Originally Posted by Deb C

As a person with a pre-existing condition, the ability to buy into this plan is a farce. Currently, if you are without health insurance for 6 months you can buy insurance from a select few companies. Going without insurance for 6 months is an extremely risky propostion. One hospitalization can put you into bankruptcy. But, if you make it six months, then these shrewd con-people can charge you, especially if you are over 55, up to 50% more for insurance. For me to purchase insurance in six months, I would be paying almost $800 a month. And that's with high co-pays and a $6,000 max out of pocket expense, before insurance starts paying. Does this look like a good deal to those of you who say we got a win with this reform?

Of course this isn't the real reform, this is a stop-gap solution to help those who need insurance right now. The 6 months rule is harsh and I really wish wasn't necessary but it is true that many who will benefit from this plan already have been without insurance for 6 months. Even at the high rates there are some who will still benefit greatly from the plan, people who in some cases have a source of income (or savings), perhaps even a fairly good one, but no health insurance.

Ultimately individuals with pre-existing conditions will be insured alongside healthy individuals on the insurance exchanges. Those with a low income will be able to obtain subsidies to help off-set the costs.

$800 - $1000 a month for an individual plan with pre-existing condition... $200 - $250 of that going straight to insurance overhead. Required checkups to maintain eligibility?

Subsidies huh? Maybe if I cancel most of my contracts, quit working, and make just enough money to survive.. I'll break even on the reform.

But you still won't find me anywhere near a doctor's office

Originally Posted by independent

$800 - $1000 a month for an individual plan with pre-existing condition... $200 - $250 of that going straight to insurance overhead. Required checkups to maintain eligibility?

Subsidies huh? Maybe if I cancel most of my contracts, quit working, and make just enough money to survive.. I'll break even on the reform.

But you still won't find me anywhere near a doctor's office

The plans with a pre-existing condition are prior to the exchanges coming into effect (along with the subsidies). It seems you my be confusing the 2 here...

Yeah the current plan is available but not required. Are you assuming that the exchanges will significantly change the pricing of this plan? I expect instead that three more years of growing demand & biflation will increase the costs even more.

Originally Posted by independent

Yeah the current plan is available but not required. Are you assuming that the exchanges will significantly change the pricing of this plan? I expect instead that three more years of growing demand & biflation will increase the costs even more.

It is hard to tell exactly what will occur, though I would argue that the plan in the future will be purchased on an exchange with a mix of people in various states of health (similar to health insurance provided to people working at a large corporation) while this plan is an artificially created partially subsidized plan. It is really an apples to oranges comparison.

I checked some prices on the MA exchange to get an idea what a similar plan costs today. Note that these plans aren't eligible for subsidies, in MA the subsidized plans are separate.

For an individual who is 64 years old in Boston (I would imagine the most expensive case!):

Bronze Low - $455-$617 -- 2K deductible, 5K out of pocket max + copays
Gold $796-$1106 -- No deductible, $20 dr. visit copay, $75/ER visit,$150/hospital stay.

For a 35 year old also in Boston:

Bronze Low -- $231-336
Gold --$401-629

This doesn't seem that bad to me, especially as subsidies are available...

Consider that in the federally created exchanges the gap between older and younger plans will be made less, thus somewhat lowering the cost for older individuals.

The economic issues (ie biflation) are a separate problem...

We were handed over into these greedy hands and told it was better. It's not just the United Health Care subsidiary that's criminal.

Please consider reading the comment after this news piece.

From: Don McCanne <don@mccanne.org>
Subject: qotd: PacifiCare violated state law nearly 1 million times

Los Angeles Times
September 7, 2010
California regulators seek up to $9.9 billion in fines from PacifiCare
By Duke Helfand

California regulators are seeking fines of up to $9.9 billion from health
insurer PacifiCare over allegations that it repeatedly mismanaged medical
claims, lost thousands of patient documents, failed to pay doctors what they
were owed and ignored calls to fix the problems.

In court filings and other documents, the California Department of Insurance
says PacifiCare violated state law nearly 1 million times from 2006 to 2008
after it was purchased by UnitedHealth Group Inc., the nation's largest
health insurance company by revenue.

