Centerfield

And why can't anyone get national political traction regarding health care for the uninsured?

Because the cost (monetary and moral) is more than the populace is willing to bear?
Why should I be willing to pay extra out of my pocket for the uninsured when I am in the majority?

My cost in higher premiums to cover the upaid bills of the uninsured is near $1K per year ($45B nationaly). For that extra grand I can make an appointment at most a month or two out for minor things, and be seen immediately for anything I consider serious.

Considering the costs of NHI is a little harder to figure. Most of the studies that show decreased costs from our present system assume pretty big savings from efficiency, and have to ignore single cases. Efficiency is not something most of us have come to expect from our government. The anecdotal horror stories from countries with NHI don't inspire confidence either.

We have made moral rules as a society that will not allow the free market, nor an institutional solution to function at anything near efficiently. I want to squeeze those last few days of life out irregardless of cost. The insurance company is paying for it anyway. As long as we hang onto the myth that human life is priceless it will remain pretty darn expensive to maintain.

I am not without sympathy for the problems. I wish there were a simple solution. Without a basic change in mindset I don't see anything workable.

All that being said, I'd guess that when the boomers start retiring in large numbers, and are without good health insurance there will be some changes made.

...why can't anyone get national political traction regarding health care...

In a word - Hillary Clinton.

She offered up a Healthcare plan in the 90's. She was universally panned by the right for it. I do not know the details of that plan, so I cannot tell you if the ire raised was justified or not.

So with that history, ANYONE who mentions a healthcare plan is compared to Senator Clinton. For a politicain on the right, this is bad. For a politician on the left, this is bad.

That being said, Mitt Romney (R-MA) and Gavin Newsome (D-San Fransisco) are both trying soemthing like Universal Health Care. If it works, expect to see everyone from John Kerry to Tom Delay jump on the bandwagon touting their long suport for just such a plan.

Dennis, you mention squeezing out the last few days of life at the insurance companies expense. I have to ask, what last few days? We in the US spend more on healthcare than most countries on earth combined, yet we have the 17th highest life expectancy. We are behind quite a few European countries with [gasp!] socialized medicine. Hell, Cuba has a lower infant mortality rate than the US.

Can someone tell me how our system is better considering those two facts?

Scott, why in the name of all that's holy (never mind sensible) would you assume that life expectancy is a function of the healthcare system without regard to cultural lifestyle choices such as diet and physical activity level, to name just a few of the arguably decadent by-products of American prosperity/overabundance?

I'm overweight and more sedentary than I'd like to be, and I'm not alone, and this is likely to affect my life expectancy. But I think it's silly to say that this is a problem directly caused by the mechanics of our healthcare system. I'll cheerfully concede that a drastically-reformed healthcare system that was much more strongly incentive-based could address this issue, but IMO it's still culturally driven. In other words, the primary reason the healthcare system is not more incentive-based is that the sorts of incentives that would need to be out in place would be viewed by many Americans as invasive if not draconian strikes at privacy and civil liberty.

I think they're coming, but not soon. And when they do, they'll be related to a stronger national moral uniformity as regards health. Both as cause and as effect.

I do not know the details of that plan, so I cannot tell you if the ire raised was justified or not.

I do. It was. It wasn't single-payer universal by any stretch, it was simply putting government in control of the existing multi-payer system to impose mandates and assign and control market shares.

We in the US spend more on healthcare than most countries on earth combined, yet we have the 17th highest life expectancy. We are behind quite a few European countries with [gasp!] socialized medicine. Hell, Cuba has a lower infant mortality rate than the US

Apples and oranges--different countries compile their stats in different ways, and some (such as Cuba) have even been known to (gasp!) lie. EX: Infant mortality stats are figured differently in every nation, and in the US we count every live delivery including seriously pre-term births, as well as some in-utero deaths (stillbirths). Many European nations do not count any birth in their infant mortality stats unless the baby lives for 48 hours after delivery--and somehow in some "enlightened" nations, babies with crippling birth defects almost never leave the delivery room alive, even if born kicking and screaming, and thus are not counted in the stats. In addition, we have the finest perinatal care for pre-term babies in the world, so we attempt to save a LOT of babies that in other nations would never be counted as births in the first place.

This affects not just the infant mortality figures, but also the life expectancy figures. And as Brian notes, some of our "lowered" life expectancy is entirely due to lifestyle factors, things that are not the result of our healthcare system but of simply being comparitively wealthy. EX: Obesity is a major factor, as are car crashes. Neither of those are much of a factor in poorer nations. Gotta be able to afford excessive food and cars before they become risk factors.

This is completely irrelevent, but I always pictured you as a slim guy, bk.

So, Tully, are you saying that an extremely premature baby that dies after, say, a few days counts as both an infant mortality and towards life-expectancy figures, thereby dragging down the average?

