WSJ: Ten GOP Health Ideas for Obama

[ElNono]

How do you know?

I speak from personal experience.

I spend most of my time in 2 countries with single-payer systems and I don't find being insured irrelevant. Quite the opposite.

As far as access to care?
Do the uninsured lack access to care (not just merely emergency care, but overall care)?
I'd like to know what those countries are, and exactly what do you mean.

I actually lived most of my life in a country with a mixed system, but also lived considerable time on a country with single-payer system. My sister also lived in Canada for 5 years, including having children over there.

Again, she was answering to those who claim that people are dying because of lack of insurance. The article shows those type of claims aren't sustained by empirical evidence.

I believe nobody was making that claim here. I guess it was some sort of preemptive claim?

[mogrovejo]

I speak from personal experience.

That's odd. How have you experienced a single-payer socialized health-care system in America?

As far as access to care?
Do the uninsured lack access to care (not just merely emergency care, but overall care)?
I'd like to know what those countries are, and exactly what do you mean.

Yes, including access. I've recently written here about my experience of needing a consultation to the dentist and being told I'd need to wait 6 months for one. This isn't unusual.

Portugal&Spain. But I've also lived in Italy and France and things are basically equal.

You seem to believe that "universal coverage" systems can provide equal access to everybody. Maybe in theory, but not in practice - there's always rationing. Waiting lists or limitation of drugs subsidized are de fact limitations to access - because most people can't buy private insurance. Even out-of-pocket charges can be a limitation. Plus, unlike private insurers, organizations like Assurance Maladie can (and do) run on gigantic deficits for decades. But as the French are starting to find out, one day the party has to terminate. Even in the US I'd expect to see Medicare users to have increasing difficulties to get consultations in the near future.

I believe nobody was making that claim here.

So? I never made that claim, quit the strawman arguments. I thought the article was interesting enough to worth a mention.

[ElNono]

That's odd. How have you experienced a single-payer socialized health-care system in America?

No. I was speaking outside of America, obviously.

Yes, including access. I've recently written here about my experience of needing a consultation to the dentist and being told I'd need to wait 6 months for one. This isn't unusual.

That's indeed very unusual. I actually visit the dentist every time I go back home to visit. Just call in two days in advance. Longer waiting times are normally on things like transplants, or high-end care.

Portugal&Spain. But I've also lived in Italy and France and things are basically equal.

Both in Italy and France (I'm an Italian citizen and I lived in Paris also) the system is mixed. You can opt to use the public service or pay for a private insurance and get treatment in private clinics or hospitals.

You seem to believe that "universal coverage" systems can provide equal access to everybody. Maybe in theory, but not in practice - there's always rationing. Waiting lists or limitation of drugs subsidized are de fact limitations to access - because most people can't buy private insurance. Even out-of-pocket charges can be a limitation. Plus, unlike private insurers, organizations like Assurance Maladie can (and do) run on gigantic deficits for decades. But as the French are starting to find out, one day the party has to terminate. Even in the US I'd expect to see Medicare users to have increasing difficulties to get consultations in the near future.

Rationing is exactly the reason I support a mixed system. Rationing exists in the US right now too. Any doctor you call right now will schedule you two months in the future.

All those countries you mention have an emergency system just like the US in case somebody shows up with chest pains and what not.
For non-emergency care, they can all get access to a doctor *FOR FREE* if they're willing to wait for whatever the wait time is. If you want a faster service and can afford it, then you can go with a private insurance which will be no different than what you have here in the US. The private insurance sector in both France and Italy are doing quite well.

But the reality is that people that can't afford private insurance can still go to a hospital with a broken foot, get treated, and don't receive a $5000 bill they can't pay or bankrupts them. People with chronic conditions can go and actually get care without receiving a bill back or without having to wait for an emergency from their unattended chronic condition.

As far as sustainability, well, the Brits started their system right after World War II, when the country was just coming out of that war... tough time to roll out a universal care system. But it's still there 60+ years later. I'd say history is not on your side on that.

