I loathe the 16th amendment.

[Whomp]

It will be interesting to see what happens to socialized medicine when the aging population, which requires 4x the medical attention, comes to fruition. Medicaid and medicare, federal programs, are in dire straits compared to Social Security. I wonder how that plays out with the nanny states as countries like Japan and Italy incur a similar problem.

I can only give personal experience for my feelings on socialized medicine. When a friend was found to have aggressive cancer issues she had to leave the UK and come back to the US for treatment. I'm not sure where the "free" system failed her but the reality is she is in the states to handle this.

Narz read the 16th amendment. It clearly states congress has the right to collect taxes.

 

[trundle]

Truly private medical care. Think what that means. You deny it exists. It doesn't not exist because a doctor got the same public education that most people did. It doesn't not exist because he drove to work on a public road. It doesn't not exist because the electricity for his office comes from the public power grid. It just means non-socialized medicine. Pure capitalism. I walk in and pay 100% of my bill from my own pocket and the doctor gets no government payment at all. This happens all over the world every day.

I don't recall ever claiming that private health care doesn't exist. Indeed, I view the US medical system as private, excepting, of course, publically-funded hospitals and medicare patients. I do recall saying that under your definition, which excludes US insurance schemes, there is no sizable private system outside of the third world I'm aware of with which we can compare public systems. You discounted a comparison of the US and Canadian systems, you'll recall, because the US side included HMOs. I have asked, and continue to ask, for any comparison you can provide of a public system with a private one.

Please go back up the thread. Note that it was you, not I, who decided that the HMO system in the US is not "truly private." You criticized another poster for comparing Canadian public health care with US private insurance, claiming that the latter was not "truly private." You have still not been able to offer any basis for comparison, then, beyond a handful of your own personal experiences, to compare a public system with a "truly private" one. Again, if you have any studies which compare a public system to something you consider "truly private," please provide them.

For the sake of clarity, I'm going to skip replying to most of your above comments and stipulate: yes, pay-as-you go medical care exists in some fashion pretty much everywhere. With one big caveat; I'm not aware of any industrialized nation where it exists as the primary source of medical care. When comparing private to public insurance, at least we can say "This is how it works in the US, and this is how it works in the UK or Canada;" while there are differences (indeed, significant ones) between the countries, we can at least start to draw some conclusions. Until you offer a some real world, large scale, modern pay-as-you-go system to compare any of this to, any suggestion that such a system is better is pure conjecture.

Insurance systems (public and private) developed historically for a reason. It's very difficult (if not impossible) for a worker making $30k/year to keep $100k in liquid assets on the gamble that he'll be the 1 in 1000 guy to get cancer. It is quite reasonable, however, for him to be concerned enough about this possibility that he'll get 1000 guys together and all of them throw in $120 each, covering the statistical likelihood that one of them will get cancer and the extra money for administrators to maintain the fund. That's a bad bet in some ways -- you're paying $20 more into your health care than is called for probabilistically, and you can't get your $120 back if it happens that you develop some condition not covered (in this example, anything but cancer). But it also means that you don't have to choose between keeping $100k liquid or accepting cancer as a death sentence.

So, unless you can illustrate -- using a mass, real world system -- that something in the last few decades has changed the needs which insurance was designed to meet in the first place, I'm going to stick with the historical record. Indeed, the mere fact that private insurance exists on the scale it does suggests that any supporter of free market ideology should recognize the demand for it.

I do have one more note, though:

I stand by my statements that socialized medicine is not as efficient as truly private medical care, and that I would prefer to not be taxed just so an extra layer of government can spend my money - not on actual medical services - but to tell me what procedures I can and can not have my own money pay for. Obviously less efficient than me just spending my money directly on truly private medical care.

As noted earlier in the thread, please define 'efficiency' before continuing this claim. Efficiency of what?

By far the most efficient system for health care, from a return on investment standpoint, for instance, would be to provide as little as possible. Since some people will get better anyway (through the body's natural recuperative mechanisms), you will realize some return for zero investment. That's a nigh-infinite percentage return. It's not going to get any better than that. Of course, that's much less efficient in terms of, say, lost work hours, so I'll need you to clarify what sort of efficiency you're striving for.

 

[Sahkuhnder]

I don't recall ever claiming that private health care doesn't exist.

In denial already? How sad. Allow me to help you refresh your memory:

...You want him to compare real world socialized medicine schemes (i.e. as practiced in particular countries) with something that exists purely as a fantasy in your head?

