The Free Market And Health Care

I know very little about health care delivery. But one thing I do know -- health care delivery is not a normal market and applying the standard free market platitudes to it is just plain silly. Greg Mankiw does that today and Paul Krugman has the appropriate response:

[E]conomists have known for 45 years — ever since Kenneth Arrow’s seminal paper — that the standard competitive market model just doesn’t work for health care: adverse selection and moral hazard are so central to the enterprise that nobody, nobody expects free-market principles to be enough. To act all wide-eyed and innocent about these problems at this late date is either remarkably ignorant or simply disingenuous.

I say disingenuous.

Speaking for me only

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    Disingenous indeed (5.00 / 1) (#1)
    by cal1942 on Sun Jun 28, 2009 at 04:22:08 PM EST
    Mankiw has the Business Conservative Disease.

    Be as disingenuous as possible to preserve unnecessary parasites or debilitating advantage.

    Only their slavish followers are that stupid.

    Anyone who's given the matter any thought knows what the game is here.

    Here's the part I liked: (none / 0) (#2)
    by oculus on Sun Jun 28, 2009 at 04:30:21 PM EST
    We don't need government-run grocery stores or government-run gas stations to ensure that Americans can buy food and fuel at reasonable prices.

    Hoo boy. (none / 0) (#4)
    by Fabian on Sun Jun 28, 2009 at 04:44:39 PM EST

    That IS priceless (none / 0) (#43)
    by splashy on Mon Jun 29, 2009 at 12:53:35 PM EST
    No mention of things like food stamps, which would be more equivalent to basic health care paid for by the government. The stores and suppliers are privately owned, but the government pays for the food.

    On Fareed Zakaria (5.00 / 1) (#3)
    by BackFromOhio on Sun Jun 28, 2009 at 04:35:22 PM EST
    Krugman today pointed out that there is one healthcare insurer with 71% of the market in Iowa, as just one example of the absence of competition.

    Who has the other 29%? (none / 0) (#5)
    by Fabian on Sun Jun 28, 2009 at 04:46:19 PM EST
    And when do you sue under anti trust laws?

    I don't think you can because (none / 0) (#6)
    by inclusiveheart on Sun Jun 28, 2009 at 04:54:11 PM EST
    IIRC Congress passed legislation protecting the industry on many fronts.

    and yet we're supposed to believe that (none / 0) (#7)
    by of1000Kings on Sun Jun 28, 2009 at 05:03:35 PM EST
    we just let the 'free market' do it's thing?

    wow, that's just plain idiotic...

    there's nothing free market about health care considering about 3-5 companies run 80% of the hospitals (and Tenet is one of the worst run companies in the world)...


    That would call for (none / 0) (#26)
    by Spamlet on Sun Jun 28, 2009 at 09:29:07 PM EST
    civil disobedience on a massive scale.

    I'm right there with ya... (none / 0) (#18)
    by of1000Kings on Sun Jun 28, 2009 at 06:24:37 PM EST

    man, I'm saying too much today that's gonna end up having me black-bagged and detained for a long time without recourse...the American way...


    And you think such a think won't happen (none / 0) (#45)
    by sarcastic unnamed one on Mon Jun 29, 2009 at 01:58:46 PM EST
    in another system?

    If so, think again.


    The free market principle (5.00 / 4) (#8)
    by inclusiveheart on Sun Jun 28, 2009 at 05:13:36 PM EST
    that people have an option not to buy something is completely overlooked in these free market discussions - it is also the key reason that healthcare does not fit into a free market system - because getting sick enough to need medical treatment isn't really a choice people make.

    Plus the system we have now doesn't allow people to choose who gives them care if they do have a medical condition.

    If Ted Kennedy weren't a big Senator and really rich, he would never have been allowed by his insurer to go to North Carolina for his brain cancer treatment - in fact, they probably would have denied him care at all - he's too old and the prognosis for brain cancer too short - the insurers argue the cost is too high and regularly deny treatment to people with brain cancer and leave them to die.  ANd for those reading who may agree with the insurers, I would say that by not treating people and learning more about the disease through treatment, we are never going to be able to find a cure.