Furthermore, I think the US doesn't necessarily needs to copy any of those systems. Just take the best from each, and tailor and improve it for americans. There's no reason the US can't have the best system of them all. We certainly are the most resourceful nation. I think we could do it if there was the political will.

So? I never made that claim, quit the strawman arguments. I thought the article was interesting enough to worth a mention.

Actually, you asked three questions and proceeded to post the article. I have to assume you were talking to yourself, again.

[Marcus Bryant]

To bring everyone up to speed: http://www.theatlantic.com/doc/200909/health-care

[TeyshaBlue]

You know, it just seems self-evident that increased compe ion would lower prices. I completely understand that. Unfortunately, my electricity bill dissagrees.

Why so?

The effects of deregulation of the electricity market in Texas have been, well, not good. Pricing certainly hasn't seemed to improve much with the extra "compe ion".

It just doesn't follow that when you try to open up monopolistic combines of companies, that lower prices just fall out as a result.

Nobody says that breaking a monopoly leads to lower prices. At least I certainly don't.

Agreed.

You cannot realistically compare market forces behind restaurants to those behind insurance companies. Well, I guess you could if hamburgers cost $150.

What do you mean by "market forces"? What about the market for laptops or TV sets, is that one better? A PC is more expensive than a cheeseburger, so I guess it works better.

Are you suggesting a public option for computers?

What I meant was, I can go choose a restaurant and purchase a meal at virtually any price point I want. I can do it at any time I wish because, Big Macs are cheaper than health insurance...that's why your comprison is bogus.

Restaurant pricing is lower due to, in part, increased compe ion and the fact that national chains enjoy an economy of size and structure...something that is largely denied insurance companies due to the state regulation structures. There is certainly no "standard" that is comparable state to state.
You cannot realistically compare the two.

[TeyshaBlue]

To bring everyone up to speed: http://www.theatlantic.com/doc/200909/health-care

I read that several months ago...I can't remember who originally posted it here. It's a superb article that really drove home the points of pricing opacity and the copay system deficiencies. Certainly worthy of a repost.

[mogrovejo]

The effects of deregulation of the electricity market in Texas have been, well, not good. Pricing certainly hasn't seemed to improve much with the extra "compe ion".

How do you know? Because prices raised? That's not enough.

I'm not versed about the case of the Texas electricity market. In some specific markets, like natural monopolies, the maximum efficiency is realized through a single supplier - this is often the case with public utilities. But not only - in other cases, monopolists in markets where barriers to entry are low can behave as if there's compe ion and maximize efficiency. That's why I'm not in favour of breaking up monopolies merely because one exists (assuming no barriers to entry the market) but only when there's a factual (and not hypothetical) loss to the consumer.

In any case, your electricity bill doesn't disagree with the fact that increased compe ion leads to lower prices, ceteris paribus. Your electricity bill simply doesn't provide enough information to agree or disagree with that.

Are you suggesting a public option for computers?

No, I think that would be as ridiculous as a public option for health care.

What I meant was, I can go choose a restaurant and purchase a meal at virtually any price point I want. I can do it at any time I wish because, Big Macs are cheaper than health insurance...that's why your comprison is bogus.

The market forces are still the same, it's just that buying meals is a cheaper and more frequent acquisition. That doesn't make the comparison bogus, the actual price is pretty irrelevant when comparing markets.

Restaurant pricing is lower due to, in part, increased compe ion and the fact that national chains enjoy an economy of size and structure...something that is largely denied insurance companies due to the state regulation structures. There is certainly no "standard" that is comparable state to state.
You cannot realistically compare the two.

Why not? Every market is different - and the biggest difference I actually see in these cases isn't exactly the price but the information asymmetry (although I suspect that the biggest reason for information asymmetry in the health-care market is that consumers don't have an incentive to look for it). But I have no idea why would the market structure impact be totally different depending on the price of the good. Compe ion works for very expensive things and very cheap ones alike.

Obviously regulations and the degree of government intervention have an impact, but that's exactly what we're discussing here, isn't it?

But why can't one argue that a national, government sponsored, restaurant chain, with free food for everyone, would be cheaper than the current system, with multiple pro-profit restaurants, while providing universal access to nutritional and tasty food?

