Robert Samuelson: Health care rules the labor market

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  • RedShirt USS Enterprise, UT
    Sept. 10, 2018 6:49 a.m.

    To "Utefan60" if Canada's system is so great, why do they have wait list insurance?

    Why is it that, prior to the ACA, you were more likely to die in Canada waiting for care than you were to die in the US because of a lack of insurance?

    I think you should do some research on those countries, and how they limit medications, limit procedures, and limit what care you get. It isn't a limit on what they will pay for, but nationwide they do not allow certain procedures.

    As for bankruptcies, in Canada, they are due primarily to tax debt. If that isn't enough for you, their bankruptcy rate is about the same as the US. So, do you want to declare bankruptcy because of medical debt or tax debt. In the US few people file bankruptcy for taxes, so does that mean Canada pays too much in taxes?

    If socialism is so great, tell us what nation has declared itself socialist and has the same standard of living as the US.

  • Utefan60 Salt Lake City, UT
    Sept. 9, 2018 1:36 a.m.

    Redshirt1701 - Deep Space 9, Ut, Canada has amazing universal socialized health care. And it is working amazingly well contrary to the Fox like snippets about it that are easy and honestly disproved.

    Universal health care is a standard in almost every developed country in the world. And it works. Germany, Denmark, Canada, Thailand, etc.

    I want you to research just one question. How many Canadiens filed for bankrupsey last year due to medical costs? There is an answer. While you are at it, tell us how many people in the US filed for bankrupsey last year for medical reasons? Hint, it's in the hundreds of thousands. Look it up.

    Universal Health care even covers those who for a "short time were unemployed" . There are many people who lose their job related insurance who are left high and dry when they lose their jobs. It's a reality that the GOP just doesn't care about.

    But keep using the "socialialism' arguments. They are fasle fronts to deny millions of US citizens health care by the GOP.

  • RedShirt USS Enterprise, UT
    Sept. 6, 2018 7:25 a.m.

    To "countryvoice3" the data came from the Kaiser Health Foundation, Census Data, and a couple of other government sites.

    They also state that the numbers thrown around about the uninsured numbers are exaggerated because they include people who were without insurance for part of the year. That means if you lost your job and didn't have insurance for a month or two you were considered uninsured.

    But lets look at what the government did. We gave insurance to the poor, but the poor can't use it. The government spent a lot of money to just appear to take care of a problem. See "Even the Insured Often Can't Afford Their Medical Bills" in the Atlantic.

  • Matt in MI Saline, MI
    Sept. 5, 2018 7:23 p.m.

    @countryvoice3:

    You didn't really respond to any of my points, and instead are attacking a proposition I did not make.

    I want to separate "helping the poor" from "buying routine care."

    Because I understand one thing: The middle class ultimately ends up paying their own way. It might come in the form of lower salary or wages, or higher prices, or lower earnings in a retirement plan, but it does come.

    And the middle class is *BIG*.

    So, I want to make it possible for the middle class to pay for their own care in a way that makes the most economic sense.

    You oppose this.

    That's understandable. Many people would rather pay $300/month instead of a surprise $1800 expense on average of once per year.

    I'm not one of those people.

    So, I have no objection to YOU buying whatever insurance YOU like, even if it doubles your cost.

    You simply have the objection to ME buying the type of insurance I like.

    Now do you understand my objection?

  • countryvoice3 Salt Lake City, UT
    Sept. 5, 2018 6:08 p.m.

    First of all Redshirt..your claim of less than 10% of pre ACA uninsured couldn't afford insurance is impossible to source, and of course you don't provide any sources so I guess you rely on some virtually dark web connection.

    Of course common sense revolts at the thought that 36 million of 40 million simply refuse to cover themselves either because they want someone else to pay or they just refuse.

    The closest one can come to sourcing causes is Kaiser..the premier authority and they say.."Poor and low-income adults were particularly likely to lack coverage, and the main reason that most people said they lacked coverage was inability to afford the cost."

    Once again you are trading in conspiratorial nonsense and that's not with any churlish intent, just fact.

  • RedShirt USS Enterprise, UT
    Sept. 5, 2018 3:42 p.m.