"This is about intentional disregard for the interests of doctors, hospitals
and patients in California, and the pursuit of cutting costs at any means
possible," said Adam Cole, the insurance department's general counsel. "It's
a story of intense corporate greed."

http://www.latimes.com/health/la-fi-...,6657147.story

Comment: The largest health insurer in the nation (in terms of revenue),
UnitedHealth Group, through UnitedHealthcare's subsidiary - PacifiCare,
violated California state insurance laws nearly a million times! This is the
industry that the Patient Protection and Affordable Care Act was designed to
protect instead of replacing, even though that meant that not everyone would
be insured and many more would be underinsured. This was a trade-off that
resulted in a loss on both ends.

This is more than the gross incompetence of an insurer that has failed to
provide the excessive administrative services for which we are being gouged
involuntarily. As the insurance department's general counsel said, "It's a
story of intense corporate greed."

It's time to throw these incompetent thieves out, fix Medicare, and then
provide it for everyone.

Originally Posted by scotths

It is hard to tell exactly what will occur, though I would argue that the plan in the future will be purchased on an exchange with a mix of people in various states of health (similar to health insurance provided to people working at a large corporation) while this plan is an artificially created partially subsidized plan. It is really an apples to oranges comparison.

I checked some prices on the MA exchange to get an idea what a similar plan costs today. Note that these plans aren't eligible for subsidies, in MA the subsidized plans are separate.

For an individual who is 64 years old in Boston (I would imagine the most expensive case!):

Bronze Low - $455-$617 -- 2K deductible, 5K out of pocket max + copays
Gold $796-$1106 -- No deductible, $20 dr. visit copay, $75/ER visit,$150/hospital stay.

For a 35 year old also in Boston:

Bronze Low -- $231-336
Gold --$401-629

This doesn't seem that bad to me, especially as subsidies are available...

Consider that in the federally created exchanges the gap between older and younger plans will be made less, thus somewhat lowering the cost for older individuals.

The economic issues (ie biflation) are a separate problem...

What about pre-existing condition prices? More of us have pre-existing conditions than you might be aware of.

Here's a bit of info on the MA system.

Executive Summary from PNHC:

The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and
made available subsidized, Medicaid-like coverage for additional poor and near-poor residents of
the state. It also mandated that middle-income uninsured people either purchase private health
insurance or pay a substantial fine ($1,068 in 2009). Smaller fines (up to $295 per employee)
were also levied on employers who fail to offer insurance benefits.

The reform law has not achieved universal health insurance coverage, although half or more of
the previously uninsured now have some type of insurance policy.

The reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3
billion in fiscal 2009. In the face of a state budget crisis in fall 2008, Gov. Deval Patrick
announced that he will keep the reform afloat by draining money from safety-net providers such
as public hospitals and community clinics.

While the number of people lacking health insurance in Massachusetts has been reduced, several recent surveys demonstrate that substantial problems in access to care remain in the state. While the new health insurance improved access to care for some residents, many low-income patients who previously received completely free care under the state’s old free care program now face co-payments, premiums and deductibles that stop them from getting needed care.

In addition, cuts to safety-net providers have reduced health resources available to the state’s
remaining uninsured, as well as to others who rely on safety-net providers for services in short
supply in the private sector. These safety-net services include emergency room care, chronic
mental health care, and primary care. The net effect of this expensive reform on access to care is at best modest, and for some patients, negative.

By mandating that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms. Thus, the reform augments the already high administrative costs of health care. Moreover, the agency that administers the new law (the“Connector”) adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies.

The reform failed to reduce overreliance on expensive, high-technology services. Indeed, some
of its provisions such as changes in Medicaid rates and cuts to safety-net providers (who do more primary care) have further tilted health spending toward expensive, high-technology care.
A single-payer system of non-profit national health insurance could save about $8-$10 billion
annually in the state through reduced administrative costs. This money could be used to cover
all of the state’s uninsured residents and to improve coverage for those who now have insurance, without any increase in total health care costs.