Personally, I don't think that the lower prices would result from the increased compe ion between insurance companies - only in part, but not the most significant one. A quick analysis of the profits that health insurance companies usually make shows that the margin there is smaller than people expect (especially those who want an extremely inefficient organization like the government to drive prices down by competing with those companies - 0% chance of happening). I think the gains for the consumer will come mostly from the regulatory impact and compe ion between regulators.

[TeyshaBlue]

How do you know? Because prices raised? That's not enough.

I'm not versed about the case of the Texas electricity market. In some specific markets, like natural monopolies, the maximum efficiency is realized through a single supplier - this is often the case with public utilities. But not only - in other cases, monopolists in markets where barriers to entry are low can behave as if there's compe ion and maximize efficiency. That's why I'm not in favour of breaking up monopolies merely because one exists (assuming no barriers to entry the market) but only when there's a factual (and not hypothetical) loss to the consumer.

In any case, your electricity bill doesn't disagree with the fact that increased compe ion leads to lower prices, ceteris paribus. Your electricity bill simply doesn't provide enough information to agree or disagree with that.

If you're not versed in the Texas electricity market, then stop there.

Personally, I don't think that the lower prices would result from the increased compe ion between insurance companies - only in part, but not the most significant one. A quick analysis of the profits that health insurance companies usually make shows that the margin there is smaller than people expect (especially those who want an extremely inefficient organization like the government to drive prices down by competing with those companies - 0% chance of happening). I think the gains for the consumer will come mostly from the regulatory impact and compe ion between regulators.

A quick analysis will yield a misleading conclusion. Profit is meaningless unless you look at the Return On Investment involved. Insurance ROI is massive. If their profit margin is 5%, which has been floated, then that 5% margin with a high ROI percentage needs to be weighted a bit differently.

Give me 5% margin anyday with a ROI +50%. That's a slam dunk.

[mogrovejo]

No. I was speaking outside of America, obviously.

Irrelevant. You said one cant' know what would happen in America until it was actually tried.

That's indeed very unusual.

No, it's not.

I actually visit the dentist every time I go back home to visit. Just call in two days in advance. Longer waiting times are normally on things like transplants, or high-end care.

Where? I never went to the dentist in Milan, but I can get info on that.

Both in Italy and France (I'm an Italian citizen and I lived in Paris also) the system is mixed. You can opt to use the public service or pay for a private insurance and get treatment in private clinics or hospitals.

It's like that pretty much everywhere, including in Spain and Portugal. That's why I pay for private health-insurance.

Rationing is exactly the reason I support a mixed system. Rationing exists in the US right now too. Any doctor you call right now will schedule you two months in the future.

Rationing exists every where. The difference is if one wants the government doing it or the consumers and doctors.

All those countries you mention have an emergency system just like the US in case somebody shows up with chest pains and what not.
For non-emergency care, they can all get access to a doctor *FOR FREE* if they're willing to wait for whatever the wait time is.

Good you put for free in between the asterisks. Free health-care is bloody expensive.

If you want a faster service and can afford it, then you can go with a private insurance which will be no different than what you have here in the US. The private insurance sector in both France and Italy are doing quite well.

Yes. Which shows how well the public sector is doing.

I'd love to have a system where I could actually opt for one of the systems. Unfortunately, that's not what happens. You can't opt out of the public system, you can simply choose not using it in spite of being *free*. The fact that so many people opt to pay for private health-care when they could get it for free in the public system shows the crazyness of the all thing.

The problem is obvious: lots of people simply can't afford to have decent health-care because they spend the money paying for the public system - whether they like it or not.

As far as sustainability, well, the Brits started their system right after World War II, when the country was just coming out of that war... tough time to roll out a universal care system. But it's still there 60+ years later. I'd say history is not on your side on that.

Of course it is, unless you have historical examples (or even a theoretical one) of something running deficits forever. The NHS, in spite of Thatcher best efforts, is running deficits every year - this to provide inhuman degrees of rationing. Sarkozy is already asking for huge co-payments in the public system - the last time I was in France I paid €13 for the "moderation fee" in the urgency room. They're closing hospitals, doctors are leaving the public system and the true reforms are still to come.

