Why The Libertarian Position On Health Care Works
The Market Ticker ® - Commentary on The Capital Markets
Posted 2012-06-15 11:14
by Karl Denninger
in Health Reform
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Why The Libertarian Position On Health Care Works
 

This ought to illustrate it for you quite clearly.

Barack Obama’s political fortunes may hang on the U.S. Supreme Court’s view of his health-care law. For Joy Waldon, the stakes add up to a quarter of her paycheck and some peace of mind.

A heart defect and a history of melanoma make it imperative for the 56-year-old New Yorker to find a new insurance plan to replace coverage that runs out at the end of June. With the best option so far costing $1,000 a month, Waldon says her hope lies in the health law’s subsidies, online marketplaces and other benefits that are supposed to kick in by 2014.

$1,000 a month for someone with a history of melanoma (an aggressively-malignant form of skin cancer) and a heart defect isn't bad when you think about it.  That's an implied cost of medical care of $12,000 a year.

Here's the problem -- the heart defect may or may not kill you.  The melanoma may or may not recur.  But if you have Obamacare (or Romneycare) you will have no choice but to subsidize the possibility for this person, while this person will have to buy insurance against an event they may be willing to shoulder the risk of themselves.

Now let's talk about the realities of these conditions.

Waldon said she’s found plans available for about $300 in monthly premiums that would cover catastrophic care. For the more comprehensive coverage she wants, including prescription drugs and office checkups, she’d pay at least $1,000, almost as much as her monthly rent, she said. On her annual income of about $50,000, “I can’t afford it,” she said.

So in other words for $3,600 a year, which she can afford, she can insure against the cancer coming back or the heart condition threatening to kill her.

But she wants someone else to cover her office visits and prescriptions.

And who is that "someone else"? 

It's her.

Why?

Because insurance is a thing you buy to cover you when something that is unlikely but catastrophic occurs.  When you "insure" against a sure thing you pay more than you would otherwise.  You have to, becasue the payout is certain and nobody works for free, including the insurance company.  As a consequence you simply pay more.

Then we add, through government law, the requirement that people who choose not to buy insurance and have no money will get treated anyway.  Who pays that bill?  You do.  This is true both here and abroad; we develop drugs and charge $300/month for them, but in Canada, the UK and other nations the same drug is available for $20/month.  Why?  Because the government there demands that price or they'll ignore the patents and as a result the entire cost of development is shifted to US Citizens.  The drug companies for their part make it illegal to buy the drug there and reimport it.

Is this right?  No, it's dead wrong.  It's just for us to pay for the development of what we use, but not just for us to pay for what everyone else uses.  And while removing that subsidy would undoubtedly result in some drugs not being developed at all, what was developed and available would be much, much cheaper -- maybe by as much as 75% or more -- than what we have now!

Which is better?  A medical system you can't afford that's 4x as expensive or one that's 1/4 of today's price but you can afford to pay for routine things out of your own pocket and can choose whether to accept death if a catastrophe happens or you can buy insurance to cover that possibility?

Those are the only two choices folks.  Currently medical spending at the Federal Level has grown by 9.3% compounded annually since 1980.  This means it doubles every 7-1/2 years or so and last year it totaled $820 billion.  That spending will rise to more than $3.2 trillion in 15 years, a number we cannot possibly pay, which means that everyone younger than 70 (on average) will face the collapse of our government if we do not deal with this now.

Gary Johnson does not have any position on this that is cogent and makes sense.  But the Libertarian position on health care is that:

  • You have the right to buy as much health care as you'd like, with your own money.  Said price must be set, published, and offered on a non-discriminatory basis (that is, in a free market) without forcing you to pay someone else's bill -- anyone else's bill.

  • You have the right to choose to buy insurance against uncommon but catastrophic events or to choose to face the consequences of not buying said insurance.  Some people will simply choose to pay cash (those who have it), some will choose to buy insurance, and some will make their peace with God if they become gravely ill.  This is a personal choice and no government has the right to demand you do it "their way", nor does the government have the right to force you to pay someone else's bill.

  • The use of government force to impose and maintain wildly-disparate prices and terms is immoral and a direct violation of the Libertarian Non-Aggression Principle.  There is simply no argument that can be made in support of the current health care system at any level.  Billing someone in this country at 10 times or even more the rate that someone else with the exact same ailment or symptoms is billed can only happen where government makes legal the abuse of customers.  Absent that intervention any such enterprise would be either sued or boycotted out of existence in an afternoon.  Consider the local gas station -- your gas is $33.00/gallon, mine is $3.33.  How many gallons would you buy from said station?  Zero, right -- unless you had no choice!  Well?