The Massachusetts reform law is not providing universal access to care, even in a state with
highly favorable circumstances, including previously high levels of spending on health care for
the poor, high personal incomes, and low rates of uninsurance.

If it is a totally community-rated pool with age tiers then it might actually do a good job of covering chronic & pre-existing conditions. There are still huge sustainability problems behind that though, from PPP conversions in a national market for local services; high out of pocket costs for unexpected expenses (most people filing a medical bankruptcy did have insurance); and there is of course the spiraling portion of GDP problem leveraged up by the massive amount of private financing that makes the whole thing run. That PPP thing is going to really aggrevate & politically motivate the red-state boomers when they get a new monthly $700 bill - that might be the thing that scares me the most.

Interesting times, indeed.

Originally Posted by Deb C

What about pre-existing condition prices? More of us have pre-existing conditions than you might be aware of.

Those prices are for a plan on the exchange regardless of pre-existing conditions.

The reform has been more expensive than expected, costing $1.1 billion in fiscal 2008 and $1.3 billion in fiscal 2009. In the face of a state budget crisis in fall 2008, Gov. Deval Patrick announced that he will keep the reform afloat by draining money from safety-net providers such as public hospitals and community clinics.

So, as far as I can tell here this is a problem in paying for the subsidized plans (ie not the ones on the exchange above). Perhaps this is in part due to the high unemployment rate as well as the cash shortage virtually all states are facing at the present moment. Also, the federal government has more options in obtaining revenue to pay for such programs than the states do.

many low-income patients who previously received completely free care under the state’s old free care program now face co-payments, premiums and deductibles that stop them from getting needed care.

Potentially a problem.... OTOH some might think that these people should pay something towards their care. More details are needed to understand if this is a significant problem or not.

In addition, cuts to safety-net providers have reduced health resources available to the state’s remaining uninsured, as well as to others who rely on safety-net providers for services in short supply in the private sector. These safety-net services include emergency room care, chronic
mental health care, and primary care. The net effect of this expensive reform on access to care is at best modest, and for some patients, negative.

If people are able to obtain insurance and use cheaper office visits instead of ER visits and such that could be a good thing...

By mandating that uninsured residents purchase private health insurance, the law reinforced the economic and political power of health insurance firms.

This is a vague statement that is hard to quantify the effect of. Ideally we would have the insurance companies competing with each other for customers and that would help drive down cost and up service. If this isn't the case then perhaps this needs to be re-evaluated to determine why.

Thus, the reform augments the already high administrative costs of health care. Moreover, the agency that administers the new law (the“Connector”) adds an extra 4 to 5 percentage points to the already high overhead of private health insurance policies.

It is reasonable to pay something for the advantages of an exchange. An apples to apples comparison of different insurance plans in an environment where one has real freedom of choice regardless of pre-existing conditions would seem like what is needed to foster real competition. Not sure if 4-5% is reasonable or not...

The reform failed to reduce overreliance on expensive, high-technology services. Indeed, some of its provisions such as changes in Medicaid rates and cuts to safety-net providers (who do more primary care) have further tilted health spending toward expensive, high-technology care.

So, some people who previously weren't able to take advantage of the latest technology are now able to do so. Not immediately clear that this is a bad thing (though it could be if the use of technology is wasteful!)

A single-payer system of non-profit national health insurance could save about $8-$10 billion annually in the state through reduced administrative costs. This money could be used to cover all of the state’s uninsured residents and to improve coverage for those who now have insurance, without any increase in total health care costs.

Perhaps single payer is better.. We have little chance of obtaining that any time soon...

Originally Posted by independent

If it is a totally community-rated pool with age tiers then it might actually do a good job of covering chronic & pre-existing conditions. There are still huge sustainability problems behind that though, from PPP conversions in a national market for local services; high out of pocket costs for unexpected expenses (most people filing a medical bankruptcy did have insurance); and there is of course the spiraling portion of GDP problem leveraged up by the massive amount of private financing that makes the whole thing run. That PPP thing is going to really aggrevate & politically motivate the red-state boomers when they get a new monthly $700 bill - that might be the thing that scares me the most.