    Add to that (5.00 / 1) (#23)
    by jbindc on Sun Jun 28, 2009 at 08:31:01 PM EST
    I saw a short blurb a few years ago about two hospitals in the Denver area who wanted to merge, and while keeping both facilities open, each hospital would specialize in certain areas.  The Justice Department said no, as it would be the beginnings of a monopoly.  Unfortunately, since these hospitals had to compete with each other, costs went up because each had to offer things like a neo-natal unit and a cardiac care units.  To do this, both hospitals had to buy expensive equipment and have highly specialized professionals on staff, so since it cost the hospitals more money, guess where the costs were passed on?

    You know, you'd think the Republicans (5.00 / 4) (#24)
    by inclusiveheart on Sun Jun 28, 2009 at 08:34:11 PM EST
    and their "pro life" friends would be handing out neo-natal care for free all over the place, but no.

    That's because (5.00 / 1) (#29)
    by Matt v on Mon Jun 29, 2009 at 07:15:05 AM EST
    their idea of "pro-life" extends only to the unborn.  Once born, your on your own.



    Babies in the NICU technically (5.00 / 1) (#41)
    by inclusiveheart on Mon Jun 29, 2009 at 11:13:05 AM EST
    should still be in the womb.  That's why they should be handing it out for free - if they want to be consistent - which they never do - but if they wanted to be they should.

    too old (2.00 / 0) (#30)
    by Abdul Abulbul Amir on Mon Jun 29, 2009 at 07:25:43 AM EST
    ...he's too old and the prognosis for brain cancer too short...

    Welcome to Obama care.

    "Maybe you're better off not having the surgery, but taking the painkiller."
    B. H. Obama


    Obama's Grandmother's (5.00 / 2) (#42)
    by inclusiveheart on Mon Jun 29, 2009 at 12:43:35 PM EST
    situation was completely different from Senator Kennedy's situation.  I actually think that Obama has some significant problems in his view of how the healthcare system should work - particularly in that personal responsibility stuff he likes to talk about and seems to believe - but if he was saying this in the context of his Grandmother, then it is a legitimate and important question - not well phrased in my opinion because the central point in asking a question like that is really about quality of life when one's body is shutting down due to disease.  It shouldn't be a question of hip replacement surgery being "too expensive", it should be about surgery of any kind being too much for the body to handle on top of everything else that is taxing it.

    In any case, Kennedy was in relatively good health before they discovered the brain cancer and he has already outlived the normal prognosis of six months - which many other Americans wouldn't have had the luxury of doing because they couldn't go down to Henry Friedman at Duke and get the cutting edge treatment that he and a handful of other talented brain surgeons are doing at research centers around the country.  A friend of mine was going to be left to die in his 30's by the private insurers - Friedman saved him from both the insurers and the cancer.  He is now more than ten years out and continues to be able to work, be a father and husband.  That's a lot more productive than just letting him die and in my opinion a totally worthwhile investment.


    Here's the whole thing (none / 0) (#33)
    by jbindc on Mon Jun 29, 2009 at 08:39:20 AM EST
    However - I still don't want the WH or Congress making these decisions for me.  Link

    Reporting from Washington -- President Obama suggested at a town hall event Wednesday night that one way to shave medical costs is to stop expensive and ultimately futile procedures performed on people who are about to die and don't stand to gain from the extra care.

    In a nationally televised event at the White House, Obama said families need better information so they don't unthinkingly approve "additional tests or additional drugs that the evidence shows is not necessarily going to improve care."

    He added: "Maybe you're better off not having the surgery, but taking the painkiller."

    Obama said he has personal familiarity with such a dilemma. His grandmother, Madelyn Dunham, was diagnosed with terminal cancer and given less than nine months to live, he said.

    She fell and broke her hip, "and the question was, does she get hip replacement surgery, even though she was fragile enough they were not sure how long she would last?"

    Obama's grandmother died two days before he was elected president in November. It was unclear whether she underwent the hip-replacement surgery.