Furthermore, I think the US doesn't necessarily needs to copy any of those systems. Just take the best from each, and tailor and improve it for americans. There's no reason the US can't have the best system of them all. We certainly are the most resourceful nation. I think we could do it if there was the political will.

Following that path you'll quickly stop being the most resourceful nation.

A public health-care system in the US is economic suicide. Americans already spend an awful lot of money in health-care, with the crazy insurance-employer system; with a public, gigantic, nation-wide system that would add the government inefficiencies, things would blow up rather quickly.

[mogrovejo]

If you're not versed in the Texas electricity market, then stop there.

I can stop, but that doesn't make you right. Again, your electricity bill doesn't prove what you think it does.

A quick analysis will yield a misleading conclusion. Profit is meaningless unless you look at the Return On Investment involved. Insurance ROI is massive. If their profit margin is 5%, which has been floated, then that 5% margin with a high ROI percentage needs to be weighted a bit differently.

Give me 5% margin anyday with a ROI +50%. That's a slam dunk.

Do they have a +50% ROI? Profit margins matter because that's what they are supposedly obtaining from lack of compe ion and monopoly power. Ant the price/earnings ratios of health-insurance companies stocks aren't exactly hight.

[ElNono]

Irrelevant. You said one cant' know what would happen in America until it was actually tried.

Opinion. And I *do* claim you can't know until you try it in the US. I was using pretty much the rest of the world to make the claim, which is, indeed, true.

No, it's not.

Yes, it is.

Where? I never went to the dentist in Milan, but I can get info on that.

Jorge Grana
3244 Pedro Calderon de la Barca
Capital Federal
Argentina

A checkup will cost you U$S 20. Fixing a cavity will cost you U$S 15.

It's like that pretty much everywhere, including in Spain and Portugal. That's why I pay for private health-insurance.

No, you pay because you choose to pay. If you couldn't pay, you would still be able to get service without going bankrupt.

Rationing exists every where. The difference is if one wants the government doing it or the consumers and doctors.

Rationing also happens in the inability to afford care. The more we remove of those, the better.

Good you put for free in between the asterisks. Free health-care is bloody expensive.

Plenty of things are bloody expensive. Our military comes to mind.

Yes. Which shows how well the public sector is doing.

The public sector is rated better than the US system at a fraction of the cost. THAT tells you how well they're doing.

I'd love to have a system where I could actually opt for one of the systems. Unfortunately, that's not what happens. You can't opt out of the public system, you can simply choose not using it in spite of being *free*. The fact that so many people opt to pay for private health-care when they could get it for free in the public system shows the crazyness of the all thing.

It's not crazy at all. The state provides a service, at a certain level, quality and cost for everybody. If you want better/different then go with what you want. It's not different than the state providing Police service, but there's plenty of private security services that are also doing quite well, and that has nothing to do with the level of service of the public Police. They're just providing a separate service to cater a different market segment.

The problem is obvious: lots of people simply can't afford to have decent health-care because they spend the money paying for the public system - whether they like it or not.

I don't see a problem at all. Taxes get levied one way or another. The question is how those taxes are spent, and what are worthwhile services to spend them on. I think providing at least basic healthcare to everybody is a worthwhile service.

Of course it is, unless you have historical examples (or even a theoretical one) of something running deficits forever. The NHS, in spite of Thatcher best efforts, is running deficits every year - this to provide inhuman degrees of rationing. Sarkozy is already asking for huge co-payments in the public system - the last time I was in France I paid €13 for the "moderation fee" in the urgency room.

Yet they still spend less % of the GDP than we do in healthcare. Even when their system has been in the red for the past 20 years.

They're closing hospitals, doctors are leaving the public system and the true reforms are still to come.

Frankly, I find this very unconvincing without further references. I know that the state has been trying to trim expenses, and my uncle in Paris told me about the introduction of the co-pay system, but nothing else noteworthy other than Bachelot saying that the 100% coverage rule was 'set in stone' sometime last year.