Interesting times, indeed.

Not sure exactly what you mean by PPP conversions... The exchanges will be created at the state level. I have been assuming that the costs/reimbursement rates etc. would be based on geographic region (as they are in MA, select a different zip code get different prices). They certainly won't be national rates. (I am assuming your concern is that people in conservative states with a low cost of living will have their costs driven up by the cost of living in northern cities as a result of a national market? My apologies if I misunderstood...)

The bill does add maximum out of pocket expenses (in the plans above, those on the gold plan have no out of pocket expenses beyond the copays listed) and removes lifetime caps on insurance payments. Hopefully that will help to reduce bankruptcies.

The GDP problem is a concern, but I see it as 2 perhaps 3 separate problems. One part is to get the individual insurance purchasers into one large pool so they get the benefits of stable pricing regardless of pre-existing conditions that are available to large corporations presently. The second is to provide some subsidies to help those on the margins afford care. The third is to reduce average costs. Progress is clearly made on 1 and 2 and steps are taken on 3.

Health insurers are asking for immediate rate hikes of more than 20 percent in Connecticut for some plans, citing rising medical costs and federal health reform laws as reasons.

Both issues — the new federal health care reform and rising medical costs — are significant drivers of the increases, according to filings by insurers with state regulators that were reviewed by The Courant.

It remains to be seen how much of the requests will be approved. Many people might not see an increase before Jan. 1, and these proposed changes would largely affect new business, mostly in the individual market.

But the overall price shift is the clearest indicator yet of what customers and employers can expect when health insurers submit proposed 2011 rates in late October and November. The current round of price requests launches a clash between insurers who say the increases are justified and consumer advocates and government officials who say the numbers are wildly inflated.

http://www.ctnow.com/health/hc-healt...,5611833.story

Originally Posted by Deb C

Health insurers are asking for immediate rate hikes of more than 20 percent in Connecticut for some plans, citing rising medical costs and federal health reform laws as reasons.

Both issues — the new federal health care reform and rising medical costs — are significant drivers of the increases, according to filings by insurers with state regulators that were reviewed by The Courant.

It remains to be seen how much of the requests will be approved. Many people might not see an increase before Jan. 1, and these proposed changes would largely affect new business, mostly in the individual market.

But the overall price shift is the clearest indicator yet of what customers and employers can expect when health insurers submit proposed 2011 rates in late October and November. The current round of price requests launches a clash between insurers who say the increases are justified and consumer advocates and government officials who say the numbers are wildly inflated.

http://www.ctnow.com/health/hc-healt...,5611833.story

Is it 2014 yet....reason why Democrat head's will roll this November.

First of all, James, I suspect your son is at least as happy to be out of your house as you are!

Here is a terrific article on the state of the health care system and why, alas, the reform won't do any good at all with respect to costs. Essentially the author argues, sensibly in my view, that as long as the profit motive drives the system costs will increase. What a shock. There's also some amazing data in the review about varying health care costs between communities. It turns out that communities with more doctors and more hospital beds spend more on health care, but without any net benefit to their health. Wow.

But how will this ever be fixed now? I have no idea.

This is what happens when corporate owned presidents make make room deals with the devil.

Just days away from the implementation of new rules that will prevent insurers from denying coverage to children with pre-existing conditions, numerous major insurers have opted to end the sale of child-only policies.
Anthem Blue Cross and associate WellPoint, Aetna Inc., Cigna Inc., CoventryOne and others have been making under-the-radar announcements about their child health offerings in recent days, drawing sharp criticism from Democrats and progressive activists who championed the president's health care reform agenda.

Insurers say the government's mandate to extend coverage to children with pre-existing conditions could endanger their obligations to other policy holders -- essentially blaming the Obama administration for their actions.

For more on greed: http://www.rawstory.com/rs/2010/09/m...erage-mandate/

It was supposed to read, back room deals with the devil.

Originally Posted by KaiserD2

Here is a terrific article on the state of the health care system and why, alas, the reform won't do any good at all with respect to costs. Essentially the author argues, sensibly in my view, that as long as the profit motive drives the system costs will increase.