    The event, hosted by ABC News' Charles Gibson and Diane Sawyer, gave Obama a prime-time forum to promote his healthcare overhaul. A total of 164 guests were invited. ABC pre-screened questions, though the White House was not made aware of what they would be.

    Republicans described the event as an "infomercial," faulting ABC for giving the president such valuable TV time in the midst of a high-stakes partisan policy discussion.

    The audience -- which included doctors, patients, health insurers, students and people with ailing relatives -- clearly was unhappy with the current healthcare system. Gibson asked for a show of hands to see how many wanted to leave the system unchanged. No one raised a hand.

    I do not want Congress, the WH or the insurance (5.00 / 2) (#38)
    by MO Blue on Mon Jun 29, 2009 at 09:19:52 AM EST
    companies making these decisions for me or my family.

    I would be willing to bet that the "no further treatment option" would not be applicable to members of Congress or the WH.

    Many illnesses, including cancer, are currently not curable but they have become treatable with the individual living several  years after the initial diagnosis.   Also, people with terminal illnesses have been known to live for several years rather than the few months that were predicted.  Maybe just doping them up and waiting for them to die might not be the best option.  

    I do agree that families need good information so they can make informed decisions about whether or not to pursue additional tests or what types of treatment are the best for the patient. Hospice care is also a treatment choice. In my experience, good doctors or their facilitators will provide you with this information and will spend a lot of time discussing the options available.



    What???? (none / 0) (#49)
    by Abdul Abulbul Amir on Mon Jun 29, 2009 at 05:25:22 PM EST
    The context was quite similar.  Those "too old" should not get some treatments.  Welcome to Obama-care.


    How about a pace maker for a 100 year old?

    Or a hip replacement for a 95 year old?

    Other single payer nations have age limits on many treatments, thats what effectiveness boards do.

    BTW, do you really think that hip replacements for terminal cancer sufferers are at all common?


    It's not just (5.00 / 3) (#11)
    by gyrfalcon on Sun Jun 28, 2009 at 05:25:57 PM EST
    adverse selection and moral hazard by the blasted insurers, either, it's the near total helplesness of the consumer, for crying out loud.  Few employers offer options, and those whose employers don't offer health insurance at all have virtually no affordable options.  Every state has different rules, every insurance company offers different plans from state to state, they're impossible for the average person to sort through intelligently, and most states I'm familiar with have only two or three insurers at most who dominate the market.

    And that's just the insurance part.  We're in absolutely no position to evaluate our primary care doctors, never mind specialists or entire hospitals.  And many insurance plans allow you very little room to shop around anyway.

    Who is Mankiw kidding?

    Talk about living in an ivory tower!

    Not only that...we have to become (5.00 / 7) (#21)
    by oldpro on Sun Jun 28, 2009 at 07:23:40 PM EST
    a nation of bookkeepers.  Just wait until your household has a real illness and you have to (try to) sort through all the billings, prepays, partial pays, primary insurance coverage, secondary coverage, etc. etc.

    If you weren't enraged before, you will be then.


    Medicare (5.00 / 3) (#35)
    by gyrfalcon on Mon Jun 29, 2009 at 09:02:07 AM EST
    The only time I've had to do that was in my late mother's last years, and between Medicare and her Blue Cross "medigap" insurance, all I had to do was watch the paperwork come in and file it away.  With several hospitalizations, major outpatient procedures, various specialists, etc., the only thing we ended up paying for was half the ambulance fee.

    Of course, that was before Medicare Part IV, so she also had to pay for all her meds out of pocket, but luckily, those only became expensive in the last year.  But other than that, she was as totally covered as it's possible to be for a pretty small cost.


    My sister has Medicare (5.00 / 4) (#40)
    by sallywally on Mon Jun 29, 2009 at 10:24:07 AM EST
    and she has all the things the Repubs say will be taken away by a serious public government-run option (well, really single-payer): complete choice of her doctor(s); almost everything covered; no "bureaucrat" standing between her and her physician.... and of course, all those are missing from the insurance companies' plans. Not to mention how much more efficiently Medicare is run than are the insurance monopolies.