And, to be honest, 13 euros is nothing. Without insurance, a basic eye exam here costs $65 in Walmart. Up to $135 on Optical World.

Following that path you'll quickly stop being the most resourceful nation. A public health-care system in the US is economic suicide. Americans already spend an awful lot of money in health-care, with the crazy insurance-employer system; with a public, gigantic, nation-wide system that would add the government inefficiencies, things would blow up rather quickly.

We obviously disagree on this. The current for-profit health-care system in America is already bankrupting americans left and right, already being subsidized by the government, and still not proving a safety net, plus it's one of the most expensive in the world.

[TeyshaBlue]

I can stop, but that doesn't make you right. Again, your electricity bill doesn't prove what you think it does.


Do they have a +50% ROI? Profit margins matter because that's what they are supposedly obtaining from lack of compe ion and monopoly power. Ant the price/earnings ratios of health-insurance companies stocks aren't exactly hight.

Not to derail the thread, but to bolster my point of not trusting managed "deregulated" monopolies....My youngest brother is VP of a company that designs outage, job tasking software for electric utilities across the nation. Among his staff are folks who worked for these companies. His understanding of the electric market far surpasses both of ours. His opinion of the Tx market is that it's largely a sham. Municipal providers do much, much better on a $/kwh ratio. Muni providers could conceivably be compared to public option providers, but that's admittedly a bit of a stretch. Muni providers, MOU (Municipal Owned Utilities) operate in a not for profit model.
Texas elect rates are among the highest in the nation...lots of factors to be filtered...our growth rate, our reliance upon natural gas..etc, but when taken into account, it's still my brother's opnion that deregulation driven compe ion has hurt the Texas market.

P/E ratios do not equal ROI from a standpoint of profit anysis. P/E figures are subject to market worries and concerns. A sizeable component of Insurance ROI figures are lobbying expenses.
But to get a feel for really good ROI figures, Walmart's is roughly 9.2%. Dell's is 12%. Best figures I've found for Insurance companies range from 5.8 - 9.6%...or to put it in another light, roughly $78-$100 per enrollee. But they have the lock on enrollees in our current market.

All this being said, Insurance companies are not the droid we're looking for. They are a part of the issue, and inevitbaly add ineffieciencies to the costs of healthcare...but there is a synergy between Insurance, GPO and Pharma that needs to be examined. These fall outside of traditional P/L analysis.

[Wild Cobra]

Jorge Grana
3244 Pedro Calderon de la Barca
Capital Federal
Argentina

A checkup will cost you U$S 20. Fixing a cavity will cost you U$S 15.

How much is transportation and lodging?

[ElNono]

How much is transportation and lodging?

Round trip flight from the US is probably around $900.
Lodging I have no idea, but should be fairly cheap. I stay at my parent's house (which is 5 blocks from there) when I go visit.

Obviously, I don't make that trip just to go to the dentist.

[TeyshaBlue]

Round trip flight from the US is probably around $900.
Lodging I have no idea, but should be fairly cheap. I stay at my parent's house (which is 5 blocks from there) when I go visit.

Obviously, I don't make that trip just to go to the dentist.

How good is their cooking?

I'm in!

[ElNono]

How good is their cooking?

I'm in!

Icecream is great!

[Wild Cobra]

Round trip flight from the US is probably around $900.
Lodging I have no idea, but should be fairly cheap. I stay at my parent's house (which is 5 blocks from there) when I go visit.

Obviously, I don't make that trip just to go to the dentist.

I know. I couldn't help joke about it though.

[ElNono]

I know. I couldn't help joke about it though.

Well, if you have to get two or three crowns done, you might actually be able to justify the cost... kid you not...

[ChumpDumper]

Rationing exists every where. The difference is if one wants the government doing it or the consumers and doctors.

Or accountants and bottom line driven CEOs.

[Wild Cobra]

Well, if you have to get two or three crowns done, you might actually be able to justify the cost... kid you not...

Probably make a nice vacation out of it too...

