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 11 
 on: September 23, 2009, 08:28:58 EDT 
Started by DavidLeoThomas - Last post by Ihlosi
I agree that single payer or, at the very least, private support for single payer is a better option by far.

I'm a bit confused why "single payer system" and "public health insurance" are used synonymously. It's perfectly possible to have a public system and still have "multiple payers", e.g. like Germany does. You're still able to pick your public health insurance provider from several available ones. And then there's still a private insurance system coexisting next to the public one.

 12 
 on: September 23, 2009, 01:47:14 EDT 
Started by DavidLeoThomas - Last post by Medivh
The Swiss would disagree with you. Switzerland's health care system is entirely private, though regulated very heavily. Essentially, the "we're jerks to old people" plan should, if Obamacare follows the Swiss model, be illegal, and cheap and easy to contest.

This isn't to say that I think you're completely wrong, just that setting up a completely privatised universal healthcare system is not immediately doomed so much as harder to get right. It also isn't to say that I think that privatised universal healthcare is the better solution. I agree that single payer or, at the very least, private support for single payer is a better option by far.

 13 
 on: September 22, 2009, 23:45:59 EDT 
Started by DavidLeoThomas - Last post by DavidLeoThomas
I don't misunderstand the political reality;  I aim to change that reality.

Not, primarily, by posting to an internet forum, of course - but IRT has often been a good place both to clarify my ideas and refine my arguments.

 14 
 on: September 22, 2009, 22:26:17 EDT 
Started by DavidLeoThomas - Last post by Blue Boy from Red Country
I whole-heartedly agree, but sadly, a single-payer system would be incredibly difficult to establish in the US, for several reasons...
  • Americans in general view discretionary income as a form of personal liberty; they also tend to be hypercritical, especially when the government is involved. Many Americans would prefer to be able to choice from many less ideal options than to simply be given an ideal option, because the former gives them a sense of freedom.
  • The Health Insurance industry - like many other industries - is so entrenched that disbanding it outright would have a dramatic (and initially problematic) effect. Even if you put politics aside, the logistics of getting everyone switched over properly to a single-payer system would be a lot.

Granted given how little has been done over the decades, some dramatic change is needed; however, I'd rather something be done than nothing. The current proposal is far more politically viable.



 15 
 on: September 22, 2009, 13:30:39 EDT 
Started by DavidLeoThomas - Last post by DavidLeoThomas
Competition.  It works great to keep costs down, quality up, and consumers happy.  Right?

... right?

Well, most of the time, yes.

If a box of cookies costs twice as much as a comparable box of cookies, I'll buy the cheaper one.  If a box of cookies is twice as good as a comparably priced box of cookies, I'll typically buy the better one.  The company that's performing better, does better and everything works out (modulo externalities).  With cookies, I don't actually know the quality of the specific cookies I'm buying, but this turns out not to matter so much - I can guess (with fair reliability) at the quality of the next batch, and the company benefits from keeping me as a customer.

The problem with health insurance is that the costs for an individual are typically low for a long time, and then become typically high.  In terms of the cookie example above, I'm paying $10/month for a box of cookies every several months and the expectation that, many years from now, I'll be able to get tens or hundreds of boxes a month without paying significantly more.  Once I'm costing the cookie-makers so much more than I'm paying them, competition does not motivate them to keep giving me good cookies - it motivates them to give me bad cookies in the hopes that I'll leave and stop costing them so much money.

Competition works when keeping and winning customers is valuable.  In health insurance, that's only true for some of the customers.  In health insurance, driving away those customers that most need the service helps the bottom line - the market incentive is for insurance companies to treat these people badly.  Competition will fix nothing.

Of course, this is checked to some degree by the threat of legal action if people are treated too poorly, and the possibility of bad press leading to loss of customers in the profitable group.  The first of these will only motivate a minimal standard of service, and may not even suffice - as high as legal costs are medical costs can top them, and the people victimized are busy dealing with whatever medical issue incurred the costs in the first place and may therefore be less likely to take action.  The other may motivate a higher standard of care, but only to the degree that it's cheaper to actually provide service than to work PR, manage the media, pay out bribes, etc - and this is assuming the profitable people care about those in the other group; if insurance is legally mandated (as proposed) and it is easy to switch plans, we might see a lot of subscribers to Young Healthy Insurance: "We're Jerks To Old Or Sick People To Save You Money".

The addition of a self-sustaining public option does not fix things.  If it has to pay for itself, it is subject to the same pressure of competition as any other insurer - pressure which pushes in a direction counter to the best interest of the consumers and counter to the public good.

