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October 25, 2009

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Jim

Once the government starts to subsidize anything, the price rises accordingly. Think about college tuition, housing, ethanol (at least as far as its affect on food prices), ANYTHING....

Cecil Turner

Defenders of a broad health insurance mandate argue that it will lower average costs in the health care market.

And since they plan to subsidize the higher-cost individuals (e.g., preexisting conditions), that is probably correct as an instantaneous effect. And then we get a bait-and-switch suggesting that will lower overall health care costs, which is a risible claim demonstrating a need for remedial arithmetic. Moreover, as the government pumps money into the program, costs will . . . ?

a. skyrocket
b. skyrocket faster than the CBO can count
c. skyrocket so quickly politicians will have to hide the costs in unrelated programs until the next election
d. all of the above
Yep, that would be "d."

bgates

Is there any good reason why health insurance couldn't be structured like life insurance? My vague understanding (which I'm too lazy to Google) is that life insurance premiums are agreed upon at the beginning of a policy, and cannot be changed by the insurer afterwards. Why, besides the employer connection, are health insurance policies always one-year contracts, when everyone wants to have coverage for a much longer time?

MDr

I could sign onto your Class One coverage; Major Medical as were the first insurance plans. The steadily increasing number of services and procedures covered by today's insurance plan are one of the major cost accelerants.

jimmyk

Health care reform is just a guise for massive income redistribution. They can solve the adverse selection problem without ripping people off. 30-year-olds who buy term life insurance pay much less than 50-year-olds. Why should health insurance be different?

But the bigger transfer will inevitably be from higher income to lower income. This will just be another way to effectively make the tax system more progressive than it already is, and make more than 50% of the population beholden to the Democrats.

jimmyk

Oops, bgates, I didn't see your life insurance reference before putting in mine. But they are complementary points. With life insurance, people can choose term insurance or a fixed rate for a longer period of time. Either way it's more or less a fair deal.

ROA

It is much easier to calculate life insurance premiums because the payout is fixed when the policy is issued. That is not the case with medical insurance.

jimmyk

They may be easier to "calculate" (I would use the term forecast), but the same principles apply. For health insurance you use data on expenditures by age to estimate the expected payouts by age, for life insurance you use death rates by age. As long as you have a representative sample you're fine. If you let people self-select into the pool you're screwed.

clarice

The services expansion is not a small thing. Look at states to see how legislatures keep expanding what things health unsurance must cover when for most sentient people catastrophic is what they need and should get.

As to the general matter of Obamacare, I think I speak for the majority of voters when I say (a) I do not trust Congress to be rational and to care about our costs, (b) I am sick of subsidizing the unproductive citizens, illegal aliens and the careless members of our society,(c) I want everyone who votes for such a monstrosity to be voted out of office in 2010.

They already have catastrophic coverage, which is all most of them need.

Actually, we are not sick of subsidizing the uc, the ia & the cmoos, we just expect them to pay for any improvement on what they are already getting, which ain't all that bad.
==========================

Pofarmer

If you want to compare life insurance to health insurance, then you need to freeze the coverage to what is available at the point in time the policy is written.

David

Including chiropractors will not reduce costs if Workers Compensation is any guide. About 35 years ago chiropractors successfully lobbied to be considered the equal of doctors for WC purposes. This change in the law added costs to the system.

Gregory Koster

This sort of "insurance" is a swell reelection plan for our Congressionals. Inevitably, lots and lots of red tape will be tossed into plans to "control costs." Said RT will work by discouraging use. But when the crisis hits and you need to get into care as quickly as a Senator, how to do so? Answer: call your Congressional. The level of RT cutting will be calculated by the contributions you've made. Think Alaska's Don Young was arrogant when he shouted about "my money" ? Wait until your health becomes his, and he and his fellow are decding how much service you get based on campaign contributions.

The only certain long term solution from Washington will come when these ninnies have wrecked the health care system to the point where their own cushy care is impaired, say 5-7 years. Even to a politician that isn't very long. That's also the only scheme worth considering: where the ninnies have to swallow their own snake oil along with the rest of us.

Tully

*I missed the economic class which explained how expanding demand by bringing 40 million new insured people into the system could reduce prices. Unless we have an expansion on the supply side with more doctors and service providers, prices seem set to go up.*

Keep beating that drum. While we do indeed have an incredibly snarled-up and inefficient system, the big reason prices keep going up is that DEMAND EXCEEDS SUPPLY, and demand for health care is inelastic.

There are two "true" reform paths. One is addressing the inefficiencies of the current system in order to expand the amount of care supplied at current spending levels. In layman's terms, more bang for the buck. That's the impetus behind consumer-driven health care, tort reform, e-records, etc. Fairly short-term implementation, just difficult to pass into law.

The other approach is to increase the supply. More doctors, more nurse practicioners, more clinics, etc. That approach requires a lot of lead time -- for short-term to medium-term purposes, supply is fixed. It takes years to train more personnel, build more clinics, manufacture more diagnostic equipment, etc..

Note that these two approaches are not mutually exclusive. As Mr. Maguire correctly points out, simply pumping more money into the system without addressing fundamentals will neither increase efficiency nor increase supply anytime soon, simply boost demand even more. And that pumping up inelastic demand will cause prices to rise even faster, perhaps much faster.

The only way to hold down prices under such a boost in demand is to severely ration. While the ObamaKill plan would indeed transfer wealth from the young and healthy to the older and more wealthy, it would at the same time mandate that those receiving that wealth transfer effectively pay more for any individual bit of care they receive. So the claim that they would actually receive more care overall is questionable at best. What would certainly not occur is anyone getting more bang for the buck.

To sum up: It will cost you more. You will probably get less. The biggest part of the bill will, in the long run, fall on your kids, just like MediCare. Not just through straight-up taxes and fees and boosted premiums, but through the decline in living standards from the deficit spending and such. And we will all be less free, with the decisions of what care you can receive in the hands of government bureaucrats.

Gee, what's not to love?

Pops

I think the simplests plan to provide healthcare for all is to simply provide those that don't have healthcare a PASS.