...you're the only one with direct access to said fantasy.

Or does your "truly private" system exist anywhere on Earth?

Bold by me.

Indeed, I view the US medical system as private, excepting, of course, publically-funded hospitals and medicare patients. I do recall saying that under your definition, which excludes US insurance schemes, there is no sizable private system outside of the third world I'm aware of with which we can compare public systems. You discounted a comparison of the US and Canadian systems, you'll recall, because the US side included HMOs. I have asked, and continue to ask, for any comparison you can provide of a public system with a private one.

Please go back up the thread. Note that it was you, not I, who decided that the HMO system in the US is not "truly private." You criticized another poster for comparing Canadian public health care with US private insurance, claiming that the latter was not "truly private." You have still not been able to offer any basis for comparison, then, beyond a handful of your own personal experiences, to compare a public system with a "truly private" one. Again, if you have any studies which compare a public system to something you consider "truly private," please provide them.

I grow weary of having to repeat myself to you, so please listen this time:

I am not defending the US government's health care system, thus a comparison between said same and Canada's system is irrelevant to the conversation.

I am defending the truly private, personal, out of pocket, I think for myself and pay for myself system.

The US HMO system is not private. It relies heavily on Medicare and Medicaid, government run, taxpayer funded, non-private healthcare. Your "I view the US medical system as private" doesn't change the fact it get most of its payments and funding directly from the US government. This is not the system I advocate, nor wish to defend. Please don't make me say this to you again.

For the sake of clarity, I'm going to skip replying to most of your above comments and stipulate: yes, pay-as-you go medical care exists in some fashion pretty much everywhere. With one big caveat; I'm not aware of any industrialized nation where it exists as the primary source of medical care.

Bold by me.


Make up your mind! First you claim it doesn't exist - now you admit it does exist.

Please link to the post where I say it is the primary source in any country. I only said I prefer it. It need not currently be primary anywhere in order for me to advocate it becoming primary.

When comparing private to public insurance, at least we can say "This is how it works in the US, and this is how it works in the UK or Canada;" while there are differences (indeed, significant ones) between the countries, we can at least start to draw some conclusions. Until you offer a some real world, large scale, modern pay-as-you-go system to compare any of this to, any suggestion that such a system is better is pure conjecture.

Insurance systems (public and private) developed historically for a reason. It's very difficult (if not impossible) for a worker making $30k/year to keep $100k in liquid assets on the gamble that he'll be the 1 in 1000 guy to get cancer. It is quite reasonable, however, for him to be concerned enough about this possibility that he'll get 1000 guys together and all of them throw in $120 each, covering the statistical likelihood that one of them will get cancer and the extra money for administrators to maintain the fund. That's a bad bet in some ways -- you're paying $20 more into your health care than is called for probabilistically, and you can't get your $120 back if it happens that you develop some condition not covered (in this example, anything but cancer). But it also means that you don't have to choose between keeping $100k liquid or accepting cancer as a death sentence.

So, unless you can illustrate -- using a mass, real world system -- that something in the last few decades has changed the needs which insurance was designed to meet in the first place, I'm going to stick with the historical record. Indeed, the mere fact that private insurance exists on the scale it does suggests that any supporter of free market ideology should recognize the demand for it.

I have offered you specific examples and illustrated my case. You have ignored them. Instead of demanding more proof, could you first please address the examples I already provided? I believe it is now your turn to offer specific examples of how your level of government bureaucracy in any way adds efficiency to the process over my preferred direct purchase system.


I will repeat one of the many you chose to ignore:

Well, my LASIK was truly private medical care. And I guess your government medical care is of lower quality because it doesn't cover such treatments. Comments?

I await your response detailing how government run healthcare is superior in this case.

As noted earlier in the thread, please define 'efficiency' before continuing this claim. Efficiency of what?

By far the most efficient system for health care, from a return on investment standpoint, for instance, would be to provide as little as possible. Since some people will get better anyway (through the body's natural recuperative mechanisms), you will realize some return for zero investment. That's a nigh-infinite percentage return. It's not going to get any better than that. Of course, that's much less efficient in terms of, say, lost work hours, so I'll need you to clarify what sort of efficiency you're striving for.

Happy to clarify this issue for you: Efficiency of use of funds. This is a tax thread after all, and our discussion arose from my complaint that government heathcare and education were not as efficient a way to use funds to purchase those services than simply allowing the end user, the taxpayer, to directly purchase the services for themselves. Cut out the middleman, fire the bureaucrat, trim the fat. I prefer to pay the doctor as discussed - directly. When I pay the government, who then pays the doctor that carries a cost and expenses overhead, and is less efficient.