The only proposals that I've seen that actually solve the problem are single-payer.  Any such system would require significant oversight - but so do the alternatives (present and proposed), and only in a single-payer system is there actually a clear way to assess the quality of what we are getting: better health outcomes for less money tends to mean the system is doing a better job.

 16 
 on: September 20, 2009, 17:16:32 EDT 
Started by wodan46 - Last post by Ihlosi
That example only works because the conversion is easy, accurate, and given. 

The experiments cited in the book are less clear in this regard (one of them used faces, for example). The result is that if there are two similar choices (with one being clearly better than the other) and another choice that is not easily comparable to the other two (but in general as good as the better of the first two choices), there's a statistically significant bias toward picking the better of the two easily comparable ones.

So, if you're trying to sell a product and your competitor offers something that's roughly as good as your product, how do you boost your sales? Introduce a slightly inferior version of your current product.

 17 
 on: September 18, 2009, 15:13:46 EDT 
Started by wodan46 - Last post by wodan46
However, if you did an experiment and offered the participants to take either $100, $80, or €85, and told them the exchange rate, you'd still end up with a significant fraction of the participants picking the $100, because it's easier to compare $100 to $80 than $100 to €85. (of course, this experiment should be done in a place where the official currency is neither US-$ nor Euro, or you'll have people just pick the local currency for the sake of simplicity, which is another type of irrationality and not part of this experiment).
That example only works because the conversion is easy, accurate, and given.  However, in most cases, conversions are not as easy or accurate or obvious, and as such, its safer to go for the definitively high value.  People act according to what makes the most sense in the real world, not the experiment's sterile one.

 18 
 on: September 17, 2009, 21:50:13 EDT 
Started by wodan46 - Last post by Blue Boy from Red Country
Having spent the last couple of days in the US, I found it interesting how the whole healthcare "debate" (or lack thereof, I don't consider hysterical yelling and screaming part of a debate) is playing out, especially compared to what happened while the last president was in office. Sometimes, I wish the Democrats would have raised as much hell against the policies back then as they're facing now, but then again, they're usually too civil for that.

I once heard that politicians as far back as Theodore Roosevelt were aware of the problems with a for-profit Health Care system. The matter has been a subject of discussion long enough that there's really little need left for broad intellectual debate; its all a matter of figuring out the details and how to introduce changes.

This current attempt at Health Care reform may actually succeed not just because of the large Democratic majority in power, but because costs have reached the point that most employers are shifting the burden onto their employees. Companies willing to pay 100% of the cost are becoming more uncommon.

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Also, it seems that you don't need the internet for a decent flamewar, letters to the editor of the local newspaper will do just fine. Wink

lol, "flamewars" have been happening for a long time... The Internet just allows them to happen much faster. Cheesy

 19 
 on: September 17, 2009, 08:32:34 EDT 
Started by wodan46 - Last post by Ihlosi
Interest is a subjective term.

That is why the experiments first try to eliminate the subjectivity. "Maximize the amount of money/chocolate/etc you have at the end of the experiment." is a fairly objective goal.

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What if the person wants to lose?

That would also be irrational, at least as far as market actors are concerned. The free market only delivers the predicted results if everyone wants to "win".

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What if the person lacks all the information or knowledge needed?

This concern can also be eliminated in the experiments. They show that even if people want to win and have all the information they need, they'll still make suboptimal choices.

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According to your interpretation, if I step out the front door of my home, then get blown up by a landmine, I'm being irrational, even though I had no reason or warning to presume such an event would happen.

No, that's not what I said, and neither does the book.

However, if you did an experiment and offered the participants to take either $100, $80, or €85, and told them the exchange rate, you'd still end up with a significant fraction of the participants picking the $100, because it's easier to compare $100 to $80 than $100 to €85. (of course, this experiment should be done in a place where the official currency is neither US-$ nor Euro, or you'll have people just pick the local currency for the sake of simplicity, which is another type of irrationality and not part of this experiment).

 20 
 on: September 17, 2009, 00:06:57 EDT 
Started by wodan46 - Last post by wodan46
But rationality is an absolute property.
Irrational as in "making a decision that easily identified as being against their own interests".
Interest is a subjective term.  What if the person wants to lose?  What if the person lacks all the information or knowledge needed?

According to your interpretation, if I step out the front door of my home, then get blown up by a landmine, I'm being irrational, even though I had no reason or warning to presume such an event would happen.  If a person acts within the boundaries of their knowledge and talents to pick the choice they want the most*, then they are being rational.  That is my perspective.

*and they can pick no other, for if they did, they'd by definition want it more.

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