See, to have healthcare provided you must have a decent job, to get a decent job, you must get some level of education, to get some level of education you need transportation, to get onto said transportation, to get educated, to land a job, to pay for your healthcare....here's your BUS PASS.

Done! Whats next?

Save the planet...eat an environmentalist!

Patrick R. Sullivan
The other approach is to increase the supply. More doctors, more nurse practicioners, more clinics, etc. That approach requires a lot of lead time -- for short-term to medium-term purposes, supply is fixed.

Not necessarily. There is a huge potential pool of healthcare providers currently denied the right to practice by occupational licensure laws. Registered nurses being forced to work under the supervision of MDs who don't know as much as the nurses for practical purposes, say. It's not a trivial problem.

Charlie (Colorado)

Oh, I don't doubt that a mandate lowers average premiums for everyone; it's just that it does it by raising average premiums on the low-risk.

Pops

""The other approach is to increase the supply. More doctors, more nurse practicioners, more clinics, etc. That approach requires a lot of lead time -"""

Or, as Britain found out, you just import Islamic radicals to provide your government healthcare....

I know nossing.  Nossing at all.

A couple of important causes of the run-up in share of GDP that medical care takes is the increasing costs and prices of both drugs and technologies. These have arguably been cost effective.
=================================

Charlie (Colorado)

Tully, I'm unconvinced of your essential assumption: that inelastic demand exceeds supply. I shouldn't be surprised if that's true of Medicare demand, as old people tend to be sicker, and the supply is price-controlled. But overall cost is also driven by other forcing factors, like the costs of litigation and litigation insurance.

clarice

Chaco, in South Florida a lot of oldsters treat doctors' visits as social events and since there isn't even a $1 co-pay they abuse the system and certainly are not invested in helping to clamp down on fraudulent billing which is also endemic there. These are the same consumers who threatened the Deli Den with a cass action suit if they weren't permitted to take uneaten rolls home.

The demand in some cases is absolutely ineleastic--especially where the consumer pays nothing for misusing the system.

clarice

**cLass action suit****

Charlie (Colorado)

The demand in some cases is absolutely ineleastic--especially where the consumer pays nothing for misusing the system.

Clarice, that's more or less the definition of elastic demand: if the price went up, with a co-pay (or by reducing the reward by dropping the social visit part) people wouldn't want to do it as often.

DaveinPhoenix

Me.Me.Me.Me.Me.Me. What I want. What I need. Me.Me.Me. The government will pay for it. We'll make those evil corporations pay if it takes 50 years. I don't care about the millions of taxpayers who they employ. They're gonna pay. Me.Me.Me.

Look at what our "Great Society" has created.

clarice

Typo--which I missed Chaco--I meant supply was inelastic and demand elastic..Ooppsie Thanks for the backstopping.

glasater

Zero has gone to war along with others who "say" that insurance companies are fat cats rolling in dough.

Here is an article giving stats claiming the opposite.

bgates

If you want to compare life insurance to health insurance, then you need to freeze the coverage to what is available at the point in time the policy is written.

Why? The insurance company shouldn't be concerned about what treatment it's paying for, just how much the payment costs. So the insurance is capped at $X lifetime, whether that's $X in leeches, pills, hypospray, or nanobots.

bio mom

Patrick, you can go to the nurse (4 undergrad years). I will choose to see the M.D. (4 undergrad, 4 med school, 3-5 residency years).

glasater

For me--MD's are a few notches above a diesel engine mechanic:)

Patrick R. Sullivan

bio mom, MDs have advantages over nurses for more complicated procedures (e.g. brain surgery), not for garden variety aches and pains--which are far more common.

In fact, for most things practical experience counts for more than extra years of 'education'. Which the AMA has spent years concealing.

Charlie (Colorado)

In fact, for most things practical experience counts for more than extra years of 'education'. Which the AMA has spent years concealing.

Patrick, having been through medical school, and known more than a few nurses, nurse practitioners, and physician's assistants, I've got to say I think you're talking through your hat.

This is not to say that NPs and PAs don't have their place, but they really do need to be backstopped by a real MD; every so often the blinding morning headache really is a glioma.

Pops

Just in case you didn't know....

When the government reports sometime soon on the number of H1N1 cases I am sure it will be very high..

HERE IS WHY:

Took child to doctor today.....they did a nasal flu test...it does not distinguish between normal seasonal flu and H1N1. Doctor told me it will be reported as H1N1 since that is what they are seeing and the test to make sure which it is costs 300 dollars.
Doesn't hurt that vaccines and dollars will flow to the areas with the highest outbreaks of H1N1.

So there will be alot of seasonal flu getting reported as H1N1.

sammy small

bgates - Life insurance has fixed plan costs because the risk has been quantified to a level to do so. Actuarial tables tell them pretty much when the average life will end. It also pays in "then-year" dollars, which is much cheaper than the "current-year" dollars that you are paying them.

Medical insurance is all about the unknowns, better known as risk. These guys try to manage risk with all the existing conditions, smoker/non-smoker, pre-screening, etc on the front end. They also try to reduce the cost increases on the back end by formularies, procedure limitations, negotiated cost blocks, etc.

Some of these can be quantified to a reasonable degree. The big risk that is the wild card is cost increases for all the new technology, new drugs, and lots of procedural stuff caused by doctors trying to avoid lawsuits.

The features of the bills touted by the Dems in Congress all seem to increase the front end risk without any effect on the back end costs. That only leaves one way for overall costs to go and that is up. How they get paid for is ultimately a question of whether it is all taxpayers or just a limited subset.

sylvia

"Although obviously Obama attended it, I missed the economic class which explained how expanding demand by bringing 40 million new insured people into the system could reduce prices. Unless we have an expansion on the supply side with more doctors and service providers, prices seem set to go up."

Well I agree and disagree. It seems to me there will be two opposite effects on cost from this.

One, adding a pool of younger healthier people should lower premiums because you have more premiums paying in to about the same amount of services- as they are young and healthy, they won't need much.