At least if you're able to enjoy yourself after seeing the dentist...

[mogrovejo]

Not to derail the thread, but to bolster my point of not trusting managed "deregulated" monopolies....My youngest brother is VP of a company that designs outage, job tasking software for electric utilities across the nation. Among his staff are folks who worked for these companies. His understanding of the electric market far surpasses both of ours. His opinion of the Tx market is that it's largely a sham. Municipal providers do much, much better on a $/kwh ratio. Muni providers could conceivably be compared to public option providers, but that's admittedly a bit of a stretch. Muni providers, MOU (Municipal Owned Utilities) operate in a not for profit model.
Texas elect rates are among the highest in the nation...lots of factors to be filtered...our growth rate, our reliance upon natural gas..etc, but when taken into account, it's still my brother's opnion that deregulation driven compe ion has hurt the Texas market.

That's nosense (and I don't care about argumentum ad verecundiam).

"Deregulation" can lead to higher prices, ceteris paribus, if:

- you're calling deregulation to the regulation of a previous existent monopoly. If a natural monopoly is broken up by state intervention, than it's possible prices may go up due to the entrance of less compe ive providers who aren't able to offer the in bent's price. But this isn't called deregulation but regulation.

- you're calling deregulation to a package of laws that politicians label deregulation but in fact impose further regulations on the industry, driving up the prices.

If you know any other scenario, please explain it, even theoretically, instead of resorting to pla udes like "it's the way it is", "my bill says so" and "it's my brother's opinion".

If the Muni providers are able to provide electricity at a lower cost than their compe ion, then they are still able to do it. If the compe ion tries to sell at a higher price, nobody will buy from them. Unless the reason why Muni providers were able to provide electricity at a lower cost was the same that a public option provider in health care would - by getting subsidies from the government. Which would mean that the electricity bill would lie because part of the price was erased from the bill and traded to the tax return form . Which would be a shame because taxpayers, even those who spend very little electricity, would be paying for the electricity of consumers.

P/E ratios do not equal ROI from a standpoint of profit anysis. P/E figures are subject to market worries and concerns. A sizeable component of Insurance ROI figures are lobbying expenses.
But to get a feel for really good ROI figures, Walmart's is roughly 9.2%. Dell's is 12%. Best figures I've found for Insurance companies range from 5.8 - 9.6%...or to put it in another light, roughly $78-$100 per enrollee. But they have the lock on enrollees in our current market.

All this being said, Insurance companies are not the droid we're looking for. They are a part of the issue, and inevitbaly add ineffieciencies to the costs of healthcare...but there is a synergy between Insurance, GPO and Pharma that needs to be examined. These fall outside of traditional P/L analysis.

I know the differences between p/e and ROR. What is getting a feel for "really good ROI figures"?

I've checked the numbers for a few well-known companies:

http://www.google.com/finance?q=NYSE:CI

http://finance.google.com/finance?q=NYSE:WCG

http://finance.google.com/finance?q=NYSE:UNH

http://finance.google.com/finance?q=NYSE:AET

http://finance.google.com/finance?q=NYSE:HUM

Uh, the idea that insurance companies drive up the costs of acquiring health care due to their for-profit nature is flat out crazy. There's no other way to put it. Take away all the profits from all the health-care insurance companies and health-care costs would hardly change a millimetre.

[mogrovejo]

Opinion. And I *do* claim you can't know until you try it in the US. I was using pretty much the rest of the world to make the claim, which is, indeed, true.

It's funny how one can't use peer-reviewed scientific studies to get some insight and suggestions about the effect of socialized health-care but you can use your absolutely subjective and potentially misinformed view of how the rest of the world to argue in favour of your position.

Yes, it is.

You have no idea about what you're talking about. Accessing a public health-care dentist is a nightmare - in Portugal, England, France, Australia, whatever.

Jorge Grana
3244 Pedro Calderon de la Barca
Capital Federal
Argentina

A checkup will cost you U$S 20. Fixing a cavity will cost you U$S 15.

That's in Argentina, not in France. I can find an even cheaper dentist in Luanda, for example.

