

I think requiring all employers to provide medical coverage is a bad move for two reasons. First, unless premiums went straight through the floor, many small businesses couldn't afford to provide coverage and stay in business. And I'm not talking about the archetypal chiseling bastard gouging workers in his illegal sweatshop for every cent he can steal from them. I'm talking about decent people trying to stay solvent in a particularly hostile small business climate. Lots of them just can't cover medical insurance premiums -- some not even for themselves or their families.

Second, I reject the linkage between medical care and employment. It's a false construct; the two have nothing whatsoever to do with one another, but as long as we continue to perpetuate the lie that they're connected, we'll never get to single-payer. That's because the majority of people will associate medical benefits with work and -- as is the case whenever an industry wants the people to do its PR work for it -- people won't blame this fundamentally insane system. Instead, they'll blame themselves for not having a good enough job to get cadillac coverage and having to settle for minimal baseline coverage instead.

Other than that, though, you've got some great suggestions. Again, single-payer universal access is the only system that doesn't force us to bet against our own mortality. But I'm fairly certain that this country won't make it to single-payer until every single citizen has his or her own magical managed care moment -- murder by actuaries; denial of coverage; failure to pay even after a negotiated agreement beforehand; premiums climbing into the stratosphere (and they've only hit the troposphere so far); deductibles, copays and drug costs continuing to soar; and on and on and on into unregulated capitalist nirvana.

I really thought "Sicko" would push people over the edge but, as usual, they mostly just pissed and moaned and bitched and whined and sniveled and then forgot all about organizing and protesting and lobbying and volunteering for the right candidates and all the other activist stuff that's been almost completely replaced by a nervous passivity in this country. A nation of narcotized suet-brains who are so adept at shooting themselves in the foot at election time that it's amazing anyone can still walk without assistance.

And that's why one of the corporate-approved suck-ups will probably be the next president, and progressives can go back into hibernation for a couple of years because absolutely nothing that threatens the status quo will be addressed by a Clinton or Obama administration.


wp

You and Leopolds Ghost are right - mandatory insurance, and the other "reforms" proposed by the corporatists are not an ideal solution. I'm just trying to think of ways to make the inevitable compromise solution more palatable and capable of helping more people get affordable health care.

The ideal solution is tax-funded single-payer health care. If we can get enough the self-centered asshats in the Beltway to push this through, I'm all for it. Maybe going halfway will build up enough momentum to carry us the rest of the way.

* Forcing the citizenry to buy "any old insurance" will not keep one
insurance provider from attempting to capture the best customers by
driving up the price beyond the reach of subsidies (which will
quickly be either oversubscribed or limited by red tape in order
to prevent "everyone potentially eligible" from "relying on
government handouts.")

* Forcing the citizenry to buy bread drives the price of bread up.

Just as the pool of unemployed keeps inflation (i.e. wages) below
the cost of living increase, so the cost of insurance is "kept down"
by the pool of uninsured who remain potential clients (many of
whom are simply underemployed and so the problem is one and the
same and targeted subsidies that you have to jump hoops for don't help.)

So the demand inelasticity is made worse if you artificially require
poor people to be insured (without demanding that the insurers
issue blanket policies to all uninsured poor people, which would
be the converse and equally extreme and unlikely to succeed
policy position.)

Once the whole market has been saturated by Starbucks, competition
has been eliminated because people have noplace else to go, so they
jack their prices up.

Insurance companies are a cartel -- driven by adjustment formulae --
they have no incentive to engage in price wars when the market
is literally a captive market. They will form bigger cartels instead.

* If we mandated full employment by requiring everyone to have a job
and fining those that didn't have (a) a job or (b) enrolled in a
targeted, post Clinton style unemployment program, what would happen?

If you forced employers to hire more workers it drives the price of labor up because it is an employer mandate. If you force "vagrants"
to get a job or end up in debtors prison it crashes wages because it
is an individual mandate. It's like night and day.

One is supply side and the other is demand side.

* Besides which, we fought a revolution to escape mercantilism -- where
individuals were mandated to do business with a list of global elite
corporations chartered by the Empire.

Is for universalization of Medicare, as a readily available frame-work for a 'single payer' system. The destruction of the present health insurance industry strikes me as just one excellent side-benefit of such a course....

The issue of the OP is that demand-side partially-unfunded mandates, coupled with commoditization of the resource, are like privatizing water by setting up for-profit "competitive water markets" and changing the law so that,

instead of requiring a single water co. to provide water to all habitable homes,

we instead require every citizen to purchase water from one or another "commoditized, deregulated" water provider (using the old government-funded common pipes, of course.)

Forcing the service provider to provide a service is supply-side --

it drives down the cost of the service because a dwindling pool of uninsured can be fought over.

Forcing the citizens to buy a service from a range of providers is
not only immoral (if this law passes I fully expect to see a "universal
cable" law requiring all citizens to purchase pay TV -- they've already
started down this road) --

it drives up the cost of the service for ALL because a dwindling
pool of non-customers AND the existing customers must fight
to keep their insurance, ANY insurance, or be punished by the gov't!

When it comes to something like driver's insurance, mandates like this are not too out of line, mostly because it is to ensure one can meet responsibilities to someone else.

Health care simply does not meet market models. Demand is out of the control of the 'consumer', and in emergencies not even, properly speaking, something the consumer decides on. If you want a good laugh, aks the paramedics in the ambulance responding to your heart-attack or broken bone which hospital will charge you least, and ask to be taken to the cheapest: they will continue driving to the nearest....

:applause:

Most folks have no idea how the insurance companies "game" the markets. It's downright incestuous.

Insurance supposedly works like an honest bookie does, by pooling the premiums and paying out when the bet is lost, calculating the odds of the thing so that the amounts paid out run a bit below the amounts collected. In fact, insurance companies use the premium pool to play various financial markets, using the extra income for purposes from competition through temporarily lowering rates below the actuarial proprieties to pressure a competitor, to simply padding the balance sheet to bring a gleam to the shareholder's eye, and a hefty bonus to the C.E.O.'s bank account. When financial markets go down rather than up, insurance companies tend to get caught in a crunch, and begin squawking about lawsuit abuse to cover their tracks as they raise premiums on their customers, or cancel coverage, to make up for the reduction in investment income.

When was the last time you heard the "insurance lobby" arguing for reduced reserve requirements? :evilgrin:

In the Reagan/Bush/c/Bush rush of the lemmings toward "deregulation," not only have the various components of the 'Financial' sector had the firewalls removed - retail banking + investment banking + insurance + brokerages - but the regulations regarding the level of reserves and the kinds of equities and instruments in which those reserves are held are neither scrutinized NOR candidly reported. (Try ferreting out the accounting for reserves some time. It's damned near impossible.)


:hi:

its already there, has good cost and quality controls in place, must adhere to the laws and regulations, can't discriminate against people based on pre existing conditions, etc.

Like Edwards suggests, make everyone buy into Medicare and if they can't afford it, let them have it for free.

Bottom line, though, universal health care can't succeed unless everyone participates.

It seems likely to me our views will tend to converge as we get closer to home, so to speak....