Two, on the other hand, there will be a slight increase of services because the young people who break a leg may get more services than they did before they were insured. Plus there will be a temporary increase of services as healthy people without insurance will all of a sudden, all at once, rush to the doctor when they first get insurance, like kids with a new toy, to get all the check ups they never had. Plus they will be more likely to go to the doctor for a minor complaint since they won't have to pay. But on the whole, this does not add to all the services used up for major care like cancer and heart disease.

So there will be two competing effects. It's up to some analyst to figure out how that works out in cost in terms of more money coming in, to slighlty more services used.

But either way we need more physicians. The doctor shortage happened years ago anyway, and it will get worse. The answer is not just to cut out 50 million people from medical care, so that the ones left don't have to wait in line. That is hardly an ethical way to act. The answer is to have more doctors. They should start recruiting like they do for the military.

sylvia

"The obvious concern is that if pre-existing conditions are covered, shrewd people won't buy any insurance until they get a ghastly blood test or have a nagging pain"

But people are doing this now and everyone is paying for it. The extras they will get with insurance are minor compared to what they are getting for free now anyway without insurance. My theory is people are going to game the system anyway and they are doing so already. It is hard to police everyone effectively and nor would we want to probably. I doubt it will change that much after pre existing conditions are added.

The reason we need to get rid of the pre-exisitn conditions is that it is way too easy for an insurance company to get into some monkey business with it. It leaves open a big giant loophole. So we close it. The downside is that some people are going to cheat, but I think that will be the minority, and it might be the price we have to pay to make sure people who pay faithfully for years are not trivially dropped.

My idea is that since most pre existing conditions are for a year, there should be a fee of one year's worth of premiums for one. That should be about a thousand to ten thousand dollars. I think this way is better because the most the insurance company could get out of cheating would be a few thousand bucks, as compared to saving hundreds of thousands of dollars for say denying cancer treatment, and hardly not worth the cost of a legal battle. It would provide an incentive for people to buy insurance, yet not allow insurance companies to make out like bandits. But that's just my idea.

Tully

There is a huge potential pool of healthcare providers currently denied the right to practice by occupational licensure laws.

The Patrick Sullivan solution: Just issue medical licensures to people until we have enough licensed practicioners! Issue my teenagers one doctor's cred each, please. Then they'll never be poor and can support me in my old age.

Tully, I'm unconvinced of your essential assumption: that inelastic demand exceeds supply.

Maybe because you're conflating two different things to construct a nonsense assumption, Charlie. (1) the fact that US health care demand is currently price inelastic, which is demonstrably true, and (2) the idea that for ANY price inelastic good (or bundle of goods) demand must always exceed supply and must remain inelastic, which is neither asserted nor demonstrable as a general case or in the specific case. Yes, demand for US health care most assuredly exceeds supply of same, and is most assuredly in a price-inelastic demand range. Barring a drastic change in the quality of US health care, that's not going to change any time soon.

It could change for segments of the health care system if the markets were made more efficient, but overall the same conditions would continue to manifest after the efficiencies were fully realized. (IOW, if we eliminated some of the inefficiencies to get more bang for the buck, excess cost growth would resume after the efficiencies were fully absorbed. It is highly unlikely that the added efficiencies would move demand to a price-elastic range other than very temporarily.)

Clarice, that's more or less the definition of elastic demand: if the price went up, with a co-pay (or by reducing the reward by dropping the social visit part) people wouldn't want to do it as often

Er, not exactly. Even a good with inelastic demand exhibits that behavior, as long as the demand is not perfectly inelastic. It's all in the ratio of the percentage changes.

glasater

I know we've read these stories of British Health Care but here is one more article:

Britain's N.I.C.E. Think Tank Not So Nice - C.S. Lewis' Prophesy Comes Eerily True
A look into who decides on life and death in the UK

Two graphs:

The case of Leslie Burke, a retired postman with a degenerative motor neurone disease, is illustrative. Burke sued the government for the right not to be denied nutrition and hydration when his illness rendered him unable to swallow or communicate. He won his first case in 2005 with a judge ruling that denying nutrition and hydration "would be a breach of claimant's rights under . . . the European Convention on Human Rights." But the General Medical Council and the Department of Health appealed and won. ...........

As Wesley J. Smith noted in the Burke case, "It all boils down to two concepts that are increasingly intertwined in modern bioethics theory and practice. First is the so-called quality-of-life ethic that presumes to judge the worth of patients' lives according to their mental and physical capacities. Under this view, doctors or bioethicists may judge a life to be of such low quality that it is not worth extending, irrespective of the patient's wishes."

sylvia

"They are typically far better off than the young who will subsidize them. Yet Congress would transfer huge sums from low-wealth twentysomethings to higher-wealth "

That's ridiculous. So the young aren't supposed to pay for insurance at all? Who do you think pays for the young uninsured when they get in an accident? Probably their parents, as they mortgage out their house to help pay. And what their parents don't pay, the rest of the insured already pay. Insurance will help all age groups, even the young.

sylvia

And one last comment. I definitely agree about coverage creep. That seemed to be the problem with TennCare, with the coverage being so good and cheap, that people started cheating and underreporting their income to get on it. If we have a public option, it has to be bare bones, so that people have an incentive to be on private. It seems TennCare has changed their ways and it seems to be doing better recently, so there is a middle ground that works apparently.

Fritz

Another issue not discussed above will be the increasing role of unions in the health care area. Once the government mandates insurance premiums and services covered it is only a matter of time before they take over an ever larger number of health care service providers. It starts with hospitals, labs and diagnostics services and eventually reaches seniors care homes (in British Columbia where I live a socialist government appropriated these homes from charities and reliogous groups without compensation for the years of fundraising that bought and paid for the land and buildings).

Once the government runs the health care it is all unionized. These become the largest and most powerful public sector unions surpassing by a large degree the teachers. For every election ad by a polical party there are 10 by the various health care unions. Needless to say the health care janitors and secrataries make 40% more than their unionized counterparts in the private sector.

Think health care is a hassle now - just wait until it gets crippled by a nurse's strike and then a technicians strike and then a janitor's strike and of course they all honor each others' pickets.

bad

Sylvia, TennCare is working better because they dumped a huge number of people from the plan.

Pops

The problem is all the government mandates that don't allow competition and flexibility in insurance plans.