 

[trundle]

Thanks for quoting me -- you have succinctly highlighted the distinction I have made from the beginning. I'm not sure where you think I've contradicted myself.

Yes: private, individual payments exist.
No: they do not constitute a medical system in any modern industrialized country.

Please note the bolded word. What I said was fantasy was, as you've quoted here, "your 'truly private' system."

I see that some confusion might be arising here because you seem to be interpreting the term "HMO" as synonymous with "medicare." The survey referenced above, and my use of privatized insurance throughout, refer to privately purchased (generally either by an individual or their employer) insurance through privately held (or publically traded) companies.

The comparison between Canada and the US was not between Canada and Medicare: it was between Canada and medical care in the US (which is provided for primarily through private insurance companies).

Please link to the post where I say it is the primary source in any country. I only said I prefer it. It need not currently be primary anywhere in order for me to advocate it becoming primary.

It needs to exist at a relevant scale and provide similar services to draw any kind of comparison at all. So, again, in order to compare a public health care system with your "truly private" one, we would need to compare it to a fantasy: the fantasy of greatly extrapolating what limited direct private payments currently exist. We cannot compare something 220 million people use in a year with something that maybe a few hundred thousand use in a year and expect a meaningful result. This is the same folly those on the other side of the aisle use, in suggesting that we can draw a direct comparison between the U.S. system and those practiced in various Scandinavian nations (the difference in scale is too enormous).

The US HMO system is not private. It relies heavily on Medicare and Medicaid, government run, taxpayer funded, non-private healthcare. Your "I view the US medical system as private" doesn't change the fact it get most of its payments and funding directly from the US government.

Do you have any references to back this up? Or by US HMO system do you mean "medicare/medicaid recipients," and not the entire privatized insurance network in the US? I am highly skeptical, since employers and individuals pay billions of dollars annually for private insurance, that the bulk of HMO funding comes from the feds.

I am aware that HMOs receive federal development funds (or at least they used to), but I've never read that these came with attachments as to what services they were allowed to cover. If they don't come with qualifiers, then this is the same sort of government subsidy you've discounted when I applied it to the cost of your private medical care. In any case, since most HMOs are for-profit companies, I highly doubt that they'd be aching to expand their coverage without a corresponding increase in cost.

I have offered you specific examples and illustrated my case. You have ignored them. Instead of demanding more proof, could you first please address the examples I already provided?

Sure, you have thus far demonstrated that a handful of vanity procedures (braces, resetting a broken nose, and lasik instead of glasses) were able to be obtained privately when the government was unable to provide them. This does not demonstrate any efficiency at all; it demonstrates that procedures a government system wasn't designed to provide were not, in fact, provided. I would have accepted this with no proof at all, as it is true on its face. If you purchase a warranty to cover your car against damage, and then your car is stolen, you haven't proven anything about the efficiency of the warranty: you have only proven that it doesn't cover something it wasn't intended to.

You need to demonstrate that the end user pays less for a covered procedure. This is going to require some heavy mathematics, as you can't simply compare the end costs. You have to take into account the advantages of a single payer system (monopolistic bargaining power, efficiencies gained from single-source payments, etc.) versus those of a privatized system (marketplace competition, efficiencies gained from a decrease in administration, etc.).

As an aside, all of the examples you used are covered by my current insurance carrier. The broken nose is the only possible exception: I would have to get my PCP to agree that it was not set correctly. Since I pay some $850/year in insurance fees, if I were to want LASIK surgery alone it would seem it is a much more efficient use of my funds immediately to be insured than not (without addressing, of course, the long term savings -- see below). Now, my employer pays much more than that for my insurance, so one might argue that it's not so efficient for them. It's somewhat debatable, however, as the excellent health coverage keeps me at work more often which means that my salary is being used more efficiently.

I believe it is now your turn to offer specific examples of how your level of government bureaucracy in any way adds efficiency to the process over my preferred direct purchase system.