Yep. Exactly. In America, it does. But not in, say, Cuba or Sweden or Japan. In Russia, a baby that is not born breathing on its own AND does not live at least seven days AND weigh at least 1000g at birth is not counted as an "infant death." In some Scandanavian countries, infant euthanasia of live-born but "defective" babies is common--and they are counted as perinatal mortalities, not infant mortalities. There is NO consistent international standard for defining either infant or perinatal mortality, and most countries don't track perinatal mortality at all. To properly compare the figures cross-country, you have to have accurate combined PM and IM stats. And they don't exist.

In America, a 20-week 500g preemie (survivability factor approaching zero) that is delivered not breathing and without heartbeat, that a doctor works on to establish respiration and heartbeat and fails, is counted as a "live birth" and becomes an "infant mortality," affecting both the IM and life expectancy stats. In almost any other country, if it were counted at all it would be counted as a "perinatal mortality," which does NOT count towards infant mortality or life expectancy figures.

Apples and oranges. Without consistent definitional standards and honest reporting, the "Cuba has a lower infant mortality rate than America" claim is simply flat-out bogus, because the phrase "infant mortality" doesn't mean the same thing in both countries.

I have to ask, what last few days?

?? Bad news Scott. You are going to die. You could save us all a few bucks by not raging against the dying light when you do though.

Can someone tell me how our system is better considering those two facts?

Assuming that socialized medicine is a good thing (which is a pretty big assumption), I'd put innovation at the top of the list where our system is better. Free markets are really good at that. Castro isn't. I've heard stories that cut both ways regarding the waiting lines, but it seems to be that with socialized medicine the end of life issues are handled much differently. I'm glad to see hospice taking root here in the US.

What Brian said about the cultural standards here in the US. That seems the biggest hurdle to universal health care. It sounds good as an overall scheme, but breaks down when you get into individual cases. Waiting in line, and poor access to new drugs is fine for the other guy, but not for me.

I don't see Hillary's failed attempt as that much of a problem with future attempts. She wanted to rig the present system, which would have just made it worse IMO. It really didn't have that much to do with socialized medicine as it did with screwing up the free market more than it already was. Pretty much DOA.

Universal health care would require a complete change in how we ration health care. And make no mistake--we DO ration health care now. By the pricing of insurance coverage and the inequal coverage of different policies.

End-of-life care: No good studies since the 1993 HCFA study, which found that roughly 50% of ALL Medicare expenditures are made in the patient's last two months of life. Ten percent of patients accounted for 70% of Medicare expenditures. Half our Medicare money goes to those dying Real Soon Now, and 80% of that is spent in the last month of life. As a people and as individuals (both for ourselves and our loved ones) we really need to learn when to let go.

The people in the various Hospice organizations have my eternal admiration and support.

BK - Join the club. I'm heavier and lass active than I want to be as well. And I blame all the things you list. I just tend to think (perhaps wrongly) that some lifestyle choices, particularly those affecting my expanding waistline, are made due to our healthcare system. For instance, why bother getting my heartrate up 3 times a week when I can just take Lipitor instead? I guess you address that when you conceed a radically reformed...

As for infant mortality, I guess all the responses is what I get for not digging deep enough into my theory before posting. I stand corrected.

I still say Hillary is a big part of the reason. Her name is associated with Health Care reform, good bad or indifferent, it's a fact. Newt caught hell for mentioning reforming the system earlier this year. There were all sorts of comparisons to Hillary made.

I'd address the rest of the critiques to my argument, but y'all have humbled me pretty good, and the boss is actually expecting work out of me tonight.

Don't take it badly, scott--people everywhere quote those same stats, even ones who DO know better. It just happens to be an area I've delved deeply. Knowing that cross-national comparisons are deeply flawed doesn't help us figure out how to do better, and when you think about it, it's ourselves we're trying to improve. We don't need to "beat" others, we need to improve against our own baselines, which means knowing our own weak spots.

Bad stats used in politics are one of my favorite playgrounds. :-) Part of the reason we spend so much more on medical than other nations is that those other nations get a free ride on our med/pharma R&D. How many wonder drugs and new surgical techniques and therapies come out of, say, Germany or Cuba or China? (Damn few.) We pick up the tab for it, our consumers pay premium and "early adopter" prices for it, and other countries then get it a subsidized rate. This keeps their costs down while boosting ours, exagerrating the difference. And that's just one of the many "cost drivers" that boost US medical prices over other countries.

What Tully said at the end there. And I blame big Pharma for it. They fight tooth-and-nail against reimportation on the grounds that they've got to repay the R&D costs. That means they are willingly selling at below the real price of the drugs to foreign countries, and not giving us the same discounts, because we're the only ones willing to pay it. I want to prohibit pharmaceutical companies from selling drugs to other first world countries at a lower price than they charge Americans, or change the Medicare regulations to say that Medicare will pay no more for a drug than the drug company charges the British National Health Service or any other national health care plan in a First World country.