I can certainly understand a 18 year old doesn't want to pay huge money for health insurance, but that doesn't mean they couldn't find a reasonable policy to cover catastrophic
problems like a accident, etc. if they wanted. I don't even think I saw a doctor, except dentists, from 17 - 30 years old.
Once they get educated, or married or are having kids they get serious about things like insurance.

The problem is the government wants to socialize everyone's costs so they get all the power.

Old Lurker

Leave her alone, Bad. You blood pressure can't take it!

How're you doing?

Bruce Hayden
That's ridiculous. So the young aren't supposed to pay for insurance at all? Who do you think pays for the young uninsured when they get in an accident? Probably their parents, as they mortgage out their house to help pay. And what their parents don't pay, the rest of the insured already pay. Insurance will help all age groups, even the young.
I do agree that the young (esp. males) don't pay their fair share right now. But, then, again, many of them can't afford to. Most of them are at their lowest earning levels of their lives. Those just entering the workplace constitute the bulk of those making minimum wage.

BUT, to make things worse, and why this is going down the way it is, is that the maximum age rating under ObamaCare would be 2x. So, these young people, many making minimum wage, would end up subsidizing the about to retire baby boomers, who are at maximum earning levels.

Except that this too is seen as not workable, so there will be massive subsidization for all of those who cannot afford the mandates. Coming from whom? Mostly, those same boomers who are at their peak earning levels.

Why is this shell game better? It isn't. As repeatedly pointed out, providing free or almost free health care to 1/10 or so of our population is guaranteed to increase demand. But there are really no realistic plans to reduce costs accordingly.

The one place where there will likely be some cost cutting is in the comparative or best practices realm - which means that some treatments for some people will be approved - i.e. Sarah Palin's "Death Panels". BUT, worse, as we are seeing with Medicare right now, the determination of what treatments are provided to whom will, in the end, be politically determined. This means two things. First, it will be much harder to get new drugs and treatments approved. And, secondly, resources that should be going into new drugs and procedures will be going into lobbying efforts to get approvals.

If they were serious about bringing down health care costs, they would include malpractice reform and push (not ban) high deductible health insurance plans. That they are doing neither indicates that this all is a political shell game.

bad

Hey Old Lurker!! I'm doing well, still adjusting to meds, but the blood pressure is under control. My family makes life much more pleasant than I have a right to expect and JOM is the best medicine.

My doctors believe that Tumor activity is to blame for the blood pressure rise which then caused the headaches and Kidney issues.

But I can still cook supper every night and run errands and pray for my family and friends, so I am blessed.

rse

OT -

Clarice-

Re: the Content vs Ed Degree discussion

There's some interesting emails up on Phi Beta Cons at NRO today about the amazing credentials and experience regarded as insufficient to teach in K-12.

bgates

As Wesley J. Smith noted in the Burke case, "It all boils down to two concepts that are increasingly intertwined in modern bioethics theory and practice. First is the so-called quality-of-life ethic that presumes to judge the worth of patients' lives according to their mental and physical capacities. Under this view, doctors or bioethicists may judge a life to be of such low quality that it is not worth extending, irrespective of the patient's wishes."

You might remember Wesley J Smith as the guy who wrote, "Much has been made in the blogosphere and elsewhere about Sarah Palin’s warning against “death boards” in the current health-care reform proposals and labeling Obamacare generally an attempt to establish a “downright evil system.”

Palin’s language was, in my view, amateurish and hyperbolic." (He was also the author of Culture of Death: The Assault on Medical Ethics in America.)

If you don't remember his insults about Palin, you've most likely never heard of him at all.

Patrick R. Sullivan
...every so often the blinding morning headache really is a glioma.

Again, you're talking outliers. Treating every headache as though it is potentially a serious illness is tremendously wasteful.

And, the hat I'm talking through is the same one Milton Friedman used.

clarice

Thanks, rse. I'll check it out though years ago when I looked into this stuff,I was astonished at how patently ridiculous and guildlike the entire credentialing system is.

Good going, bad.

bgates

patently ridiculous and guildlike

When I left engineering graduate school to become a high school teacher, the guy in charge of deciding who was qualified to skip the credentialing process looked at my transcript and said, "where's the math? All I see is a bunch of calculus."

I'd have more sympathy for his perspective if I hadn't gone on to meet an elementary school teacher who I surprised with the information that 0.1 and 1/10 represent the same number.

bgates

And, the hat I'm talking through is the same one Milton Friedman used.

He has the hat to this day.

He has the hat.

Patrick R. Sullivan

Here's the argument of Milton Friedman:

In the first place, does [licensure] really raise standards of competence? It is by no means clear that it does raise the standards of competence in the actual practice of the [medical] profession for several reasons. In the first place, whenever you establish a block to entry into any field, you establish an incentive to find ways of getting around it, and of course medicine is no exception. The rise of the professions of osteopathy and of chiropractic is not unrelated to the restriction of entry into medicine. On the contrary, each of these represented, to some extent, an attempt to find a way around restriction of entry. Each of these, in turn, is proceeding to get itself licensed, and to impose restrictions. The effect is to create different levels and kinds of practice, to distinguish between what is called medical practice and substitutes such as osteopathy, chiropractic, faith healing and so on. These alternatives may well be of lower quality than medical practice would have been without the restrictions on entry into medicine.

More generally, if the number of physicians is less than it otherwise would be, and if they are fully occupied, as they generally are, this means that there is a smaller total of medical practice by trained physicians-fewer medical man-hours of practice, as it were. The alternative is untrained practice by somebody; it may and in part must be by people who have no professional qualifications at all. Moreover, the situation is much more extreme. If "medical practice" is to be limited to licensed practitioners, it is necessary to define what medical practice is, and featherbedding is not something that is restricted to the railroads. Under the interpretation of the statutes forbidding unauthorized practice of medicine, many things are restricted to licensed physicians that could perfectly well be done by technicians, and other skilled people who do not have a Cadillac medical training. I am not enough of a technician to list the examples at all fully. I only know that those who have looked into the question say that the tendency is to include in "medical practice" a wider and wider range of activities that might well be done by others. The result is to reduce drastically the amount of medical care. The relevant average quality of medical care, if one can at all conceive of the concept, cannot be obtained by simply averaging the quality of care that is given; that would be like judging the effectiveness of a medical treatment by considering only the survivors; one must also allow for the fact that the restrictions reduce the amount of care. The result may well be that the average level of competence in a meaningful sense has been reduced by the restrictions.