    Let us not forget that the (5.00 / 5) (#27)
    by MO Blue on Sun Jun 28, 2009 at 10:12:24 PM EST
    insurance companies refuse to cover the treatment that you physician wants you to have all the time. It has become SOP.

    The problem is (5.00 / 1) (#47)
    by NYShooter on Mon Jun 29, 2009 at 02:15:48 PM EST
    the Republicans are dueling with an unarmed opponent. We all know the American public doesn't have the patience and/or the intellect to think through complicated issues, so why can't the Dems speak in a language they understand:


    "In our Plan we want you to get healthy, and it will be our sworn duty to help you get there;

    In their plan, they want you to die, and they will gladly trade their immortal souls for a few dollars to see that you do."

    "WE explain; You decide"


    I suspect (5.00 / 2) (#12)
    by TeresaInSnow2 on Sun Jun 28, 2009 at 05:27:21 PM EST
    that Mr. Mankiw is a social Darwinist.

    No to market forces in healthcare! (5.00 / 5) (#19)
    by allpeopleunite on Sun Jun 28, 2009 at 06:33:07 PM EST
    I agree absolutely, and would add that not only is the market insufficient to address the healthcare needs of Americans, but that it has absolutely no place in its provision. The sickness and well-being of the masses should not be subjected to the profit motive.

    flaws to your "flaws": (5.00 / 6) (#22)
    by cpinva on Sun Jun 28, 2009 at 07:57:52 PM EST

    1. Many states require insurers to accept all comers, thus negating adverse selection.  The private insurance industry is willing to do this.

    2. All you have to do is use antitrust to break up uncompetitive markets.  If Exxon controlled 87% of the gas stations in Iowa, that's what you'd do.

    3. "Public model" saves money because it doesn't have to retain reserves to pay claims, doesn't pay property taxes or income taxes on profits, etc.

    4. If insurance companies make such exorbitant profits then maybe social security should invest in them instead of US govt bonds.

    1. please identify which states require health insurance companies operating in them to accept everyone, without excluding for "pre-existing conditions"? being required to accept everyone is not the same as actually paying all claims, the two are not mutually inclusive by definition.

    2. many states exclude health insurance companies from anti-trust laws, for "public policy" reasons. as well, it generally falls to the state attorney general, or the federal attorney general, to file anti-trust suits, not individuals.

    3. i have no idea how the reserves requirement adversely affects profitability, since those are revenues previously earned and invested. however, they are restricted in the types of reserve investments they can make, which is probably what kept them all from totally imploding in the past 6 months, as the market fell apart. state law saved them from themselves.

    4. perhaps they should be, but that would require congress to change the law. frankly, the only time i've ever heard of an insurance company losing money (net operating loss) is the result of poor investments, not the consequence of huge payouts to policy holders.

    if the public, single-payer option is such a bad idea, that will offer horrible coverage, why are the insurance companies and their paid minions arguing so strenuously against it? it seems that, after experiencing the horror, people would come flooding back to the warm, comforting bosom of the private health insurance companies.

    i wonder if mr. jackson's doctor is a member of the AMA?

    It's sad to even be attempting (5.00 / 2) (#36)
    by Militarytracy on Mon Jun 29, 2009 at 09:05:12 AM EST
    to have free market arguments when discussing how we provide humanely for our population while we have wonderful humane delivery models currently being used in other "first" world countries successfully.  I know a lot of people freak out contemplating the possible end of the world that would come with being a nation that cared about the health and well being of its population but I'm not one of them.  What Would Jesus Do?  Buy more tanks?  Those kill people too and actually do cost taxpayers and our government, and we do that with little thought or debate these days.  Ignoring the healthcare rip off and encouraging the decline of our civlization kills people for free, people not even on battlefields and just trying to live usually a pretty peaceful life.  Of course taxpayers pay for my insurance coverage and that of my family because we must have a military.....and few people disagree on that.  But a healthy population capable of living and working we don't need for some strange reason.  I don't know how much it will cost us to fix this insanity but I know it is costing us plenty not to in sick days, loss of work force, decline of the populations overall health and clogged choked emergency rooms.  Those are economic factors as well as abuse factors.  If employment and wages were a fair system in the United States I could possibly see how it is the fault of some out there that they aren't insured, but in our country none of that is "fair", and if you are unfortunate enough to suffer from the unfairness of it all please feel free to die now.  I can't believe how much of the covered debate is brought to us by people who are little more than Barbarians.