No, you pay because you choose to pay. If you couldn't pay, you would still be able to get service without going bankrupt.

First, I'd always pay. It's amazing you simply can't grasp that everybody pays an insane amount of money to health-care by default, without even having the choice to pay/not pay for it.

Secondly, saying that I'd be able to get service is wishful thinking. I wasn't. I couldn't live with a tooth ache for months and months. Lot's of people don't get surgery they need on time, they die before. And many medical services aren't available on the public service. I mean, try to get a dental implant in a public service dentist.

Thirdly, you seem completely oblivious to the fact that people would only go bankrupt due to the fact that they're paying an obscene amount of money to the national health care/insurances. I suspect you simply have never done the math. I'd be very comfortable in paying my medical expenses out of the pocket if I could save all the money that I was forced to give away to pay for health-care I don't use.

Rationing also happens in the inability to afford care. The more we remove of those, the better.

What? Remove of those what?

The public sector is rated better than the US system at a fraction of the cost. THAT tells you how well they're doing.

Rated by who? By governmental ins utions? What are the criteria?

The "fraction of the cost" is completely useless. Do you think health-care costs will diminish in the US if government takes over the system? You're into a big disappointment.

It's not crazy at all. The state provides a service, at a certain level, quality and cost for everybody. If you want better/different then go with what you want. It's not different than the state providing Police service, but there's plenty of private security services that are also doing quite well, and that has nothing to do with the level of service of the public Police. They're just providing a separate service to cater a different market segment.

Police and private security services don't do the same thing - at best, they can be complementary. But there's a reason why the state needs to offer the police service (or the military, or the judicial). Locke explains.

I don't see a problem at all. Taxes get levied one way or another.

Why? I disagree. As long as they are at their current level, I don't see taxes as an inevitability.

The question is how those taxes are spent, and what are worthwhile services to spend them on.

No. The question is if the services that politicians are offering and paying for by using others people money are needed or, on the other hand, could be offered without evolving politicians and without forcing everybody to pay for it.

Your ideas about taxes and spending are frankly amusing. You'd probably be happy in Cuba.

Yet they still spend less % of the GDP than we do in healthcare. Even when their system has been in the red for the past 20 years.

Lots of things are cheaper in Europe than in the US. I'm always surprised why people think this is a big deal and indicative of anything de per si.

This kind of analysis is so crappy... for example, a big reason why health care is more expensive in the US is because doctors are better paid. How are you going to solve that? By paying an American doctor the same a French doctor makes? You'd run out of doctors in a couple of months.

Most of those cost comparative analysis nothing but lazy, cheap propaganda. Europeans spend a lot of money in health-care indirectly that isn't factored - like in training doctors, for example.

The fact that their system isn't economic sustainable is a problem that you seem to be undervaluing. I mean, it's all nice and fine, but in the end non sustainable systems go bankrupt and terminate.

Frankly, I find this very unconvincing without further references. I know that the state has been trying to trim expenses, and my uncle in Paris told me about the introduction of the co-pay system, but nothing else noteworthy other than Bachelot saying that the 100% coverage rule was 'set in stone' sometime last year.

What's exactly unconvincing?

The co-pays are just a temporary palliative. The current system is economic suicide. They simply don't have the money to pay for it and they can't raise taxes - otherwise they'll keep losing companies and jobs. What's so difficult to understand about this?

And, to be honest, 13 euros is nothing. Without insurance, a basic eye exam here costs $65 in Walmart. Up to $135 on Optical World.

Once again, your making a comparison forgetting part of the equation. It's amazing how you keep making the same mistake endlessly.

We obviously disagree on this. The current for-profit health-care system in America is already bankrupting americans left and right, already being subsidized by the government, and still not proving a safety net, plus it's one of the most expensive in the world.

I agree, the current health-care system in America is a disgrace. It's just a bit better than the alternative you propose.

[TeyshaBlue]

I know the differences between p/e and ROR. What is getting a feel for "really good ROI figures"?