While I disagree that you've offered examples of efficiency, I'll offer you two ways that government (or private monopoly) can be more efficient:
1) Holding a monopoly (or near monopoly) allows them to use collective bargaining to establish rates. $100 spent privately may get you a lot less if a drug costs $100 for a month's supply than if the government is able to demand it be provided at $50. This is the same principal that allows private trusts to manipulate the market or unions to negotiate higher wages -- controlling one half of the supply/demand equation allows you to effectively set the price for a good.
2) While public health services add administrative costs on the buyer's end, they can decrease administrative costs on the practitioner's end. Rather than having to worry about checks and payments from dozens of insurance providers and private payers, they can submit all their bills to the same agency. Even a small medical practice can often require a full-time dedicated accountant in the US (or in the absence of a full time individual, expenditures on training for receptionists to understand how to process a variety of payment forms); the need for this can be eliminated in a single-payer system. Reducing employee overhead reduces costs, which can be passed on as savings to the single-payer.

I await your response detailing how government run healthcare is superior in this case.

Please define "superior." I thought we were discussing efficiency of funds. You have listed three procedures not covered by government run health care (at least not any government I know of -- does Canada cover braces?), and you have listed them without the prices you paid. How can I possibly compare a value I don't know (how much you paid) with one that doesn't exist (how much the government would have paid)?

If by superior you mean "provides a wider variety of services," then, sure: private, individually paid for health care will no doubt always provide a wider variety of services to those that can afford them in the marketplace. An individual can, of course, privately pay for any medical service public health care would pay for, but an individual can also pay for LASIK, plastic surgery, or voodoo. If few people need plastic surgery and many people need childhood vaccines, however, I am more inclined to ask how many childhood vaccines each system provides instead of how many different procedures they allow for.

Happy to clarify this issue for you: Efficiency of use of funds. This is a tax thread after all, and our discussion arose from my complaint that government heathcare and education were not as efficient a way to use funds to purchase those services than simply allowing the end user, the taxpayer, to directly purchase the services for themselves.

Depending on the quality of life one demands for oneself, direct purchase can be a highly inefficient use of funds. Consider: you have a chance of contracting cancer at some point in your life. Now, knowing this, you can choose to ignore it and accept a decrease in your quality of life (that cancer, when it arrives, will kill you). If you're unwilling to accept that decrease, you must have some mechanism to provide for this possibility. For the sake of simplicity, let's stick with my above numbers (1 in 1000 people diagnosed per year, $100,000 treatment cost) and to give you the benefit of the doubt (and favor the direct purchase system), I'll even suppose that you have $100,000 on hand. Let's look at a 10 year time frame (this also should favor direct purchase). This gives you some choices:
1) You can participate in a public cancer-only insurance plan. This will cost $120/year (supposing a 20% markup for administrative fees), for a net of $1200 over the 10 years. Investing the remaining $98,800 at a (very) conservative return rate of 5% leaves you with a little over $160,000.
2) Keeping the $100,000 liquid means you have to invest it at a lower return rate. Again, being generous to your side of the argument, let's say that you can pull off a 3% annual return rate, which leaves you with about $135,000. You've just lost $25,000 even if you don't get cancer by not carrying insurance. If you do, you've lost much more (depending at what point during the 10 years you are diagnosed).
3) As a kind of a compromise, you can invest all $100,000 at 5% and risk having to withdraw it early. The return here is highly variable (whether the market is up or down exactly when you need the money, etc.), but the most important factor is whether or not you get cancer at all. You could come out deeply in the hole (if you were diagnosed very early and/or the market was down at that time) or slightly ahead of plan 1 at about $3,000 ahead). This is an increase of a little under 2% (total for the 10 years, not compound), which is actually pretty good, considering you only have about a 1% chance of contracting cancer in the 10 year period. This may seem like the best option, as it carries the highest return, but keep in mind that it also carries the highest risk -- neither of the other situations can force you into debt.

This example may seem small, but it only grows further in favor of insurance with the more diseases you include or the longer time frame you apply (to say nothing of realistic interest rates, which are probably going to be closer to 10% for the investment and 1.5 or 2% for the liquid). The more ailments you are worried about covering, the more cash you would need on hand to cover them -- nor do the ailments need to be life-threatening; you may extend this example to account for LASIK, braces, or anything else if you include them as part of your minimum quality of life. Even though a longer time frame means more insurance payments, as we can see in this short time, the compound interest quickly outstrips the bills. This is also without considering the impact of tax benefits for some forms of long term investment (IRAs, 401ks, etc.) or that public health care fees (and private ones, in the US) come from pre-tax dollars (though there are some ways to use pre-tax dollars for direct medical payments).

