tag:blogger.com,1999:blog-5806884.post7684298505865223719..comments2023-10-31T03:18:26.963-07:00Comments on Great Guys Weblog: Not Free to DieBrethttp://www.blogger.com/profile/15063508651955739056noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-5806884.post-89086206248535131822011-09-25T09:02:34.487-07:002011-09-25T09:02:34.487-07:00Bret, exactly my point. Let us all decide and pur...Bret, exactly my point. Let us all decide and purchase the kind of insurance we want and think we need and not build up a huge bureaucracy to cover each and every possible contingency.erphttps://www.blogger.com/profile/09826044412670324694noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-24334851974951750682011-09-24T21:06:51.829-07:002011-09-24T21:06:51.829-07:00However, in the case of catastrophic care for 30-y...<i>However, in the case of catastrophic care for 30-year-olds, it pretty much is an insurance scenario. The odds are extremely low (less than 1 in 1,000) that a 30-year-old male will need a lot of health care.</i> <br /><br />You can't have it both ways. If it is an insurance scenario for a 30 yo male, then it must always be an insurance scenario for that male.<br /><br />In which case it is exactly analogous to life insurance: pennies on the dollar for that healthy young male, but rather a different exchange for that same male 50 years later, no matter how healthy.<br /><br />Treating it as insurance is fine, so long as you are willing to acknowledge that at some point the risk is too certain to spread, and he won't be able to get any. For that to have any meaning, though, there must be no care available to him when it is his turn, beyond what he can fund on his own dime.<br /><br />A scenario we both agree won't happen. Unlike the life insurance analog; no one has any problem with that sort of risk pricing.<br /><br />Everybody's usage needs to be changed, because (like promiscuous use of the word "free") it leads to conceptual delusions. <br /><br />Instead, confront the problem for what it really is. Lifespan, litigation, technology and heedlessly expanding the bounds of "health" care have created a situation where average life cycle cost exceeds the annual funding ability of a significant part of the population.<br /><br />Now what?Hey Skipperhttps://www.blogger.com/profile/10798930502187234974noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-53474963868601238952011-09-22T07:31:11.069-07:002011-09-22T07:31:11.069-07:00... vast majority of the money [for free clinics] ...<i>... vast majority of the money</i> [for free clinics] <i>comes from the federal and state governments.</i><br /><br />No it doesn't. <br /><br />It comes from the taxpayers and it would be far more efficiently spent if were local taxpayers paying the tab. "Free" as government grants are generally regarded, even by those who should know better, money is easily squandered.<br /><br />Free clinics are also supported by charities, money taken from paying customers at hospitals and other medical facilities and volunteers who donate their time and expertise of which I am one.erphttps://www.blogger.com/profile/09826044412670324694noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-80189644379759161152011-09-21T22:50:36.272-07:002011-09-21T22:50:36.272-07:00Hey Skipper wrote: "The problem neither Krugm...Hey Skipper wrote: "<i>The problem neither Krugman nor you come to grips with is that the concept of "insurance" simply does not apply here.</i>"<br /><br />I agree that most so-called health "insurance" is really a health maintenance contract. Indeed, the term Health Maintenance Organization identifies that fact pretty explicitly.<br /><br />However, in the case of catastrophic care for 30-year-olds, it pretty much is an insurance scenario. The odds are extremely low (less than 1 in 1,000) that a 30-year-old male will need a lot of health care.<br /><br />Those in the profession of managing health care like my wife refer to things like Medicare, not as insurance, but as coverage. The rest of us distort English a bit by calling it insurance.<br /><br />The "poor person who plays it safe and buys health insurance" that I mentioned may or may not be buying insurance in the strict definition of the term. If it's a high deductible policy, then it really is insurance.<br /><br />Anyway, you're not going to change everybody's usage, so I just have to hope you know what I meant.Brethttps://www.blogger.com/profile/15063508651955739056noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-65781002067618706042011-09-21T19:21:53.947-07:002011-09-21T19:21:53.947-07:00His "Free to Die" title initiates the de...<i>His "Free to Die" title initiates the demagoguery from the very start and is an eerie echo of the "Death Panels" quip by that great demagogue of the right, Sarah Palin.</i><br /><br />Ms. Palin's use of the term "Death Panels" was demagogic, but not wrong. Countries with socialized medicine control cost by rationing care, so the elderly and terminally ill get only palliative care. On the face of it, that is hard to argue with. However, not so much at the margins. My grandmother got a hip replacement at 84, which might very well not have been allowed in the UK. She lived for another 13 years.