....I am myself persuaded that licensure has reduced both the quantity and quality of medical practice; that is has reduced the opportunities available to people who would like to be physicians, forcing them to pursue occupations they regard as less attractive; that it has forced the public to pay more for less satisfactory medical service, and that it has retarded technological development both in medicine itself and in the organization of medical practice. I conclude that licensure should be eliminated as a requirement for the practice of medicine.

laura

bgates
I actually read Smith's book a couple of years ago and have been following his blog, Second Smoke over at first things for the last few months, it's definitely worth a look. While he may have made some disparaging comments about Palin, he is generally spot on regarding the health care issue and to be honest has gradually taken a much harder stance towards the Obama care nightmare. He is as you can see from his blog decidedly on the right side of this issue and has been fighting it a long time.

Charlie (Colorado)

So there will be alot of seasonal flu getting reported as H1N1.

I know I keep repeating myself, but there's a good reason for this. Its The Flu. It's turning out that H1N1 is the strain that's winning this year, but It Is Just Another Flu. It does seem a little bit harder on kids and pregnant women than the usual, but statistically it's not even clear that's really true. In any case, according to the MMWR flu tracking report, there were something like 28,000 cases of flu reported last week and around 50 deaths, 2000 hospitalizations — which is just like a bad flu season.

(By the way, among the flu cases that have been typed, there were about 18,000 cases of H1N1 vs about 100 cases of the other variants total, so statistically it's pretty damn likely that if you've got the flu it's H1N1. In other words, this year, so far, H1N1 is the seasonal flu.)

clarice

bgates, here you could have had a PhD in Math and been unable to teach calculus in public school unless you'd passed the local Ed School's course in remedial reading.

clarice

P.S. I think this is a way to screen out any intelligent people from entering the ranks of the DC public school teaching corps. (Though to her credit Superintendent Rhee seems to be busting a lot of chops to revise that.)

DrJ

"where's the math? All I see is a bunch of calculus."

Obviously he was looking for your coursework in Riemann spaces, topology or number theory. :)

Charlie (Colorado)

Maybe because you're conflating two different things to construct a nonsense assumption, Charlie. (1) the fact that US health care demand is currently price inelastic, which is demonstrably true, and (2) the idea that for ANY price inelastic good (or bundle of goods) demand must always exceed supply and must remain inelastic, which is neither asserted nor demonstrable as a general case or in the specific case. Yes, demand for US health care most assuredly exceeds supply of same, and is most assuredly in a price-inelastic demand range. Barring a drastic change in the quality of US health care, that's not going to change any time soon.

Um, Tully, when I said "remain unconvinced" I suppose I should have included "and won't be more convinced if you restate the same thing more vehemently." Clarice followed with an example that was a little hard to follow because of a typo, but that showed her anecdotal argument for there being some demand elasticity, ie, her observation of demand on medical care that wouldn't exist if the care had a direct cost.

So maybe you could further explain what you're trying to argue?

Er, not exactly. Even a good with inelastic demand exhibits that behavior, as long as the demand is not perfectly inelastic. It's all in the ratio of the percentage changes.

So, you're now saying — what? That anything that's not perfectly elastic is inelastic?

Charlie (Colorado)

So the young aren't supposed to pay for insurance at all?

Sylvia, it's not that the young shouldn't pay for insurance: if they want insurance, they should pay for it.

It's that the young shouldn't pay for someone else's insurance.

Charlie (Colorado)

"where's the math? All I see is a bunch of calculus."

Sigh.

I wish that was unbelievable.

rse

Oh Clarice-

If only the ed schools taught any courses in reading, remedial or not. If you do a survey of elementary teachers, few know or understand the implications of about 42 sounds with only 26 letters.

It's all about social justice. We will be equitably ignorant.

We taxpayers really are funding our own demise.

While too few of us watch and wail.

clarice

rse--online teaching is gaining ground at the post high school level. I expect as more parents opt out of public school and find good private schools too expensive or otherwise unavailable, I expect more entrepreneurs will expand the already existing online offerings.
BTW I blogged that NRO offering and neglected to hat tip you for which I offer deepest apologies.

rse

Mercy me!

I don't want credit. I just want accurate info out while it is still possible it might matter.

We will save the discussion for another day but I am very suspicious of the feds pushing the online work. Will continue to keep track and post when I find something definitively alarming.

clarice

MIT has put its entire (undergraduate) course offerings free online. Anything you want to learn is there for the taking.

clarice

My son'e brother-in-law was living in a small village in Japan where he'd gone to teach English and fell in love and married a local girl. He wanted to become a CPA. He took online courses thru UCLA, flew periodically to Guam for the tests, and was certified.It was convenient and a great deal cheaper than taking the courses at UCLA in person.

Yes, I agree it's not ideal--but then neither is the highly inflated tuition costs occasioned by the need to offer remedial courses, pay the overpriced and overstaffed ancillary services of every university etc etc.Under the guise of preserving campus collegiality we are subsidizing the most gutless administrators.

clarice

**neither ARE the highly inflated tuition costs***

clarice

BTW, this site is so much fun:
http://www.jacksonpollock.org/

rse

One of the saddest aspects of US higher ed is the emphasis on getting the degree as if that's a stand alone from the knowledge and experience a college degree used to signify.

One of my favorite JOM phrases is "credentialed morons". It's amazing how faces light up in recognition when you use that phrase to nail an obnoxious perpetrator.

I've praised and mentioned the MIT offering to all who are interested. Unfortunately that's not the type of instruction the feds and state mean when they talk of online.

This is actually not as offtopic as it seems:

"Education for all"

"Health care for all"

The 3rd mantra of these affiliated groups was "housing for all" but it's mentioned less these days.

bad

Thanks, Clarice.