    To "countryvoice3" that is nice, but it doesn't change the fact that less than 10% of the uninsured were unable to afford it. That means 90% either could buy insurance on their own or else qualified for a government program.

    All the ACA did was make us pay twice for most of them, and made insurance more expense for the rest of us.

  • countryvoice3 Salt Lake City, UT
    Sept. 5, 2018 2:49 p.m.

    Redshirt, without arguing your assertions, it's a fact from all credible sources that non elderly citizens without health insurance decreased from 16.7 % (where it had been since 1998) to 10.3%. A lot of the gain was in states that expanded Medicaid. If that happened because they were now aware so be it.

    S C Matt.."Do you want health care to be cheaper for everybody, or only some people?

    Because there are ways in which we can help people who truly need help, but also allow a rational system for those of us who accept that it is our job to provide for ourselves."

    First of all the uninsured are generally not uninsured because they are waiting for you to pay for them. In addition how do you determine those who "truly" need help. Basically you've made the assumption that life and death is for sale (market solutions) and that there are those who "deserve" your help and those who don't.

    The gigantic fact you ignore is that universal health care systems are available to all and cheaper for all..and btw contain better outcomes as a society.

  • SC Matt Saline, MI
    Sept. 5, 2018 2:03 p.m.

    @pragmatistferlife:

    "but what happens when a person shows up at the hospital you describe and can't pay at all"

    Do you want health care to be cheaper for everybody, or only some people?

    Because there are ways in which we can help people who truly need help, but also allow a rational system for those of us who accept that it is our job to provide for ourselves.

    And it is not rational to use insurance to pay for a routine annual physical. Nor for a simple sinus infection, or even "Bobby fell and needs a few stiches."

    And there's no reason insurance *can't* be part of providing for ourselves. It's a great way to cover things like double-bypass open heart surgery.

    And if you read closely, the surgery center I mentioned, even though they don't "take" insurance, has people going there with 100% of the cost paid by their insurance company.

    Read the Time Magazine article.

    What I find amazing is that people oppose a method the provides quality health care for a lower price.

  • RedShirt USS Enterprise, UT
    Sept. 5, 2018 12:45 p.m.

    To "pragmatistferlife" that is a lie. If you look at the pre-ACA numbers there was a large portion of the uninsured that could afford insurance but chose not to buy it. There was also a large number of people that qualified for Medicare/Medicaid but chose not to sign up for it. In reality the number of people that were uninsured, didn't qualify for any government program, and couldn't afford insurance was less than 10% of the total uninsured.

    What is worse is now that we have the ACA, the poor that couldn't afford insurance before still can't afford care because they have high deductible plans and they can't afford to meet their deductibles. Now we pay for them twice, instead of once.

  • pragmatistferlife Salt Lake City, UT
    Sept. 5, 2018 9:08 a.m.

    SC Matt..for the record I'm not being snarky here, but what happens when a person shows up at the hospital you describe and can't pay at all?

    You have to remember that before the ACA there were 40 million Americans without any health insurance. I'm sure some of them were there out of choice and could participate in your system. However the vast majority weren't and aren't. They are there because of poverty.

    Our core argument here is that health care is a necessity for all in order to have a moral and civil society. Having health care available for "all" benefits all. If one spends any time at all in the countries with universal health care it is obvious they have a civility we don't. A cooperation we don't. In fact they are more democratic than we are and health care is fundamental to that.

    NoNames.. keeps telling us to move because we see a benefit in civility and a democratization of life and death..our answer..no. We aren't going anywhere. We see a chance to engage our better angles, and we will to continue to fight for that.

  • Say No to BO Mapleton, UT
    Sept. 4, 2018 7:52 p.m.

    "Eds and Meds" are the only businesses left in many local economies.

    School teachers. community colleges, hospitals and clinics bring in all the payroll in some towns.

    But that business model is not sustainable. Neither industry creates wealth.

    One day we will see that problem. For now, the blinders are firmly in place.

  • NoNamesAccepted St. George, UT
    Sept. 4, 2018 5:52 p.m.

    Those who claim that tax policy, being shielded from the cost of care, who claim that most care is emergent or can't be shopped around, or otherwise dismiss any analysis of health care costs beyond an overly simplistic view of what other nations do remind me of the old saw about socialism. "When it comes to socialism, there are two kinds of people. There are those who advocate for socialism and then there are those who actually understand socialism."