    The questions are disingenious, (2.00 / 0) (#13)
    by bocajeff on Sun Jun 28, 2009 at 05:40:09 PM EST
    One side says that care will be greater, access greater without an increase in costs (actually a decrease). This can not be true. If the question was framed honestly then it would be a different argument but far more honest: would you accept less quality of care in order for everyone to be covered - or at a much higher price? I had this conversation with Masslib and she said that she would agree to have less care for greater access. This is honest.

    Personally, I favor required catastrophic insurance for everyone. Everyone else is on their own for the smaller stuff...

    Yabbut (5.00 / 4) (#16)
    by Fabian on Sun Jun 28, 2009 at 06:04:47 PM EST
    The smaller stuff is often what can prevent health crises.

    It's like that canard that anyone can go to the ER and get treated.  Most people aren't going to go to the ER because there's something bothering them that they want to consult a doctor about.  Most people show up in the ER because they need immediate medical treatment - which is what can happen when you don't seek treatment for something that has been bothering you.  

    Preventive care can prevent a lot of things.  High blood pressure can lead to a stroke and other things.  Uncontrolled diabetes can lead to kidney failure and other complications.  Untreated UTIs can lead to kidney failure.

    IMO, if there is anything that should be universally covered, it's the little things.  Grandma died of an enlarged heart because she had scarlet fever when she was a child, aka strep infection.  Now it's a quick test and ten days of antibiotics.  Much cheaper than a lifetime of heart meds.  But what if you don't get those antibiotics?  What if you don't and infect someone else?  What if they don't...?

    Public health is all about those little things.  


    Know what else is cheaper? (5.00 / 2) (#31)
    by jbindc on Mon Jun 29, 2009 at 07:30:55 AM EST
    Contraception..... as opposed to a pregnancy and delivery (not to metion coverage for a child for 18 years).

    The amazing thing is that this (5.00 / 1) (#63)
    by jondee on Tue Jun 30, 2009 at 02:11:40 PM EST
    is even up for debate when we tolerate a trillion dollar military industrial Leviathan up to it's eyeballs in rampant fraud, outright thievery and cold-blooded murder.

    To put up with the one, while at the same time getting borderline hysterical about the "socialistic" prospects of UHC, is a triumph of thanatos if there ever was one.


    No Sh*t (none / 0) (#64)
    by squeaky on Tue Jun 30, 2009 at 02:38:44 PM EST
    That is the ginormous elephant sitting in the middle of the room that no one seems to notice..

    Oh, but how are we going to fund public health care...? lol

    No question about it when GE et al, are getting handouts to the tune of a trilion to make things that kill Iraqis and those that look like Iraqis.


    Do you really think people in, say, (none / 0) (#50)
    by sarcastic unnamed one on Mon Jun 29, 2009 at 05:32:20 PM EST
    the UK or Canada don't also put off going to the doc until it really hurts?

    Now that's a canard.


    You misstate the current situation (5.00 / 7) (#28)
    by otherlisa on Mon Jun 29, 2009 at 02:07:10 AM EST
    People who now have insurance are not adequately covered to deal with their healthcare needs. With 63% of personal bankruptcies currently the result of health costs, and 75 odd percent of those people have insurance.

    We get lousy care whether we are covered or not, because of the profit motive in medicine, especially in the insurance industry.


    The freakshow of people (5.00 / 3) (#37)
    by Militarytracy on Mon Jun 29, 2009 at 09:18:08 AM EST
    making scary threatening arguments have even seeped into the psyches of people who need healthcare reform the most.  One of the kids who went in for rib extension the day that our son did last week had a mother who is terrified that if we have healthcare reform her son will not get his "special" rib surgeries and his other needs met.  She is scared to death that healthcare reform will mean we allow our sick or our special needs children to die.  On the other hand, her son is quickly approaching the cap that his insurer will pay for his care in his lifetime.  She doesn't know what she'll do then but it is KNOWN that soon he will have no insurance coverage and he requires a couple of hundred of thousands of dollars in care yearly in this inflated market struggling to survive the insanity itself.  But she is more afraid of the ghost in the closet that Fox News swears is in there.