"Big pharma?" Pat, are you having a socialist moment? I promise not to tell. But I guess then that you'd concede that under some circumstances (oligopolistic ones?), we shouldn't just let (whatever currently passes as) the free market determine prices. In other words, sometimes, if a company or an industry dominated by a handful of main players gets too powerful, then we shouldn't just let them charge whatever prices they feel like charging. I guess this is something of an uncomfortable spot for a republican.

That said, it sort of frosts my cake too that European countries in effect pay for drugs at prices that America subsidizes. At least in part, this must be due to the fact that many such nations control prices governmentally. This raises an obvious question, which is , "can any nation afford not to set governmental price controls if everyone else is doing it?"

But I guess then that you'd concede that under some circumstances (oligopolistic ones?), we shouldn't just let (whatever currently passes as) the free market determine prices.

I'm sorry, Brian. Do you mistake the US pharmaceuticals and health care markets for "free markets?" They're not. How is noticing that a "socialist moment?" Both parties have been thoroughly complicit in making sure they're not--the American Big Pharma/healthcare lobby is the biggest lobby in the world.

Just a joke Tully,.Sorry if it fell flat. Would you agree that its a bit out of the ordinary for a republican to say "big pharma," since such phrasing is usually a pet semantic tool of the left? That's all I meant.

If more people noticed what you did, it would sure be a good thing. This is my way of pointing out that oligopoly is a problem, and it's one that many people who are too reflexively pro-business miss. Am I far off the mark in calling this oligoply? I'll cheerfully concede that in my rudimentary understanding of it, it doesn't necessarily involve the aspects of lobbying and getting the government all complicit in ensuring the continuation of market dominance. Maybetit's a common progression, though.

But if you say its much more than oligopoly, I'll go along. You know far more than I on such matters.

Am I far off the mark in calling this oligoply?

Nope. A government "regulated" (i.e. facilitated) oligopoly AND oligopsony, with all the worst market features of both, including inefficiency and adverse welfare effects for consumers.

The "business" argument in favor of the current system basically boils down to suppliers' claims that their monopoly/oligopoly profits drive innovation. Which is true to an extent--but they also drive massive ongoing price inflation.

I have another oligopoly question which I'm hoping you'll indulge me by trying to answer.

What's the "business argument" in favor of an oligopoly that's not especially subject to either government regulation (at least as compared to healthcare) or much in the way of true innovation (again, as compared to healthcare).

For example, suppose we were talking about the dominance of the beverage industry by coke and pepsi, who also have flagship brands in the relatively newer non soft-drink categories, and who tend to swallow up any successful breakout company. I know that the industry isn't innovation free per se, if you account for newer categories like snapple, sports drinks, energy drinks, bottled and flavored wate, and so on. And I know that government standards apply to things like bottling and shipping and labor.

But compared to healthcare, it's a different ball of wax. The innovation is primarily illusory marketing..it's all water and flavored water, and we're getting people to sometimes pay $30 or $40 per gallon for the stuff in some instances(which I know, quickly gets into other issues, like what you are really paying for when you buy a $5 bottle of water at a Patriots game).

So is the business argument in such cases that oligopoly tends to be harmless when it concerns relative commodities so long as the prices are still driven relatively low? Because I can't help but wonder whether even cheap things like soda and water could be substantially less expensive if we weren't paying for all the marketing and many many smaller businesses only did local advertising.

FWIW, having spent over a decade in retail, I noticed that the rule "there can only be two or three" extended to virtually every single section of a grocery store, and that it accelerated extremely rapidly when companies began paying retailers for shelf space. Coffee, Diapers, Cereal, soda, paper goods, didn't matter. There were almost always no more than 2 or 3 major players, and if a new one emerged as successful, it always got swallowed up by one of the big three.

Niche markets work regionally, it's all in the product. If the pricing gets out of line, niche players get more market share via price or quality competition.

But in retail markets such as soft drinks, there's no government subsidy or group buying--the consumer who actually pays for the final product is the one making the market choices. Soft drinks are a luxury good by almost any standard, whereas for the most part medical care is not. (Cosmetic sugery is an example of medical treatment as a luxury good.)

Make sense to me.

But egting back to my question, are you saying that the dominance of 2 or 3 huge players in retail markets isn't considered an oligopoly or not a harmful one because the market concerns luxury goods which anyone can do without if they really need to?

Just trying to understand, thanks for indulging me.

Pretty much, but not quite. ALL open markets with differentiated goods will have major and minor players with assorted market share, but that doesn't necessarily make them oligopolies. Luxury good markets and consumer good markets in particular will always show signs of oligopoly structure. Oligopoly is a descriptive definitional term for a market structure characterized by a few large players having a large share of the market, but they can and do arise naturally. And what an oligopoly is differs by who defines it.

The problem of oligopolies "claiming" excessive profits is generally related to cartels. In luxury goods, you can simply not buy if you don't think they're providing value.

"Perfect" competition can only occur with undifferentiated goods, things that do not differ from one producer to another. And it also only occurs where the natural barriers to market entry are low or non-existent. Very few markets exhibit "perfect" competition. It's more of a theeoretical concept than an applied one.