I call upon Gary Johnson to advance and support an actual Libertarian position on Health Care right here and now.  If he needs reading material on this problem and Libertarian solutions I recommend either Leverage (look to the right) or he can click this link and start reading with the 2009 entries.

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User Info Why The Libertarian Position On Health Care Works in forum [Market-Ticker]
Ichirovader
Posts: 25
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There is no way this ends well.
Poodlelover
Posts: 147
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She in particular CAN afford $1000. Is a quarter of her paycheck too much to ask if she otherwise has major health problems and this gives her access to some of the best medical care in the world?

Is it really a bad thing if a severely sick person is spending almost as much on health care as rent? I don't think so, where else is her paycheck going?
Jinxx0r
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Quote:
So in other words for $3,600 a year, which she can afford, she can insure against the cancer coming back or the heart condition threatening to kill her.

But she wants someone else to cover her office visits and prescriptions.


The problem is that the cost shifting is killing peoples ability to pay out of pocket for services. That still must be fixed to make this viable or the cost shifting will continue to make this impossible. You have touched on this many times in the past. It's like I go to get my oil changed and it's $250 dollars, but the guy who is broke pays nothing to have it done because it's rolled into my ability to pay.

I agree with the premise of your ticker though. Insurance should be about covering the catastrophe (and that catastrophe not bankrupting you). It shouldn't be about sniffle care... (as long as the sniffle care isn't fraudulently inflated).
Jinxx0r
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Quote:
She in particular CAN afford $1000. Is a quarter of her paycheck too much to ask if she otherwise has major health problems and this gives her access to some of the best medical care in the world?

Is it really a bad thing if a severely sick person is spending almost as much on health care as rent? I don't think so, where else is her paycheck going?


That depends. If she's being ripped off on the cost of that care, via the policy, then no. The $1000 premium is NOT just paying for her. It's paying for others too. What is the true cost of her care? That's the question. Yes, she should pay for her own care, but what is that true cost to her?
Poodlelover
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"That depends. If she's being ripped off on the cost of that care, via the policy, then no. The $1000 premium is NOT just paying for her. It's paying for others too. What is the true cost of her care? That's the question. Yes, she should pay for her own care, but what is that true cost to her?"

Agree, it's salt on a wound for a person to pay not for the actual service but also the cost-shift. Unfortunately, it really has to happen in some capacity for the provider (hospital) to make money, pay salaries, etc.

Unless you're paying up front, in which case there's no need for cost-shifting because the provider knows you can pay, they are extending credit. And since many (most?) won't pay that back on large bills, it carries an absurd premium like lending to any sub-prime borrower.

And the reason the hospital extends that credit is because they legally have to for, say, emergency procedures.

This all leads inexorably to the final conclusion that if A) providers are legally compelled to offer certain services regardless of ability to pay that B) they need to cost-shift OR have this money guaranteed in some other form--such as government health care.

I believe a one-pay system is absolutely inevitable, though this transition period is sure dragging out.
Tm22721
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My understanding is that screening by catastrophic providers is stricter than others.

Where exactly can you get catastrophic coverage with her pre-existing conditions ?

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Mpilar
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Quote:
And the reason the hospital extends that credit is because they legally have to for, say, emergency procedures.

And that's part of the problem isn't it? That legal requirement to provide a service, regardless of whether or not they'll get paid, makes them slaves...it's only natural for them to make others pay for it.

Get rid of that blatantly unconstitutional requirement, and the pieces start to fall back into place.

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Michelj
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I've seen a documentary showing big pharma offering 99% reduction offers to retailers and still making money. The true cost of development is imho probably a fraction of what they say they are (or could/should be). Increasing "cost" with purposely expensive procedures and employing many many extremely well payed bureaucrats and what have you scams is easy when you're pulling the strings.
How do you distinguish which dollar goes to what. Maybe the dollars from the rest of the world are paying for the development (more than) and the Americans are just plain ripped off.

It's just a remark, I agree with all the rest of the points you make.
Noodleman
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I remember over a decade ago when I had top of the line corporate PPO insurance and needed a simple outpatient surgical procedure that took about 40 minutes in an office setting with local anesthesia. There was a list of approved surgeons within the network. It took me 2 months to see the first available doc and he was the new kid in the practice right out of residency.

At that point - I knew our system was totally broken.

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Mannfm11
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ichirovader wrote..
There is no way this ends well.