    How sad (5.00 / 4) (#39)
    by MO Blue on Mon Jun 29, 2009 at 09:28:30 AM EST
    Mothers of sick children should not have to go through with what that mother is going through.

    The lifetime caps imposed by insurance companies are inhumane IMO. There should be a special place in hell for those in politics and the media who use scare tactics and lies to prevent people from getting the care they need.


    Are you using the Military hospitals (none / 0) (#53)
    by Inspector Gadget on Mon Jun 29, 2009 at 06:20:30 PM EST
    and doctors since your husband is a soldier, or do you buy private insurance for your family?

    Perhaps you could share your experiences in gov't run medical for your family.


    Joshua is Tricare Prime (none / 0) (#56)
    by Militarytracy on Tue Jun 30, 2009 at 10:22:29 AM EST
    I did have an Uncle who was a Shriner Potentate in California who flew to see me when Joshua was about a year old and he talked me into also placing Joshua in the Shriners program.  We traveled on our own money to Salt Lake City to get the Shrine Hospital's opinion there.  Because of them we began to get some expert opinions from top notch physicians.  The Shriners were going to pay for Joshua's Rib surgery care but I was furious that Tricare would deny him and I fought.  I fought and I won by showing them what Joshua was going to cost them without the surgery.  I did not find out until the last minute that Joshua was going to be covered by Tricare though, about a week before his initial surgery.  When we moved here he was supposed to have his primary care physician at Lyster Army Hospital here on Fort Rucker.  One of his clips had grown through one of his ribs though and he needed to be X-rayed and have the X-ray sent to his Rib doctors and his physician at Lyster looked dumbfounded at me and babbled that she didn't know where to X-ray.  But for some reason her hand was temporarily paralyzed and she couldn't phone anyone.  She topped the cake by saying that she knew nothing about Freeman Sheldon Sydrome as well.....most G.P.s don't though.  It is very rare and that is why God created medical databases as well as phones to call genetists.  So I wrote a letter to the hosptial Commander detailing how Joshua seemed to be unable to be treated there and he transferred Joshua to a private doctor in town here.  This doctor only works a few days a week though and is very difficult to get an appointment with, but he cares enough about Joshua that he makes the phone calls and uses the databases.

    Most of Joshua's care is outside (none / 0) (#57)
    by Militarytracy on Tue Jun 30, 2009 at 10:24:17 AM EST
    of the "Tricare Network" because the Tricare Network does not contain the elements he needs for his care, everything done needs a separate approval.

    Universal single payer (5.00 / 1) (#48)
    by splashy on Mon Jun 29, 2009 at 05:20:46 PM EST
    Would lead to lower costs and better care. All those countries that have it that have lower costs and better care prove it.

    How can people argue with that as though it isn't true? I'm amazed.


    flaws (2.00 / 0) (#20)
    by diogenes on Sun Jun 28, 2009 at 06:57:50 PM EST
    1.  Many states require insurers to accept all comers, thus negating adverse selection.  The private insurance industry is willing to do this.
    2.  All you have to do is use antitrust to break up uncompetitive markets.  If Exxon controlled 87% of the gas stations in Iowa, that's what you'd do.
    3.  "Public model" saves money because it doesn't have to retain reserves to pay claims, doesn't pay property taxes or income taxes on profits, etc.
    4.  If insurance companies make such exorbitant profits then maybe social security should invest in them instead of US govt bonds.

    We have been doing this for decades (none / 0) (#9)
    by joze46 on Sun Jun 28, 2009 at 05:21:55 PM EST
    It's really funny when we debate about health care while one of the culture Icons goes into his second autopsy, even though Michael Jackson has an honest and forth coming private family doctor, or is he, Hmm, the question is spinning still.