Old Lurker

Hey Bad...sorry I was late on your 6:25. You sound great! And cooking dinner and keeping Mr. Bad out of trouble I'll bet. It's so nice to have you here making us laugh!

clarice

BTW. if you or any self-learners you know want a complete list of free oline courses in just about anything, here's the list of what's available:
http://selfmadescholar.com/b/self-education-resource-list/

narciso

Educational coursework is not about teaching
a subject, but imparting the right diverse, nonjudgemental, progressive framework, what
does that lead to "my friends"

Charlie (Colorado)

rse--online teaching is gaining ground at the post high school level. I expect as more parents opt out of public school and find good private schools too expensive or otherwise unavailable, I expect more entrepreneurs will expand the already existing online offerings.

Not just POST high school. Check out the Colorado Virtual Academy.

Andrew_M_Garland

The Senate Baucus healthcare bill will raise government spending by at least $829 billion. But don't worry, it will raise taxes and fees by $910 billion, providing an extra $81 billion to the Treasury.

At best. Some say it will cost about $2,000 billion.

Try not to think about the results for Medicare; it costs at least 8 times as much as originally estimated when it was established, and costs more than the employment taxes currently collected to support it.

"Healthcare Reform" is a huge tax hike combined with rationed medical services.
Obamacare Bails Out Medicare

TV Commercial For Healthcare Reform

laura

Charlie,
My ninth grade daughter is using the K12 program only through a county school system here in VA.
We used K12 for 7 and 8th grade as a home school program. The high school program is different in that you must either pay for the International K12 academy or go through a charter or public school system. She has five classes and five teachers. The curriculum is tough, but very good and the teachers have been extremely helpful. She has algebra 2 honors, a sophomore english class, latin, earth science, and personal finance for her courses.
The problem is lack of contact with other kids and motivation. She swims with a team and is playing ice hockey this year so she's not completely isolated, but she really misses the actual going to schooland being part of a high school. Those are factors that don't matter much to us adults anymore but are crucial to adolescents. It's hard enough being 14 and hating your mother much less having her be your main companion.
We also were led to believe there would be more online and IM interaction with the other students, newspapers, clubs etc. That has not materialized in our program and is a loss.

clarice

Yes, I can see that, laura.Lots of home school organizations have tried to work around that with organized activities.
Charlie..yes, exactly. I saw a couple online high schools a few months ago--the best ones have individual tutoring sessions online--

laura

Clarice,

That's the best part, she gets lots of one on one time with her teachers. All she has to do is ask. They have regular office hours and the occasional online class using eluminite, an online whiteboard program complete with VOIP.
Her latin teacher has been at this the longest and sets up regular classes 3 times a week. She gives the students ample time to chat with each other before and after. This is very good for the students.
When she took geometry this summer through the Iinternational Academy K12 program, they were able to exchange IM's and text each other. She even helped a girl in Dubai with her work. For some reason, probably because it's public school now they are not allowed to that, they can only contact the other students through the K12 website. To be honest, I think if she were allowed that contact she would probably not have any problem with lack of social interaction since that is a teenagers main communication method anyway.

clarice

Maybe you ought to raise this issue with the other parents and with the school. It seems a simple enough fix and your point seems utterly reasonable.

jimmyk

So, you're now saying — what? That anything that's not perfectly elastic is inelastic?

No, he's pointing out that you don't seem to understand the definition of elastic. Demand responding to price does not make it elastic. Inelastic demand still responds to price, just not as much as elastic demand.

Not that I'm buying his overall argument. Medical costs aren't going up because "demand exceeds supply," whatever that means in a market where prices and quantities are set in complicated ways by governments and insurance contracts. Costs are going up primarily because we've gotten older and wealthier and want to spend more on our health. This is the fundamental thing that Obama doesn't get, and why reform is not popular.

Frau Ohrwurm

Leslie Burke himself noted dryly that he was aware that "bioethicists have a low opinion of the quality of life of people with profound disabilities."

Dr. Ezekiel "Bioethics 'R' Moi" Emanuel's ears are ringing, and it's not tinnitus.

John Dunshee

If Congress can mandate that you buy health insurance, what else can they mandate that you buy?

And how long will it take for Congress to realize that they have this nifty new power and start using it elsewhere?

And you didn't like earmarks.

Frau Ohrwurm

Sylvia did not keep up with the news from Europe: Germany's health care system is headed for deep Nummer Zwei. LUN

Uriel

Insurance for those with "Pre-Existing" Conditions is NOT insurance.

In the ongoing healthcare debate, I have yet to anyone state the obvious in regard to insuring individuals with "pre-existing" conditions. Perhaps out of a fear of seeming harsh or uncaring.

The OBVIOUS that I speak of is that providing health care or health coverage to individuals with "pre-existing" conditions is quite simply NOT INSURANCE. That is, it cannot be defined as Insurance. What those with "pre-existing" conditions receive is called WELFARE. In this instance, it is welfare provided by a private company in the free market and subsidized by other consumers.

Allow me to provide a very basic description of what insurance IS, and what it IS NOT. Insurance is a privately provided service whereby the provider offers to pay for catastrophic occurrences that befall the buyer in exchange for regular payments. That is, you pay premiums, and IF you get sick the insurer will pay your expenses. The pay-out by the Insurer has the potential to exceed the sum of the Insured's payments. This is the same way that all insurance works.

What Insurance IS NOT, is the payment of expenses for a catastrophic occurrence that has ALREADY occurred, and is ongoing. This is what those with "pre-existing" conditions are demanding when they try to get health insurance.

If you would like a simple proof of this, do the following:

Buy a house. Do not buy Homeowners' Insurance. Wait until your house catches fire. Do not attempt to put out the fire. When your entire house is fully engulfed in flame, call the insurance company. Explain the situation to the Insurance company (that your home is presently burning and cannot be saved). Then, and only then, ask to purchase homeowners' insurance. When they inform you that they cannot give you a policy because your house is currently burning down, explain to them that you have a RIGHT to homeowners' insurance.

You cannot do this, because once your house has burned down, there is nothing to insure. Likewise, once your health has failed, and you have what is called a "Pre-Existing" condition, you no longer have anything to insure. It is your SOUND health that is insured (ensured) by health insurance. If it were your "Pre-Existing" condition that was insured, they would call it "Illness Insurance", not health insurance. Try getting a car insurance company to pay you for a "pre-existing" collision.