    Tax policy encourages us to have insurance pay for everything possible because a 5% profit margin on insurance is a lot cheaper than a 25% tax bill. Insurance insulates us from the true costs so we don't make "rational" (as that term is used by economists) decisions for the 90%+ of healthcare that is not emergent. Insurance negotiations with providers also discourages providers from posting their rates making it difficult for consumers to make "rational" decisions.

    Bottom line, I respect others' rights to form socialist societies to handle their various needs. I simply demand the right not to join, not to help fund, not to participate in their folly.

    If the rest of the world is so much better for healthcare and guns, please move.

  • SC Matt Saline, MI
    Sept. 4, 2018 4:18 p.m.

    @SMcloud:

    "The free market isn't working."

    The free market isn't given a real chance.

    And as for shopping around, it's easy. You do it in advance.

    There is enough care out there that's delivered day by day in ways that don't involve an ambulance that you could easily weed out all of the places you'd *never* want to go for care.

    They simply need to post prices. People would see that they're the outlier and they would then lose every bit of business *except* for ambulance cases, and then they'd lose them too because they'd shut down due to having lost 85% of their business.

    This can work even with an insurance model. There's no reason that you can't have insurance to buy your life-saving drug if it's out of your price range. That's called risk-pooling, and it works.

    But using insurance to cover routine medical care? That's like buying auto insurance that covers oil changes.

    And there's a really good reason auto insurance doesn't cover oil changes. Because if it did, oil changes would cost $150.

  • Redshirt1701 Deep Space 9, Ut
    Sept. 4, 2018 4:04 p.m.

    To "SMcloud" but health insurance isn't like a normal market. It is a government micromanaged system that is just a hair away from socialized medicine. The problems that you see with insurance are due to government "action", not the market working.

    People shop around for a heart attack like you do when your car breaks down, house floods, or any number of non-medical emergencies. People won't spend any amount for life saving drugs. They will pay whatever they can afford, meaning if a company wants to sell a pill for $1000 per dose that people will only do so as long as they have money. If that pill costs the company $50 to make, it won't take long for them to realize that they can make more money selling the same pill for $60.

  • SMcloud Sandy, UT
    Sept. 4, 2018 3:26 p.m.

    Treating healthcare like it fits into a normal market isn't working.

    It works great with non essential procedures: think Lasik or breast implants.

    But how is someone supposed to shop around during a heart attack? How does one even know how much anything costs? What am I to do if I can't afford a lifesaving drug -- these hospitals and pharmaceutical companies know that we will spend any amount to save our own lives and price accordingly.

    The free market isn't working.

  • SC Matt Saline, MI
    Sept. 4, 2018 2:57 p.m.

    @Unrepentant Progressive:

    "Problems are from excessive administrative costs and inflated pricing from the Corporate Medical Industrial Complex."

    Inflated pricing is *exactly* what you get when you pay for every little thing with insurance, instead of a free market.

    I've seen this. Shortly after moving to a new area, one of my kids got injured at a fast-food restaurant. When I took him to the emergency room, I wasn't sure if we were going to be able to get the fast-food place to pay, so I didn't present my insurance card. Since we were new to the area, it was also our first visit, so they didn't already have our insurance information.

    The first bill I saw was the "uninsured patient" rate. It was half of what they eventually got after we figured out that the fast-food place wasn't going to pay, and I presented my insurance information.

    Every insurance company overpays. Every doctor bills enough to get all that every insurance company is willing to pay.

    I'd love to have a real free market system. It would be far cheaper than what we currently have.

  • SC Matt Saline, MI
    Sept. 4, 2018 2:46 p.m.

    @Pragmatist:

    "There is no market solution."

    I would disagree.

    There's a surgical center in Oklahoma that doesn't participate in insurance at all. We're talking about real problems, like total knee replacement, not a simple hangnail.

    Some *employers* are beginning to notice that these guys are far cheaper than traditional hospitals.

    Search for a Time article titled "what happens when doctors only take cash."

    What happens is this: The Oklahoma State Public Employees insurance fund tells people that if they use these guys (or others that meet the criteria) then the employee pays nothing. No copay. No deductible. Nothing.