I've checked the numbers for a few well-known companies:

http://www.google.com/finance?q=NYSE:CI

http://finance.google.com/finance?q=NYSE:WCG

http://finance.google.com/finance?q=NYSE:UNH

http://finance.google.com/finance?q=NYSE:AET

http://finance.google.com/finance?q=NYSE:HUM

Uh, the idea that insurance companies drive up the costs of acquiring health care due to their for-profit nature is flat out crazy. There's no other way to put it. Take away all the profits from all the health-care insurance companies and health-care costs would hardly change a millimetre.

I'm leaving the electricity market debate lay where it is...you clearly don't have an understanding of the Tx market and how municipal suppliers operate..and I aint the one to educate you.


As far as insurance companies driving heathcare costs, you completely ignore the willful collusion between GPO's and Insurance and Pharma companies with an assist by the large pharma distributors. Deleting the profits does not negate the upward pressure of the third party, insurane company model.
Bob's Drug Company works with Larry's Group Purchasing Organization and offers Larry's GPO Aspirin @ $5/bottle. Larry's says "No...too high." Insurance says, ok we'll honor that price. Now Bob has to work a rebate deal with Larry...sell my Aspirin for $5/bottle and we'll rebate you x% of the contract. That gets the deal done. Had insurance said, "No we wont honor those prices!", then the rebate scenario goes away. Insurance rarely says no because they can build the drug costs into their billing population, until the costs of medications skyrocket. That's why they battle the current crop of biologicals ie..Remicade, Humira, Enbrel..etc... At 20k a pop, they can't realistically increase a person's premium to pay for that...so they just say "No."

[mogrovejo]

I'm leaving the electricity market debate lay where it is...you clearly don't have an understanding of the Tx market and how municipal suppliers operate..and I aint the one to educate you.

So you ran out of arguments and resorted to ad hominem arguments and personal insults?

As far as insurance companies driving heathcare costs, you completely ignore the willful collusion between GPO's and Insurance and Pharma companies with an assist by the large pharma distributors. Deleting the profits does not negate the upward pressure of the third party, insurane company model.

What do insurance companies gain from this alleged collusion?

Bob's Drug Company works with Larry's Group Purchasing Organization and offers Larry's GPO Aspirin @ $5/bottle. Larry's says "No...too high." Insurance says, ok we'll honor that price. Now Bob has to work a rebate deal with Larry...sell my Aspirin for $5/bottle and we'll rebate you x% of the contract. That gets the deal done. Had insurance said, "No we wont honor those prices!", then the rebate scenario goes away. Insurance rarely says no because they can build the drug costs into their billing population, until the costs of medications skyrocket. That's why they battle the current crop of biologicals ie..Remicade, Humira, Enbrel..etc... At 20k a pop, they can't realistically increase a person's premium to pay for that...so they just say "No."

This isn't collusion, it's the consequence of a system where the consumer isn't paying for the expenses.

The conclusion that the for-profit nature of insurance companies isn't a problem remains.

[mogrovejo]

Millions have difficulties accessing an NHS Dentist

Millions of adults in England and Wales haven’t been to an NHS dentist since April 2006 mainly because they couldn’t find one to treat them, says new research carried out for national charity Citizens Advice as it urges Primary Care Trusts to spend newly allocated resources to improve access.

he Ipsos MORI survey found that lack of access is the most common reason cited by people in England and Wales for not seeing an NHS dentist since April 2006, along with not needing treatment. It was mentioned by 31% of respondents in England and Wales who have not been to an NHS dentist since April 2006. This is the equivalent of approximately 7.4 million people who have not been to an NHS dentist since April 2006 because of difficulties in finding one. Of these, the equivalent of approximately 4.7 million have sought private treatment instead and the equivalent of approximately 2.7 million have gone without treatment altogether.

The research also reveals that the problem is more evident in the South West (53%) and the North West (39%).

Citizens Advice Chief Executive David Harker said:

"These figures show the scale of the lack of access to NHS dentistry, reflecting the evidence which bureaux across England and Wales have been reporting ever since the early 90’s. People on low incomes are particularly affected as private treatment is just not an option."

Universal access to health-care.