Of course, as I stated previously, there is certainly a much more efficient use of funds: accept cancer as a death sentence and invest all $100k in long term investments. Don't withdraw it early if you're diagnosed with cancer and pass it on as an inheritance. This depends on your age, however -- if you're under 55 or 60, your earning potential almost certainly outstrips the cost of cancer treatments (if you're over that age, it will depend on your salary). That is why, again, one must consider "efficiency" in light of the quality of life one insists upon.

 

[Sahkuhnder]

...I'm not sure where you think I've contradicted myself.

Yes: private, individual payments exist.
No: they do not constitute a medical system in any modern industrialized country.

Please note the bolded word. What I said was fantasy was, as you've quoted here, "your 'truly private' system."

So now your latest version is that what you really meant is that the system doesn't exist? The capitalist economic system?

Is that the system you told me:

...exists purely as a fantasy in your head?

Is that the system that you questioned:

...does your "truly private" system exist anywhere on Earth?

Not as you now claim "in any modern industrialized country", your exact words were "anywhere on earth". I say it exists everywhere on earth. Capitalism is the most common economic system in both times past and up to and including today. Did you buy anything today? The capitalistic system is everywhere - even if you claim it isn't.

I see that some confusion might be arising here because you seem to be interpreting the term "HMO" as synonymous with "medicare." The survey referenced above, and my use of privatized insurance throughout, refer to privately purchased (generally either by an individual or their employer) insurance through privately held (or publically traded) companies.

The comparison between Canada and the US was not between Canada and Medicare: it was between Canada and medical care in the US (which is provided for primarily through private insurance companies).

Once again (fourth time now ): Stop bringing up a comparison between Canada and US HMOs and Medicare. That is not the system I am talking about, and is not the system I advocate. Your survey is irrelevant as is does not include the medical care I am talking about. HMOs are told by the government what procedures the government will pay them for, how much they will be paid, etc., so they are not the truly private, direct medical care system I advocate.

It needs to exist at a relevant scale and provide similar services to draw any kind of comparison at all.

Pure nonsense. Says who? Why? I can say I prefer it even if I'm the only one to ever have directly purchased their own medical care in all of history. I'm sure we are both smart enough to draw a comparison on the issue.

So, again, in order to compare a public health care system with your "truly private" one, we would need to compare it to a fantasy: the fantasy of greatly extrapolating what limited direct private payments currently exist. We cannot compare something 220 million people use in a year with something that maybe a few hundred thousand use in a year and expect a meaningful result. This is the same folly those on the other side of the aisle use, in suggesting that we can draw a direct comparison between the U.S. system and those practiced in various Scandinavian nations (the difference in scale is too enormous).

Gotcha.

You made those numbers up out of thin air. Prove me wrong and provide the link to your data.

No link? Let's just use common sense to analyze them then shall we?

Your quote about private medical care: "maybe a few hundred thousand use in a year". Lets say that means 300,000 people. The country has 300 million people, so you would have us believe only one person in a thousand uses private medical care? Look around, how many people are wearing glasses? Who paid for those glasses? Hint: They did, using the truly private, out-of-their own pocket, medical care system.

Let's just take a couple common branches of private medicine, dentists and optometrists. In the USA there are about 156,000 dentists and 40,000 optometrists. Are you sure that those almost 200,000 doctors only have an average of 1.5 patients per year? That doesn't count private practice general practitioners, cosmetic and reconstructive surgeons, and who knows how many other branches of medicine that have private patients. Your numbers are blatantly false and I'm calling you on them.

I'd even bet that you, unless you came from a very poor welfare poverty family (and even then) have had private medical care sometime in your life. Did you ever have your teeth checked or cleaned? Ever have a cavity? Ever get your eyes checked at a doctor's office? Ever wear glasses or contacts? Your parents no doubt took you to a private doctor at some time, and then simply paid - out of pocket - for your medical care. Congratulations - you are a participant in the truly private medical care system.

Do you have any references to back this up? Or by US HMO system do you mean "medicare/medicaid recipients," and not the entire privatized insurance network in the US? I am highly skeptical, since employers and individuals pay billions of dollars annually for private insurance, that the bulk of HMO funding comes from the feds.

I am aware that HMOs receive federal development funds (or at least they used to), but I've never read that these came with attachments as to what services they were allowed to cover. If they don't come with qualifiers, then this is the same sort of government subsidy you've discounted when I applied it to the cost of your private medical care. In any case, since most HMOs are for-profit companies, I highly doubt that they'd be aching to expand their coverage without a corresponding increase in cost.