    Because paying cash is *that much cheaper* than routing payments for medical care through 3 layers of administrivia.

    I'd be interested in knowing why you think it isn't, and that market solutions can't work.

  • Redshirt1701 Deep Space 9, Ut
    Sept. 4, 2018 9:54 a.m.

    To "unrepentant progressive" how did people get snookered by Trump, when the problems that we currently have with the cost of insurance have been around for nearly 40 years, and were made much worse when Obama signed the ACA into law.

    You do realize that Obamacare raised costs by 40%, and has failed to do any of the good it promised.

    Why would we want social medicine? That is like saying you are tired of having a Ferrari, and want to trade it in for a used Ford Pinto.

    To "Dart Thrower " if you want healthcare to be like electric utilities, look at California. You know, the state that has rolling brownouts, high prices, and are getting rid of effective means of production just to look politically correct.
    To "marxist " and how do things change when you replace insurance premiums with taxes?

    To "one old man" you have the leeches mislabeled. The leeches are the politicians that keep burdening the insurance companies with more and more regulation and mandates. The politicians then use their position to entice insurance companies to contribute to their campaign funds.

    To "Freiheit" look at the mismanagement in the military, do you want that for healthcare too?

  • Nate Pleasant Grove, UT
    Sept. 4, 2018 9:13 a.m.

    @SMcloud "When is America going to figure out what the rest of the established world already has...."

    Most of the health care systems you point to are hybrids. They tried it with all-out socialism and found themselves going broke, so they brought back enough free market to stay viable.

    We don't need to follow their course. They are swinging back our way.

    @SMcloud "That's America's healthcare system. It's a laughingstock."

    America's current healthcare system is still too much governed by Obamacare, and yes, it is a laughingstock.

    Now the same advocates for Obamacare want to design our next health care system. They wrecked it once, and somehow think we will trust them. We don't.

  • Freiheit Salt Lake City, UT
    Sept. 4, 2018 6:56 a.m.

    "Why would any rational person believe that the same government that cannot balance the budget could possibly manage to run a health care system? The very thought is astounding. "

    And yet we trust that same incompetent government to defend our very existence with a very expensive military whose budget no one seems able to question. We also trust our water supply, transportation, air travel safety, law enforcement, and other vital functions to government entities. This mindless, irrational hatred of anything government is insanity in action, and it's costing us dearly.

    Single payer on a national level would eliminate the costly middle men in our present "system."

  • Pssst LOGAN, UT
    Sept. 3, 2018 9:37 p.m.

    Health care is not free market. It is run by the AMA; there is no competition if no one advertises prices or makes detailed comparisons between individual doctors and hospitals; where there are no consumer reports and for a long time insurance has not been portable.

    On top of that there are no guarantees of any kind (you will be asked to sign escape clauses not holding anyone liable) , no contract prices, and products are advertised fraudulently in many cases.

    Obamacare was much much worse - but we are not free market either, our 'private' system is not by any means completely free of government control. Both systems ('public' and 'private') are awful.

    Let us try making health care truly free market and let voluntary charitable assistance also thrive. Above all let us live in a much more healthy way and avoid doctors etc as we would a plague.

  • SMcloud Sandy, UT
    Sept. 3, 2018 8:57 p.m.

    Healthcare does not work well in the "free market"

    Imagine going into a store and there are no prices on anything until you get to the end and you can't take anything out of your cart. And they don't tell you that the tomatoes are actually from an out of network farm so today they are ten thousand dollars. Surprise!

    That's America's healthcare system. It's a laughingstock.

  • Millenial Snow Sandy, UT
    Sept. 3, 2018 8:54 p.m.

    The system we have now stinks. My family pays a huge premium and still have to pay a high deductible even to start getting any coverage.

    My friends from the UK can walk into an ER anywhere in the country and never be afraid that they will get run over by crazy bills. Their taxes are not that different - add what you currently pay to your insurance and it's about the same.

  • SMcloud Sandy, UT
    Sept. 3, 2018 8:52 p.m.

    We Americans spend more on healthcare and get worse outcomes.

    When is America going to figure out what the rest of the established world already has:

    Universal Healthcare works.

  • unrepentant progressive Bozeman, MT
    Sept. 3, 2018 6:06 p.m.