One thing for certain, it is going to end. The market will eventually force a change in price.

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Lenguado
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Noodleman,
Quote:
top of the line corporate PPO insurance. . .

There was a list of approved surgeons within the network

Betting you didn't really have a PPO. Not saying you are BSing, but what you describe is middle of the road HMO insurance medical coverage.

I currently have "top of the line corporate PPO insurance". Ain't no list of "approved surgeons" - and ain't no "network". Get seen almost immediately. Only issue is when the provider doesn't accept the particular insurance company, but that isn't a "network" thing.

Guessing that you either were sold a 'bill of goods' (labeled as a PPO, but really a HMO) - or you are mis-remembering.

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Anti
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Corporate insurance has deteriorated markedly over the past 30 years. Back in the day, it was a fringe benefit to attract and retain valuable workers, then it became a cost and the workers - well they were expendable. Work harder peon! There is an H1B waiting in the wings to take your place buddy, or we maybe can send your job overseas.

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Phxkevin
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I have trouble supporting the unsupportable. But I'm also conflicted. I can't imagine the third world situation where you have to step over the sick and dying in the street. Will charity hospitals really step up to the plate? My perception is that today's charity hospitals survive off cost shifting and government support. The current healthcare model is not sustainable, and the proposed changes (e.g. Obamacare) are not going to solve the problem of cost and cost shifting.

Whatever the end result (such as single payer) we have to remove the waste and abuse from all parties. Plus fix the "end of life" practice where a large percentage of lifetime medical cost is spent in the last few months of life.


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True charity hospitals would not survive today. The problem is that you can only provide healthcare with government support, because the cost is so high due to government intervention.

You must weed the garden before you could possibly grow a flower.
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Phxkevin wrote..
I can't imagine the third world situation where you have to step over the sick and dying in the street.
Is that what occurred here for the 150 years before the Nanny State stepped in? NO.

Get a clue, people. And the first step is admitting that you've been bamboozled.

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Johnpuma
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From the article: "Billing someone in this country at 10 times or even more the rate that someone else with the exact same ailment or symptoms is billed can only happen where government makes legal the abuse of customers."

Is there a specific provision of ObamNey Care that "makes legal the abuse of customers"? An other identifiable section of existing health insurance law?

If government did act effectively to make illegal the abuse of customers I do not think the national collective eardrum would survive the roar of those howling about the concomitant "abuse of the the job creators." And I suspect much of the outcry would be from Libertarians.

Then: "So in other words for $3,600 a year, which she can afford, she can insure against the cancer coming back or the heart condition threatening to kill her."

This is simply not true. The $3,600 a year will pay, by definition, only for dealing with the catastrophes of recurrent melanoma or a serious heart incident. It's the coverage for drugs and office visits that MIGHT prevent cancer recurrence or heart failure. BUT that's precisely the coverage that is not affordable.

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Noodleman
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"I currently have "top of the line corporate PPO insurance". Ain't no list of "approved surgeons" - and ain't no "network". Get seen almost immediately. Only issue is when the provider doesn't accept the particular insurance company, but that isn't a "network" thing.

Guessing that you either were sold a 'bill of goods' (labeled as a PPO, but really a HMO) - or you are mis-remembering"

Maybe the definition of a PPO has changed in the last 10-15 years, Lenguado. But when I had it the PPO stood for "Preferred Provider Network" which did have a list of network or preferred physicans. The insured could go outside that network if his physician of choice was not on the list - but it would cost an arm and leg to do so. As I said, when I needed a minor surgical procedure I had to wait for 2 months to see a network surgeon (new to the practice) for a 40 minute procedure in his office. That's the truth of the matter.

I believe most HMO require the patient to see one of their docs and most have their own buildings and hospitals (like Kaiser). I was not insured by an HMO. I was told it was a PPO. And by definition - that made sense to me.

Managed care has made medical care a complicated mess. One almost has to be an medical actuary to understand all the terms and the various charged attached to each plan. I know from experience that it's hard to keep all the terms and all the different options/requirements straight.

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"Ammunition beats persuasion when you are looking for freedom." Will Rogers, 4 Nov 1879 - 15 Aug 1935

Morla
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Quote:
Is there a specific provision of ObamNey Care that "makes legal the abuse of customers"?
That's already legal now. Health corps are allowed to perform outright collusion that would be trouble in any other industry.

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Fear of govt IS the government.. Statism is a pack of unbacked threats; If govt gets out of control, ignore it and go about life as you see fit. Where's your crown, King Nothing?
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