Only Health Insurers are asked to pay the expenses of those who have already have a claim and who have not paid any premiums. In any other situations this is known as a GIFT. This particular gift is paid for by other policy-holders.

The only alternatives to the present situation in regard to individuals with "pre-existing" conditions are:
1. Deny "insurance" to anyone with a "pre-existing" condition; or,
2. Provide coverage for "pre-existing" conditions through government managed welfare.

The latter would pay for those expenses related to the "Pre-Existing" condition, and leave those with such conditions to purchase private health insurance to cover all other medical expenses. This would put individuals with "pre-existing" conditions on the same footing as healthy individuals when buying health insurance for care not related to their "pre-existing" condition. That is, with something to actually INSURE.

One way or another, however, the healthy will be paying the medical expenses of those with "pre-existing" conditions. Personally, I would prefer having this administered by the free market (as it is today). However, in today's America, The People seem less concerned with having their money TAKEN via taxation and redistributed by the Government, than they are with voluntarily paying a lesser cost through the efficiency of the free market. [I think I sense an argument against the "witholding" of taxes here]

Lastly, in the interests of "Full Disclosure", I have a "Pre-Existing" condition.

Dave (in MA)
GO PHILLIES!
Uriel

Insurance for those with "Pre-Existing" Conditions is NOT insurance.

In the ongoing healthcare debate, I have yet to anyone state the obvious in regard to insuring individuals with "pre-existing" conditions. Perhaps out of a fear of seeming harsh or uncaring.

The OBVIOUS that I speak of is that providing health care or health coverage to individuals with "pre-existing" conditions is quite simply NOT INSURANCE. That is, it cannot be defined as Insurance. What those with "pre-existing" conditions receive is called WELFARE. In this instance, it is welfare provided by a private company in the free market and subsidized by other consumers.

Allow me to provide a very basic description of what insurance IS, and what it IS NOT. Insurance is a privately provided service whereby the provider offers to pay for catastrophic occurrences that befall the buyer in exchange for regular payments. That is, you pay premiums, and IF you get sick the insurer will pay your expenses. The pay-out by the Insurer has the potential to exceed the sum of the Insured's payments. This is the same way that all insurance works.

What Insurance IS NOT, is the payment of expenses for a catastrophic occurrence that has ALREADY occurred, and is ongoing. This is what those with "pre-existing" conditions are demanding when they try to get health insurance.

If you would like a simple proof of this, do the following:

Buy a house. Do not buy Homeowners' Insurance. Wait until your house catches fire. Do not attempt to put out the fire. When your entire house is fully engulfed in flame, call the insurance company. Explain the situation to the Insurance company (that your home is presently burning and cannot be saved). Then, and only then, ask to purchase homeowners' insurance. When they inform you that they cannot give you a policy because your house is currently burning down, explain to them that you have a RIGHT to homeowners' insurance.

You cannot do this, because once your house has burned down, there is nothing to insure. Likewise, once your health has failed, and you have what is called a "Pre-Existing" condition, you no longer have anything to insure. It is your SOUND health that is insured (ensured) by health insurance. If it were your "Pre-Existing" condition that was insured, they would call it "Illness Insurance", not health insurance. Try getting a car insurance company to pay you for a "pre-existing" collision.

Only Health Insurers are asked to pay the expenses of those who have already have a claim and who have not paid any premiums. In any other situations this is known as a GIFT. This particular gift is paid for by other policy-holders.

The only alternatives to the present situation in regard to individuals with "pre-existing" conditions are:
1. Deny "insurance" to anyone with a "pre-existing" condition; or,
2. Provide coverage for "pre-existing" conditions through government managed welfare.

The latter would pay for those expenses related to the "Pre-Existing" condition, and leave those with such conditions to purchase private health insurance to cover all other medical expenses. This would put individuals with "pre-existing" conditions on the same footing as healthy individuals when buying health insurance for care not related to their "pre-existing" condition. That is, with something to actually INSURE.

One way or another, however, the healthy will be paying the medical expenses of those with "pre-existing" conditions. Personally, I would prefer having this administered by the free market (as it is today). However, in today's America, The People seem less concerned with having their money TAKEN via taxation and redistributed by the Government, than they are with voluntarily paying a lesser cost through the efficiency of the free market. [I think I sense an argument against the "witholding" of taxes here]

Lastly, in the interests of "Full Disclosure", I have a "Pre-Existing" condition.

Charlie (Colorado)

Those are factors that don't matter much to us adults anymore but are crucial to adolescents. It's hard enough being 14 and hating your mother much less having her be your main companion.

Well, it was different for me as I was a Very Unusual Child. But looking through the curriculum here in CO it does apper that, unlike a lot of our schools, one could get an education online.

Charlie (Colorado)

Uriel, you might find my piece last year "Today's health insurance Ain't insurance" of interest.

Stephanie

If anyone could point me to any additional information on any academies for high school and whether it is available in Georgia, I would appreciate it. Georgia Virtual Academy is all I find and it is only for K-8.

My daughter is having extreme problems in school this year (she has Aspergers) and has totally withdrawn from social life. One on one social life. She lives on her computer where she can communicate and does so with hundreds of friends around the world. It is so bad that therapy is to commence this week. Pity, too, she has extended her fears of socialization to golf and is balking at playing on the high school team. She wants to withdraw from school and go to only on line classes. We are hoping that with therapy and with socialization work with a psychiatrist this will diminish, but she is severely depressed right now.

It is heartbreaking, and I have been struggling with this for the last several weeks. It reached critical mass when she started faking illnesses to avoid going to school or football games and finally had a full blown breakdown.

She feels a failure because she can't cope with the demands that high school is making and that the teachers are demanding (it doesn't matter if you don't want to do this group project, you have to) when she is terrified of the social interactions and has retreated into full blown depression.

