The scary woman from Queens

[Pete F.]

Originally Posted by detbuch

There is this peculiar notion that if private business entities charge so much that not everyone can afford their product it is because they are too greedy. But if public entities are "unaffordable" for all, it is because everybody isn't paying enough.

That's simple isn't it?
From The Grumpy Economist
https://johnhcochrane.blogspot.com/
Single payer sympathy?
A July 30 2018 Op-Ed in the Wall Street Journal, titled "The tax and spend health care solution"
Why is paying for health care such a mess in America? Why is it so hard to fix? Cross-subsidies are the original sin. The government wants to subsidize health care for poor people, chronically sick people, and people who have money but choose to spend less of it on health care than officials find sufficient. These are worthy goals, easily achieved in a completely free-market system by raising taxes and then subsidizing health care or insurance, at market prices, for people the government wishes to help.
But lawmakers do not want to be seen taxing and spending, so they hide transfers in cross-subsidies. They require emergency rooms to treat everyone who comes along, and then hospitals must overcharge everybody else. Medicare and Medicaid do not pay the full amount their services cost. Hospitals then overcharge private insurance and the few remaining cash customers.
Overcharging paying customers and providing free care in an emergency room is economically equivalent to a tax on emergency-room services that funds subsidies for others. But the effective tax and expenditure of a forced cross-subsidy do not show up on the federal budget.
Over the long term, cross-subsidies are far more inefficient than forthright taxing and spending. If the hospital is going to overcharge private insurance and paying customers to cross-subsidize the poor, the uninsured, Medicare, Medicaid and, increasingly, victims of limited exchange policies, then the hospital must be protected from competition. If competitors can come in and offer services to the paying customers, the scheme unravels.
No competition means no pressure to innovate for better service and lower costs. .....
...

As usual, I have to wait 30 days to post the whole thing. It synthesizes some of my earlier blog posts (here here here) on how cross subsidies are worse than straightforward, on budget, taxing and spending.

Let me here admit to one of the implications of this view. Single payer might not be so bad -- it might not be as bad as the current Medicare, Medicaid, Obamacare, VA, etc. mess.

But before you quote that, let's be careful to define what we mean by "single payer," which has become a mantra and litmus test on the left. There is a huge difference between "there is a single payer that everyone can use," and "there is a single payer that everyone must use."

Most on the left promise the former and mean the latter. Not only is there some sort of single easy to access health care and insurance scheme for poor or unfortunate people, but you and I are forbidden to escape it, to have private doctors, private hospitals, or private insurance outside the scheme. Doctors are forbidden to have private cash paying customers. That truly is a nightmare, and will mean the allocation of good medical care by connections and bribes.

But a single provider than anyone in trouble can use, supported by taxes, not cross-subsidized by restrictions on your and my health care -- not underpaying in a private system and forcing that system to overcharge others -- while allowing a vibrant completely competitive free market in private health care on top of that, is not such a terrible idea, and follows from my Op-Ed. A single bureaucracy that hands out vouchers, pays full market costs, or pays partially but allows doctors to charge whatever they want on top of that would work. A VA like system of public hospitals and clinics would work too. Like public schools, or public restrooms, you can use them, but you don't have to; you're free to spend your money on better options if you like, and people are free to start businesses to serve you. And no cross-subisides.

Whether we restrict provision with income and other tests, and thus introduce another marginal disincentive to work, or give everyone access and count on most working people to choose a better product, I leave for another day. It would always be an inefficient bureaucratic problem, but it might not be the nightmare of anti-competitive inefficiency of the current system.

[detbuch]

Originally Posted by Pete F.

That's simple isn't it?
From The Grumpy Economist
https://johnhcochrane.blogspot.com/
Single payer sympathy?
A July 30 2018 Op-Ed in the Wall Street Journal, titled "The tax and spend health care solution"
Why is paying for health care such a mess in America? Why is it so hard to fix? Cross-subsidies are the original sin. The government wants to subsidize health care for poor people, chronically sick people, and people who have money but choose to spend less of it on health care than officials find sufficient. These are worthy goals, easily achieved in a completely free-market system by raising taxes and then subsidizing health care or insurance, at market prices, for people the government wishes to help.
But lawmakers do not want to be seen taxing and spending, so they hide transfers in cross-subsidies. They require emergency rooms to treat everyone who comes along, and then hospitals must overcharge everybody else. Medicare and Medicaid do not pay the full amount their services cost. Hospitals then overcharge private insurance and the few remaining cash customers.
Overcharging paying customers and providing free care in an emergency room is economically equivalent to a tax on emergency-room services that funds subsidies for others. But the effective tax and expenditure of a forced cross-subsidy do not show up on the federal budget.
Over the long term, cross-subsidies are far more inefficient than forthright taxing and spending. If the hospital is going to overcharge private insurance and paying customers to cross-subsidize the poor, the uninsured, Medicare, Medicaid and, increasingly, victims of limited exchange policies, then the hospital must be protected from competition. If competitors can come in and offer services to the paying customers, the scheme unravels.
No competition means no pressure to innovate for better service and lower costs. .....
...