    Did Michael Jackson have that drug cocktail many artists do, do? Then Uh Oh.  

    Will we all have Congressional Style MRI, Rock star Icon medication, over the top in your face better than anything with clouds separating and lightning bolts frank in your stein Health Care System? Yes we can...have Rush Limbaugh's secret medical performance drugs with out anyone knowing then I could run around declaring my talents on loan from GOD. Just hoping GOD doesn't call in that loan...

    The other funny thing is we do subsidize food in terms of farmers; let's not go there this has been going on for other decades. Actually if we look at Wal-Mart they are selling food too. And we get loans from the Chinese, then turn around and sell food and other goods cut rate with low paid workers... and no health care. Sheesh.

    We give tax benefits to oil companies that are part of the Arab OPEC syndicate loaded with the Wahabbi that use the profits to wage war against us. I'm rolling on the floor now laughing my side hurts.

    We have been doing this for decades. Don't even talk about the free money through the Federal Reserve, or the World Bank, or the International Monetary fund loop holes and a loaded IRS that should have been fired and now wide spread banking fraud in a community that is run by professionals, college graduates MBA, Doctor all have jobs while they screw up the system.

    While Joe Six Pack stands in the unemployment line. This is a WTF" moment. Like Obama said this is our moment but he didn't say what kind and right now it happens to be a "WTF" moment.

    Please to let you know this is said with laughter and with pause. Well for what ever it worth America has a pretty good water distribution system and it is run by the local governments we have a decent postal system and it run by the government we do have a decent sewer system and it is run by the government. We do have pretty decent police and military system and its run by the government.

    What the hell why not kick in the health care too? Of course there is a lot of sub contractor biding that is going on in these areas but is that what you mean by free market? Or it's called the "political market". Hell that's been going on since the time of Caesar that's why we put "IN GOD WE TRUST" because you can not trust the politicians...    

    Disingenuous on the free-market stuff, yes but (none / 0) (#44)
    by vicndabx on Mon Jun 29, 2009 at 01:11:06 PM EST
    Paul should've went on to explain that the moral hazard and adverse selection stuff refers (primarily) to actions taken by providers of care and receivers of care, i.e. docs, hospitals, and us.  A reprint of the Kenneth Arrow's doc is here.

    Jesus Christ (none / 0) (#58)
    by Militarytracy on Tue Jun 30, 2009 at 10:32:03 AM EST
    Number 1.  What a total crock

    Number 2.  Your document you reference is from 1963, two years before I was even born.  Society and the economics of insured healthcare have changed.


    Hey, don't shoot the messenger (none / 0) (#60)
    by vicndabx on Tue Jun 30, 2009 at 11:51:12 AM EST
    Paul K was the one who referred to the paper as "seminal."  

    The reason why Paul K doesn't (none / 0) (#65)
    by Militarytracy on Tue Jun 30, 2009 at 06:28:10 PM EST
    go onto explain that the moral hazard and adverse selection stuff refers to actions taken by us is because the existing system resembles the system in 1963 very little if at all, and the input that consumers have on the system is very little outside of paying your premium and arguing with denials or lack of services.  The paper was only "seminal" in exposing the "market" differences between healthcare and other free markets not dealing directly in delivering life or death.

    Why do you suppose that is? (none / 0) (#46)
    by sarcastic unnamed one on Mon Jun 29, 2009 at 02:02:12 PM EST
    has a higher infant mortality rate than all other developed countries.[14]

    Actually the real question is (1.00 / 0) (#54)
    by sarcastic unnamed one on Tue Jun 30, 2009 at 01:30:43 AM EST
    will this change in the "system" be better than that?

    Luckily for us, (none / 0) (#59)
    by sarcastic unnamed one on Tue Jun 30, 2009 at 11:43:18 AM EST
    the reality is that you and the rest of those who's entire thought process consists of "OMG, ANYTHING has to be better than what we have now!!!!" remain a fringe element.

    I sincerely hope we soon top that list. (none / 0) (#62)
    by sarcastic unnamed one on Tue Jun 30, 2009 at 01:13:42 PM EST