I think that's an oversimplified "profit = evil" ideological statement.

The reality is that in many industries, a competitive, for-profit market drives down prices for many other goods as one seller tries to improve competitive position by undercutting the competition.

I think a better question is: Why is the health care dynamic so much different than other private industries that this doesn't work? Why is it that retailers, for example, keep prices down "for profit" with competition and health care providers and/or insurers can not? Why doesn't everything rise 15-20% a year at "for profit" Wal-Mart or McDonald's if profit is the main cause for out of control cost increases?

It feels good to slam the profit motive and put (almost blind) faith in government, but I think it's really the easy way out here and only a small part of the problem. I'm not arguing to keep the health care/health insurance status quo, but people who think the main problem is "profit" are, IMO, misguided and/or ideologically opposed to corporate profits.

Also don't forget that "government run" comes with government salaries and government benefits that are increasingly unaffordable and unavailable to the private sector middle class as well. And then there is that "non-profit" government education which spends more and more per student each year (far exceeding inflation) and has done so for decades without better outcomes...

Originally Posted by ziggyX65

I think that's an oversimplified "profit = evil" ideological statement.

The reality is that in many industries, a competitive, for-profit market drives down prices for many other goods as one seller tries to improve competitive position by undercutting the competition.

I think a better question is: Why is the health care dynamic so much different than other private industries that this doesn't work? Why is it that retailers, for example, keep prices down "for profit" with competition and health care providers and/or insurers can not? Why doesn't everything rise 15-20% a year at "for profit" Wal-Mart or McDonald's if profit is the main cause for out of control cost increases?

It feels good to slam the profit motive and put (almost blind) faith in government, but I think it's really the easy way out here and only a small part of the problem. I'm not arguing to keep the health care/health insurance status quo, but people who think the main problem is "profit" are, IMO, misguided and/or ideologically opposed to corporate profits.

Also don't forget that "government run" comes with government salaries and government benefits that are increasingly unaffordable and unavailable to the private sector middle class as well. And then there is that "non-profit" government education which spends more and more per student each year and has done so for decades without better outcomes...

I have no problem with profit, it's over the top profit at the expense of human suffering. Wal-Mart for example, makes it's enormous profits on the backs of it's employees. Most are single moms and people without much education. Most Wal-Marts started in rural areas where the education was not on the affordability scale for most residents. Plus, when a Wal-Mart builds its big box store that negotiates the lowest prices with its clout, it runs mom and pop business out of business. 'THAT' is making profit on the backs of the people. They do not redistribute their growing profit with rasied salaries or benefits, it goes into more profit for the corporation that then builds more stores, and the cycle of enormous profit continues on the backs of people.

The same principle holds with the insurance industry. They make profits for the industry, CEOs and and share holders. When someone is considered uninsurable, they are usually dropped because it would cut into profit. They are all about greed. Look at the criminal CEO salaries. That's pure unadulterated profit. And these are the corporate mobsters that have our health in their hands.

Originally Posted by Deb C

I have no problem with profit, it's over the top profit at the expense of human suffering. Wal-Mart for example, makes it's enormous profits on the backs of it's employees. Most are single moms and people without much education. Most Wal-Marts started in rural areas where the education was not on the affordability scale for most residents. Plus, when a Wal-Mart builds its big box store that negotiates the lowest prices with its clout, it runs mom and pop business out of business. 'THAT' is making profit on the backs of the people. They do not redistribute their growing profit with rasied salaries or benefits, it goes into more profit for the corporation that then builds more stores, and the cycle of enormous profit continues on the backs of people.

I mostly agree with this. But it isn't evidence that "profit" is the reason for out of control price increases. One can say that profit comes at a social cost, whether it's rampant inflation or giving employees and small businesses a raw deal. That's a fair statement, and I'm certainly no fan of megacorporation policies and influence on government. But it's not the same as suggesting that the profit motive ensures out of control cost increases.