As usual, I have to wait 30 days to post the whole thing. It synthesizes some of my earlier blog posts (here here here) on how cross subsidies are worse than straightforward, on budget, taxing and spending.

Let me here admit to one of the implications of this view. Single payer might not be so bad -- it might not be as bad as the current Medicare, Medicaid, Obamacare, VA, etc. mess.

But before you quote that, let's be careful to define what we mean by "single payer," which has become a mantra and litmus test on the left. There is a huge difference between "there is a single payer that everyone can use," and "there is a single payer that everyone must use."

Most on the left promise the former and mean the latter. Not only is there some sort of single easy to access health care and insurance scheme for poor or unfortunate people, but you and I are forbidden to escape it, to have private doctors, private hospitals, or private insurance outside the scheme. Doctors are forbidden to have private cash paying customers. That truly is a nightmare, and will mean the allocation of good medical care by connections and bribes.

But a single provider than anyone in trouble can use, supported by taxes, not cross-subsidized by restrictions on your and my health care -- not underpaying in a private system and forcing that system to overcharge others -- while allowing a vibrant completely competitive free market in private health care on top of that, is not such a terrible idea, and follows from my Op-Ed. A single bureaucracy that hands out vouchers, pays full market costs, or pays partially but allows doctors to charge whatever they want on top of that would work. A VA like system of public hospitals and clinics would work too. Like public schools, or public restrooms, you can use them, but you don't have to; you're free to spend your money on better options if you like, and people are free to start businesses to serve you. And no cross-subisides.

Whether we restrict provision with income and other tests, and thus introduce another marginal disincentive to work, or give everyone access and count on most working people to choose a better product, I leave for another day. It would always be an inefficient bureaucratic problem, but it might not be the nightmare of anti-competitive inefficiency of the current system.

This guy seems to believe in, and want, free market health care. Surprised you posted it.

[Pete F.]

Originally Posted by detbuch

This guy seems to believe in, and want, free market health care. Surprised you posted it.

What I believe in and what I think is possible are different things
I think this approach could work it seems similar to the uk model
“But a single provider than anyone in trouble can use, supported by taxes, not cross-subsidized by restrictions on your and my health care -- not underpaying in a private system and forcing that system to overcharge others -- while allowing a vibrant completely competitive free market in private health care on top of that, is not such a terrible idea, “
Posted from my iPhone/Mobile device

[detbuch]

Originally Posted by Pete F.

What I believe in and what I think is possible are different things
I think this approach could work it seems similar to the uk model
“But a single provider than anyone in trouble can use, supported by taxes, not cross-subsidized by restrictions on your and my health care -- not underpaying in a private system and forcing that system to overcharge others -- while allowing a vibrant completely competitive free market in private health care on top of that, is not such a terrible idea, “
Posted from my iPhone/Mobile device

Isn't that exactly what the Repubs were arguing for as an alternative to Obamacare before it was passed--government pay for those that were truly needy and let everyone else have what they had? And isn't the UK model not as successful, or less costly, as other models?

And why would you believe in something that is not possible?

[Pete F.]

Originally Posted by detbuch

Isn't that exactly what the Repubs were arguing for as an alternative to Obamacare before it was passed--government pay for those that were truly needy and let everyone else have what they had? And isn't the UK model not as successful, or less costly, as other models?

And why would you believe in something that is not possible?

The problem with income qualified programs is that they end up being detrimental to people being able to get ahead, “I can’t make that much I’ll lose my (blank)
If everyone’s primary care was funded, two things will happen.
Emergency rooms will no longer be primary care providers (they are not efficient at that) and medical conditions will be identified at earlier stages where the costs are lower. We currently fund those things directly and indirectly in possibly the most inefficient way possible.
I should have said probable not possible
Posted from my iPhone/Mobile device
Posted from my iPhone/Mobile device