This online high school might be a good bridge until she can work her way through some therapy and have a better measure of herself and gains some coping skills to put all this into the proper perspective to allow her to overcome her demons. It seems that I have too much of an A personality to do anything other than remind her of what she is lacking, so I am on ignore. I have friends. I go to golf with the ladies. I play Bunco and actually... socialize. Horrors! I must not understand her! I have always preached to my kids to never let em see you sweat, and she is sweating, so that is another perceived failure to her evidently. Anyhoo... I'm laying low on her horizon until the docs get it under control.

Any help on the online stuff would be gratefully received. I feel like I am raising a first generation Solarian...

Mary

Stephanie,

I am sorry to hear about your daughter's difficulties. Unfortunately, the problem is exacerbated by her situation and her age. She is in the stage where the separation from the parents and other family members is very pronounced. I usually describe it as a trial separation. It gets worse for a few years and sooner or later the child realizes you are not as stupid or dorky as they thought and your family gets back together.

A friend has a daughter who suffers from an injury related problem that is resulted in similar symptlons to those of your daughter who is now a commercial artist. I will ask her where they got the best information and help.

She may be able to take some classes through the university or junior college system. I know that high school students can take classes in Virginia. Also, some universities have demonstration schools that may also be a choice.

Stephanie

It's not that she feels her parents are stupid or dorky, but I evidently contrast those things that she feels she is lacking (confidence, social skills, some modicum of success in endeavors I attempt). I did get her out to the course today to play nine holes (but she didn't want to invite any other kids at the club to play with us), but I am not in any way providing tips, solutions or suggestions to her in how to solve her socialization problems and depression. At the therapist's suggestion, I am "laying low" and curtailing some of my socializing and projects to keep it from being so "in her face." Any attempts at talking with her have resulted in a piqued "I'm not you, I can't do that."

I really hope we don't need a long term solution of isolation, hopefully only a temp. solution til the therapy takes hold and she can boldly go where she has not gone before.... OK that was dorky! Guilty as charged, but she actually self IDs as a geek, so that is actually a commonality that keeps us bonded.

Thanks for your advice, I will look into your suggestions.

rse

Stephanie-

If you give me a way of reaching you, I think I can help. I'm in Ga, an attorney, a parent, and a go to on the documented reality underlying the rhetoric in P-16 education in this state.

Clarice-

Thanks so much for the 9:53 Post on online learning. Consider it in the public domain.

rse

In our ongoing interest in Bill Ayers and education, Steve Diamond wrote recently
about Christopher Edley and the recent Renaissance Gathering.

LUN

This is the same Edley the WSJ picked today to be part of a 3 person panel to discuss why the US is Failing Math and Science.

It's not a particularly helpful discussion on the topic, but it appears that the "Ayers Group" of the education advisors is busy all of a sudden.

Cecil Turner

Insurance for those with "Pre-Existing" Conditions is NOT insurance.

No kidding. Nor does getting someone else to pay your bills result in lower overall costs, nor can a program that garners slightly more in 10 years of tax receipts than it expends in 5 years be considered "balanced."

But whatever you do, don't say "death panel" or "tax" . . . because that would be dishonest.

Porchlight

Charlie, I know I'm late to the thread, but wanted to respond to this:

(By the way, among the flu cases that have been typed, there were about 18,000 cases of H1N1 vs about 100 cases of the other variants total, so statistically it's pretty damn likely that if you've got the flu it's H1N1. In other words, this year, so far, H1N1 is the seasonal flu.)

That is not what this CBS report says.

Apparently CDC decided to stop counting individual cases back in July. The state-by-state-data in this report comes from before then, so it is possible things may have changed. However, CDC has been extremely unforthcoming (to CBS) with their data (CBS had to file a FOIA request for the info they got). So I guess this story could be classed as developing.

Anyway, CBS finds that based on the state-by-state info about specimens sent to the lab (see the figure in the middle), H1N1 comes in second to seasonal flu or "other" flu, and the overwhelming majority of specimens came back as not flu at all.

For example, California's breakdown was 2% H1N1, 12% "other," and 86% negative for flu.

So if people are being told, without a lab test, that they have H1N1, chances are they don't, and they may not have flu at all. At least according to the report.

Bottom line, it seems that doctors are diagnosing w/o testing, and that makes me suspicious about the numbers being reported, even if the number of H1N1 cases has mushroomed since July.

jimmyk

Insurance for those with "Pre-Existing" Conditions is NOT insurance.

Yes, though to be fair, there may be a legitimate issue of people who lose their insurance because they lose their job (and COBRA runs out), and who are than SOL if they have a pre-existing condition.

I suspect this is a smaller problem than it's made out to be, but more important, the solution is obviously to sever the link between health insurance and one's job by changing the tax code (as McCain had proposed). But that's too easy and doesn't transfer power to the government, so it's of no interest to the idiots in Washington, D.C.

Porchlight

Oops, slight correction to the post above. CBS' info came directly from the states; CDC has yet to respond to their FOIA request, submitted two months ago.

Captain Hate

I'd have more sympathy for his perspective if I hadn't gone on to meet an elementary school teacher who I surprised with the information that 0.1 and 1/10 represent the same number.

I'm very proud of having taught my middle school teaching (ultimately principal) post-undergrad roommate how to calculate percentages, which ed school had been unable to accomplish.

jorod

There is a corollary to the Chicago Way. It says taxpayers are chumps. Tha's how the Democrats rule....

Janet

Stephanie - One resource to maybe check into is Georgia's homeschooling network. Not that you want to homeschool, but they will know all kinds of schooling alternatives. Here in Virginia it is huge. They will know the best online courses (by high school, a lot of the homeschoolers use online courses). The homeschooling network is a great resource for alternative schooling needs.

Andrew_M_Garland

The Senate Baucus healthcare bill will raise government spending by at least $829 billion. But don't worry, it will raise taxes and fees by $910 billion, providing an extra $81 billion to the Treasury. At best. Some say it will cost about $2,000 billion.

Try not to think about the results for Medicare; it costs at least 8 times as much as originally estimated when it was established, and costs more than the employment taxes currently collected to support it.

"Healthcare Reform" is a huge tax hike combined with rationed medical services.

http://easyopinions.blogspot.com/2009/09/obamacare-bails-out-medicare.html

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