That was the point in the article that I was critiquing -- that profit is the main reason for out of control health care inflation. If that were true, prices for just about anything in private industry -- not just the cost of health care -- would be rising by double digits almost every year.

Because it isn't the case, there must be plenty of other factors as well, and to focus on "profit = evil" is choosing to ignore all those other factors which collectively still make up most of the "problem."

I just think the expectation that eliminating "profit" will make things so much cheaper through "legendary" government efficiency and cost controls is badly mistaken. Note that I'm not necessarily arguing *against* changes that would take for-profit enterprises out of the picture. But to treat that as the magic bullet to the exclusion of many other factors is somewhere out in Fantasyland.

Originally Posted by Deb C

Look at the criminal CEO salaries.

Sort of like the criminal (perhaps literally now) salaries and pensions paid out to the non-profit public sector leaders of Bell, CA... yes?

"Big Business Bad, Big Government Good" just doesn't always wash. And I say this as someone who wants to kick Big Business out of the bed they share with their political puppets.

Both the private sector and the public sector have outrageous abuses at the top. We shouldn't focus on one of them as evil without calling out the other, or else we're just ideologues.

Originally Posted by Deb C

I have no problem with profit, it's over the top profit at the expense of human suffering.

Oh, let's not mince words. "Over the top profit at the expense of human suffering" is the natural (and, arguably, the intended) outcome of a system designed as a kleptocracy. If we only see the most egregious results in situations like this where things to go extremes, that's to be expected and it doesn't mean that profit in less-egregious situations is actually good, only that it isn't as bad. After all, some things have to be worse than others; that's natural.

What is profit, anyway? In any business that employs more than the owner, it's making money from the labor of others while paying them less than the market value of what their labor produces, and is thus morally (although not legally) theft. This is so built into our entire economic system and has been for so long that it isn't even recognized and most of those using it don't consider themselves thieves -- and arguably they are not, since the blame properly goes to the system itself and not to the individuals who merely swim in it.

Extreme examples such as the insurance companies and Wal-Mart merely emphasize the tendencies of the system as a whole. They and their abuses are not the cause, they are just the inevitable result.

Ideally, a different system that abandons capitalism and the profit motive altogether, perhaps in favor of worker-ownership instead of capital-based ownership, would be the solution. Very difficult to implement, however, and not practical in the immediate future. But at the very least let us recognize that there is nothing sacred or even honorable about the profit motive. It is, very simply, greed. And on those occasions when it doesn't lead to truly awful outcomes, that is only because its scope is limited, and it is carefully watched and never trusted.

Originally Posted by ziggyX65

I think that's an oversimplified "profit = evil" ideological statement.

The reality is that in many industries, a competitive, for-profit market drives down prices for many other goods as one seller tries to improve competitive position by undercutting the competition.

I think a better question is: Why is the health care dynamic so much different than other private industries that this doesn't work? Why is it that retailers, for example, keep prices down "for profit" with competition and health care providers and/or insurers can not? Why doesn't everything rise 15-20% a year at "for profit" Wal-Mart or McDonald's if profit is the main cause for out of control cost increases?

Health care could be classified as something like a public utility. Everyone needs it, products are mostly standardized across markets, and the service has to cover a specific regional area.

There are also basically two kinds of public utilities: exclusive and open. If there were too many toll roads, cities would have a hard time functioning because the street in front of the school or fire department can't just "go out of business" or turn in to a strip mall. On the other hand, it isn't a big deal if private money decides to build a private school somewhere near the existing public one. So education is a much more open utility than roads, but it still functions economically as a utility providing basic services to residents.

Also, health care and education are positive feedback loops. Every student who learns something shares and multiplies that information in the community. Smarter and healthier people earn more money, pay more taxes, and provide more financial support to local business. Basically, education and health are two investments with real serious return financially and in the quality of life & progress of technology.

So I think the way to approach health care and the debate is to treat it as a public utility with the potential for additional open market competition. International healthcare budgets support this idea, because places with cheap, public universal coverage and competitive private premium services seem to deliver the best results at the lower per-capita GDP costs. England and Canada and Astralia kinda screwed up by restricting private competition too much, but places that have both public clinics and elite, private research hospitals seem to be enjoying the best of both worlds at a rock bottom price. Can't argue with results, IMO!