    I really don't think that it is simple to prove that health care is subject to market forces. The analogy of emergency care is a poor one. And how many of us go shopping for costs on treatment when it is somewhat elective or an emergency? Or can chose one medication over another on price. The MD has prescribed what she/he thinks best. Are we going to argue that?

    Furthermore, all this messenging about tax deductibility and insurance and pre tax wages is nonsense. Problems are not from tax policy. Problems are from excessive administrative costs and inflated pricing from the Corporate Medical Industrial Complex.

    Healthcare is like clean water. We need it universally to maintain the general welfare of our family. Indeed, not just our immediate family, but the family of every person in the country. It should be treated like any other utility for the betterment of each of us, rich or poor.

  • pragmatistferlife Salt Lake City, UT
    Sept. 3, 2018 5:37 p.m.

    No Names you make a couple of very serious mistakes.

    First of all just because a condition is not "emergent" does not mean it is not serious and will not morph into a costly procedure to correct. A situation way beyond the ability of any "free market to make personal payment possible. Take prostate cancer as an example. In the end the costs of office visits and tests all non emergent, will pail in comparison to the surgeries and follow up procedures necessary because of the disease .

    To compare vision correction, and cosmetic surgeries to progressive mortal diseases is just plain ignorant.

    Even if costs "come down" let's say 50% prostate surgeries and follow ups can put you on the line (with a 50% reduction) for 40 to 50 K. Now let your wife go through breast cancer and your gone.

    There is only one solution socialism..either medicare for all or govt. regulation of health care costs. There is no market solution.

  • Dart Thrower Ogden, UT
    Sept. 3, 2018 4:09 p.m.

    NoNames, the answer my friend is socialism. Socialism like the electrical power to your house and the water at your kitchen tap. We need to make healthcare a utility.

    Every other first world country has socialized medicine. They spend about half of what the US does on healthcare and they get better results. The International Insurance website has a nice chart if you want to look it up. According to that site, the US ranks 11th in overall healthcare and our cost per capita is about double of what everyone else pays.

    I have lived overseas on several occasions and used socialized medicine. My care was every bit as good as my experience in the US and my treatments were all successful, including surgery in Europe.

    This is another example of where the rest of the world is right and the US is wrong. The model exists, it is well proven and it delivers good results. The only people that are you telling you otherwise are those that are making a killing off the bloated "freedom" model in the US.

  • NoNamesAccepted St. George, UT
    Sept. 3, 2018 2:07 p.m.

    Health insurance companies have annual profits of about 5%. This is not surprising as the profits are all but guaranteed; Actuary tables don't lie.

    Since government takes some 25% or more of our wages, paying 5% to our employer provided health insurance is a great deal in the short run. The long term problem is that by laundering all of our medical spending through employer provided insurance so as to use pre- rather than post-tax dollars, we are insulated from the costs of our medical decisions. This drives up costs.

    Notice that costs in vision correction and cosmetic procedures (not covered by insurance) have come down dramatically. Dental (less covered by insurance than many other medical procedures) costs have stayed reasonable while outcomes have improved.

    The answer is not socialism. We simply need to let individuals deduct 100% of all medical expenses: use pre tax money for all medical costs. In that case, we have no incentive to pay 5% to the insurance companies and we'd pay out-of-pocket for most routine care, reserving insurance for unexpected expenses. Being exposed to the true costs of our decisions, we'd make better choices and costs would come down.

    Free market.

  • NoNamesAccepted St. George, UT
    Sept. 3, 2018 2:01 p.m.

    @unrepentant progressive: "Healthcare is not subject to normal economic rules like supply/demand."

    Actually, in the vast majority of cases, healthcare is subject to supply-demand curves. In fact, every time we bemoan that too many people, too frequently use the ER, we are admitting that most of healthcare is not emergent, it can and should be fully subject to supply-demand curves.

    Only a small fraction of health care cases are truly emergent. The vast majority are not emergencies and so are properly handled with regular doctor visits or a trip to a non-emergency extended hours clinic.

    Vision correction surgery, cosmetic surgery, and (to a lessor extent) dentistry & orthodontia demonstrate the power of subjecting medical care to the free market: Lower prices and far better service and outcomes than even 20 years ago, drastically better outcomes than 40 or 60 years ago.