<br /><br /><br /><i>Sowell does a good job describing the visions from a fundamental perspective in "A Conflict of Visions".</i><br /><br />One of the best books I have read.<br /><br /><i>Lastly, I completely disagree with Krugman's definition of "compassion" …</i><br /><br />Of all the conceits surrounding progressives, that has to be the most infuriating and destructive.Hey Skipperhttps://www.blogger.com/profile/10798930502187234974noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-44288364448214825982011-09-21T19:21:41.906-07:002011-09-21T19:21:41.906-07:00If, during the treatment, you end up in the ICU fo...<i>If, during the treatment, you end up in the ICU for 6 months, nobody will pull a life support plug, even if you can't pay.<br /><br />...<br /><br /> This means that a relatively poor person who plays it safe and buys health insurance ... is subsidizing the relatively high earning 30-year-old man in the example. <br />…<br /><br />Should the federal government intervene if he then gets sick and can't afford to pay for care required to save his life? Only a little more than 1 in 1,000 30-year-olds die in a given year from all causes. The other 999 that didn't buy health insurance had money to do other things</i><br /><br />There are a couple words I wish I could excise from our vocabulary: "free", and "health insurance".<br /><br />The problem neither Krugman nor you come to grips with is that the concept of "insurance" simply does not apply here. Insurance is a bet: I'm betting my house will burn down; the insurance company is betting it will not. The concept of insurance only makes sense if risk is low, the cost of the risk becoming actuality is prohibitive, and the risk pool is large. A market in fire insurance clearly makes sense — very few houses burn down, houses are very expensive to replace, and everyone who has a mortgage must have fire insurance. In contrast, flood insurance covering homes in an area that floods every six years does not. <br /><br />"Insuring" against health costs is much like flood insurance in a place that reliably floods where the risk pool is limited to those homeowners. <br /><br />Instead, we should think in terms of life-cycle health cost. Everyone is born and dies. In the US, because so few people die traumatically, most people <i>will</i> incur the overwhelming amount<br />their life cycle cost at the beginning or end of their lives. <br /><br />As much as I think Obamacare should be renamed Obaminationcare care, I am sympathetic to the fact that if we were to pass a law that required each person to put annually into a bank the amount of money that would eventually amount to the average life cycle cost over an average lifetime, the required amount would be a crushing burden for those below the median income. (Assume average lifespan of 75 years, and average life cycle health cost (LCHC) of $200,000. At 3% compounding interest, each person would have to put into their LCHC account $750 per year starting at birth. For a family of four, that would be $3000 per year; which perhaps doesn't sound insuperable. However, the actual amount would have to be substantially higher, because this requires a completely unrealistic scenario: all LCHC costs are encountered at the end of the 75 year period. Incurring merely $1500 of health care cost at the end of each decade increases the annual LCHC increment to $860)<br /><br />So your 30-year old is gaming the system, in exactly the same way I would if I had a crystal ball and through it could determine my house was going to be hit by lightning in 60 months, and therefore I would forego fire insurance for the next 59. He has a very high likelihood of eventually spending the average LCHC cost, but he is unwilling to pay for it.Hey Skipperhttps://www.blogger.com/profile/10798930502187234974noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-76724626119498712042011-09-20T11:25:52.046-07:002011-09-20T11:25:52.046-07:00Where do you suppose the money comes from for thos...Where do you suppose the money comes from for those "local free or low-cost health clinics"? My wife runs a network of those and the vast majority of the money comes from the federal and state governments.Brethttps://www.blogger.com/profile/15063508651955739056noreply@blogger.comtag:blogger.com,1999:blog-5806884.post-52682526031995786052011-09-20T10:42:11.128-07:002011-09-20T10:42:11.128-07:00The bureaucracy needed to provide the coverage of ...The bureaucracy needed to provide the coverage of every possible contingency is far more expensive than your 30 year old uninsured man example and local free or low-cost health clinics are far cheaper than the obscenity that is Obamacare or even Medicaid -- wasteful make work projects for public sector unions.<br /><br />Workers have always provided for shirkers one way or the other, but there's no way workers can provide for the institutionalization of shirking that seems to have become the goal of our entitlement society.erphttps://www.blogger.com/profile/09826044412670324694noreply@blogger.com