Originally Posted by Brian Rush

What is profit, anyway? In any business that employs more than the owner, it's making money from the labor of others while paying them less than the market value of what their labor produces, and is thus morally (although not legally) theft.

Wow. So an employer that "makes a market" for a laborer's services doesn't add value?

If I pay someone $30 an hour in wages and benefits and they produce exactly $30 of value to my business, why the hell would I hire them? If I only paid them $29, I'm morally a thief? Holy crap.

I would add also that the decision to accept a job offer is entirely voluntary, unlike taxes, so if you would tell the libertarian right that they are full of it when they say "taxation is theft" but you call an employer "morally" a thief for engaging in a mutually agreed employment arrangement, you have no leg to stand on. This is blind, pure ideologically driven selective outrage.

Frankly yours is an argument against anyone wanting to start a private business that hires people. It's only NOT theft when the government does it. So why not nationalize all private industry and "abolish" this theft? Hugo Chavez just called. He wants his ideology back.

Originally Posted by ziggyX65

Wow. So an employer that "makes a market" for a laborer's services doesn't add value?

An employer never makes such a market. The employer merely owns the market. The market is made by consumers' desire for the goods and services the labor produces.

If I pay someone $30 an hour in wages and benefits and they produce exactly $30 of value to my business, why the hell would I hire them? If I only paid them $29, I'm morally a thief? Holy crap.

As I said, the blame goes to the system, not to the individual. Obviously, you can't try to operate against the way the system is designed. The flaw here is in the system of ownership. If the workers own the business, then $30 of net value produced against $30 in pay is a perfect balance. But because ownership is assigned on the basis of capital rather than labor, that perfectly logical and obvious equation no longer applies; the whole point is to enrich the owner rather than to produce and distribute wealth.

As I said, the entire system is designed as a kleptocracy. It's hardly the fault of any one individual.

I would add also that the decision to accept a job offer is entirely voluntary, unlike taxes

Untrue. The same system that assigns ownership based on capital rather than labor also denies everyone except owners of capital the right to produce wealth through their own labor. As such, the decision to accept a job is not voluntary at all, except in the very limited sense that sometimes one can choose between one job and another. One cannot, however, choose NOT to have a job, and instead to produce wealth on one's own, unless of course one has access to capital.

It's arguable that this is more theft than taxes are, since embedded in the concept of theft is that the thief is taking what belongs to another for his own private gain, while taxes are (at least supposed to be) for the public good.

Frankly yours is an argument against anyone wanting to start a private business that hires people.

Please read more carefully. I'm assigning blame to the system as a whole, not to any individuals within it.

Originally Posted by ziggyX65

I think that's an oversimplified "profit = evil" ideological statement.

The reality is that in many industries, a competitive, for-profit market drives down prices for many other goods as one seller tries to improve competitive position by undercutting the competition.

A profits-first system with a captive market makes undercutting impossible and innovation slow. Does anyone believe that the health insurance cartel fosters improvements in medical care? All that it is good for is taking a cut and forwarding money to investors.

I think a better question is: Why is the health care dynamic so much different than other private industries that this doesn't work? Why is it that retailers, for example, keep prices down "for profit" with competition and health care providers and/or insurers can not? Why doesn't everything rise 15-20% a year at "for profit" Wal-Mart or McDonald's if profit is the main cause for out of control cost increases?

The health-insurance cartel has a captive market without responsibility to constrain costs or improve service. Wal-Mart typically has local competition for service, if not price. If anything, Wal-Mart succeeds as a vertically-integrated undercutter. It might be the only local business that can sell for less than MSRP. If you think that Wal-Mart is deficient as a merchant of books, then you can go to some retailer that has a broader selection and higher prices. (You can trust me on this: I haven't bought a book at Wal-Mart for at least ten years; its selection is awful). If you dislike Wal-Mart's selection so badly you can take an occasional trip to Barnes and Noble or order from Amazon.com.