    The problem is that both private insurance and government welfare insulate the consumer too much from our medical choices. And, most medical providers are loath to provide up front pricing.

    We don't need more socialism. We need more free market forces.

  • one old man Ogden, UT
    Sept. 3, 2018 9:27 a.m.

    "The irrefutable fact is that the Founding Fathers never intended for health care to be considered an inalienable right of any kind."

    The real irrefutable fact is that the Founding Fathers lived in a time when there was no such thing as health care of any kind.

    That was the time when people like George Washington -- suffering from a severe sore throat -- was treated by applying leaches to his arms and legs to suck blood from his body because at that time the fever accompanying infection was believed to be a result of too much blood in the body. Washington's physician's leaches sucked out so much blood that it killed him.

    Now, however, we still have leaches in our health care industry.

    They are called "executives."

    Could it be that the irrefutable fact of our modern time is that Americans are still being killed by having our DOLLARS sucked from us by leaches?

    That, I believe, is where our modern government needs to step in. That's probably the only chance we have. Other nations have figured it out. Should we follow their examples?

  • one old man Ogden, UT
    Sept. 3, 2018 9:16 a.m.

    The lead sentence in this article is " It's wages vs. health benefits."

    It sure is.

    But the truth is that one of the driving forces of American health benefits is the wages paid to those who REALLY benefit from our health benefits.

    I challenge all readers here to simply Google something like "Pay packages of health care industry executives" and see what you find.

    You will find that top execs in virtually every pharmaceutical company, hospital chain, or health insurance company are taking home multimillion dollar checks every year. The average of their pay packages run about $66,000 PER DAY.

    It takes a lot of premiums, prescriptions, and hospital bills paid by those of us who need their "services" to cover the costs of their obscene profiteering.

    When will we wake up and demand that our legislators do something to end this obscenity?

  • marxist Salt Lake City, UT
    Sept. 3, 2018 9:12 a.m.

    "High private insurance premiums condemn millions of workers to stagnant or falling incomes. "

    Medicare for all. Go Bernie!

  • John Charity Spring Back Home in Davis County, UT
    Sept. 3, 2018 8:28 a.m.

    Why would any rational person believe that the same government that cannot balance the budget could possibly manage to run a health care system? The very thought is astounding.

    The Founding Fathers established this Country on the principle that the government is beholden to the people and that it has no other source of power except the people. The great question of our time is whether we will stay true to this principle. Will we believe in our capacity for self-government, or will we abandon the American Revolution and accept the left-wing claim that a tiny group of intellectuals in a far off capital can plan our lives for us better than we can plan them ourselves?

    The irrefutable fact is that the Founding Fathers never intended for health care to be considered an inalienable right of any kind. Society disregards that wisdom to its peril.

  • pragmatistferlife Salt Lake City, UT
    Sept. 3, 2018 8:25 a.m.

    I like ..progressives idea that health care is a public utility. I've always said it wasn't necessarily a "right" but a necessity.

    That the right is willing to treat it as a commodity is in the first place just plain dumb, and Mr. Samuelson is very clear as to why.

    We may have started this path decades ago innocently but to continue the way the right wants us to is absolutely destructive for families and America in general.

  • unrepentant progressive Bozeman, MT
    Sept. 3, 2018 7:33 a.m.

    Samuelson again hits all the right notes.

    How/why American labor got snookered by trump, and continue to be is still beyond me.

    I am not at all vexed by the bite that health insurance takes out of our pay envelope each week. And I am not vexed by the millions still under/uninsured to meet a health care crisis. The great American health care industry eats up the national treasury and into the pocketbooks of most every citizen of this country. Yet, we have done little or nothing to staunch the outpouring of billions upon billions of dollars for very poor results.

    It is not the fault of Medicare, Medicaid nor Obamacare that our system is too expensive with too little results. It is the fault of bad assumptions. Healthcare is a utility like water and power, yet we treat it like selling cars, cereal and widgets. Healthcare is not subject to normal economic rules like supply/demand. Nor is it necessarily a factor of human choices.

    The country must adopt almost any other system used by other western style democratic countries (the do it cheaper with better results) to get this under control. But under the control of the party of trump, nee GOP this will never happen.