Of course Amazon.com can't sell health care insurance. So we are stuck with a profit-maximizing system that has no constraints. it can literally price people into the grave.

It feels good to slam the profit motive and put (almost blind) faith in government, but I think it's really the easy way out here and only a small part of the problem. I'm not arguing to keep the health care/health insurance status quo, but people who think the main problem is "profit" are, IMO, misguided and/or ideologically opposed to corporate profits.

We have the highest-cost system in the world and the one that offers the highest profits as a "piece of the action". Such is more the economic model of the Mafia than of... well, Wal-Mart or McDonald's. Sure, the health-insurance cartel doesn't use Mafia-style enforcement that includes the legendary(?) cement boots, but the methods are the sort that ensure that despite the highest expenditures in the world on medical care, Americans do badly in longevity.

Also don't forget that "government run" comes with government salaries and government benefits that are increasingly unaffordable and unavailable to the private sector middle class as well. And then there is that "non-profit" government education which spends more and more per student each year (far exceeding inflation) and has done so for decades without better outcomes...

How many civil servants do you know who draw seven-figure compensation? Such explains in part why Social Security is a better buy for the money than is life insurance. The Government has economies of scale and responsibility to voters.

A profit-and-loss system that promotes economic rationality is better by far than a centrally-planned economy of the Soviet model. A system that exists largely to enrich the "right people"gives no incentives for better service ofr humane treatment of people who aren't the "right people" (the "right people" obviously excluding workers and consumers)

Originally Posted by Brian Rush

An employer never makes such a market. The employer merely owns the market. The market is made by consumers' desire for the goods and services the labor produces.

I would argue that an employer provides a ready, somewhat secure venue for labor to produce. I don't think taking a reasonable fraction of the fruits of their labor is "theft." I just don't see it. Given the choice between being hired for a steady $25 per hour in wages and benefits or being a "free agent" and having to market your own skills with an uneven $35 per hour income, many would freely choose the former. In other words, they are saying that a venue that provides them with steady, secure work that doesn't require "free agency" is worth giving $10 worth of labor per hour to their employer. Theft? Really?

If this is theft, then taxation is surely theft. And no, I generally don't think taxation is theft -- but if THIS is theft, then taxation surely is regardless of the "motive" for the taking. If I hold you up at gunpoint and steal $100 from you, it doesn't matter whether I buy a new iPod with it or give it all to the local soup kitchen -- it is still theft; it doesn't matter whether or not the money I forcibly took from you is used for the public good or for personal gain. Robin Hood was a thief regardless of motive even if romanticized because he stole "for the good of the poor."

I just don't see how, in any rational universe, having money forcibly taken from you under the threat of jail time is less "theft" than a voluntary employment arrangement whereby an employer can keep a fraction of the output of an employee -- one where the employee is free to leave and won't face jail for noncompliance.

Originally Posted by Brian Rush

Please read more carefully. I'm assigning blame to the system as a whole, not to any individuals within it.

I get that. But your argument still seems to imply that private individuals never have any incentive to create a business that hires people, because it could never make them more money than if they only went into business for themselves. If hiring others at best adds $0 to the income of the enterprise, it seems pretty obvious to me that someone would usually have zero incentive to hire employees except perhaps for family businesses as the added wealth from the labor would stay in the family.

Look, I'm firmly against corporate influence in government. But I would not go so far to say that private, for-profit enterprise is immoral in pretty much all cases.

Originally Posted by pbrower2a

We have the highest-cost system in the world and the one that offers the highest profits as a "piece of the action".

Even if you took all corporate profits out of the equation, we would still have the highest-cost system by a considerable margin. That suggests to me that there's a lot more to fix than just "eliminating profit." I've seen that US health care costs are 50% higher per capita than just about anywhere else in the world. To believe profit is the entire problem, the health care industry would have to have a 33.3% profit margin, and I'm pretty sure they don't.

If one wants to say that health care, like education, is a public good that should be delivered through a public, not-for-profit system I won't argue against it. But I think the idea that profit is evil in the general case -- or that the profit motive is entirely behind the high cost of American health care -- is rubbish.