Please see my above comments. I am not advocating HMOs. I only advocate my being allowed to chose and pay directly for my own medical care. I have no desire to join an HMO.

Sure, you have thus far demonstrated that a handful of vanity procedures (braces, resetting a broken nose, and lasik instead of glasses) were able to be obtained privately when the government was unable to provide them.

Much more than just a "handful". Not just LASIK, but even basic glasses too. Glasses are almost always a part of the truly private medical system and glasses are not a "vanity" procedure. Having cavities filled, root canals done, dead teeth pulled, etc. are not "vanity" procedures.

You may dismiss having my daughter's nose be straight as purely "vanity", but all that shows is that you are not a parent. Quality medical care includes your quickly dismissed "vanity" items, examples would be skin grafts for burn victims, facial reconstruction after an accident and dentures to fill in missing teeth. Those are all "vanity" items. Should they not be allowed?

Who are you to tell me what medical care I can and can't choose anyway? What gives you the right? It's my money, and my decision on how best I should spend my money. It's none of your business. The exact reason I don't like the government telling me how to spend my healthcare budget is because someone like you tries to make my private decisions for me.

This does not demonstrate any efficiency at all; it demonstrates that procedures a government system wasn't designed to provide were not, in fact, provided. I would have accepted this with no proof at all, as it is true on its face. If you purchase a warranty to cover your car against damage, and then your car is stolen, you haven't proven anything about the efficiency of the warranty: you have only proven that it doesn't cover something it wasn't intended to.

Apples: Efficiency level of government healthcare systems vs. efficiency level of the truly private medical care system.
Oranges: Quality level of medical care and services government healthcare systems have available vs. quality level of care and services the truly private medical system has available.

Let's be sure to keep the two seperate. Your example combines them.

You need to demonstrate that the end user pays less for a covered procedure. This is going to require some heavy mathematics, as you can't simply compare the end costs. You have to take into account the advantages of a single payer system (monopolistic bargaining power, efficiencies gained from single-source payments, etc.) versus those of a privatized system (marketplace competition, efficiencies gained from a decrease in administration, etc.).

As an aside, all of the examples you used are covered by my current insurance carrier. The broken nose is the only possible exception: I would have to get my PCP to agree that it was not set correctly. Since I pay some $850/year in insurance fees, if I were to want LASIK surgery alone it would seem it is a much more efficient use of my funds immediately to be insured than not (without addressing, of course, the long term savings -- see below). Now, my employer pays much more than that for my insurance, so one might argue that it's not so efficient for them. It's somewhat debatable, however, as the excellent health coverage keeps me at work more often which means that my salary is being used more efficiently.



While I disagree that you've offered examples of efficiency, I'll offer you two ways that government (or private monopoly) can be more efficient:
1) Holding a monopoly (or near monopoly) allows them to use collective bargaining to establish rates. $100 spent privately may get you a lot less if a drug costs $100 for a month's supply than if the government is able to demand it be provided at $50. This is the same principal that allows private trusts to manipulate the market or unions to negotiate higher wages -- controlling one half of the supply/demand equation allows you to effectively set the price for a good.
2) While public health services add administrative costs on the buyer's end, they can decrease administrative costs on the practitioner's end. Rather than having to worry about checks and payments from dozens of insurance providers and private payers, they can submit all their bills to the same agency. Even a small medical practice can often require a full-time dedicated accountant in the US (or in the absence of a full time individual, expenditures on training for receptionists to understand how to process a variety of payment forms); the need for this can be eliminated in a single-payer system. Reducing employee overhead reduces costs, which can be passed on as savings to the single-payer.

Good points. May I encourage further such approaches to the discussion.

Item number 1):

There is more to quality healthcare than just absolute cost, or simply paying less for any procedure, government allowed, HMO/insurance covered or otherwise.

Have you ever visited a free clinic? There's a reason that level of medical care and service is free. Things like it is uncomfortable, usually involves a wait and a waste of my time, includes only the briefest of time with a minimally qualified practitioner, and rarely provides more than the most very basic of treatments.

Have you ever visited an upscale private doctor's office? There's a reason that level of medical care and service is expensive. Things like it is comfortable, doesn't involve a wait or waste my time, includes all the time I want with a very qualified veteran practitioner, and can always either provide the most advanced state-of-the-art treatments, or can refer me to another private facility that can.

When we buy a gallon of milk, then efficiency is price. When we buy medical care, whether through taxes paid or directly, efficiency is not only price, and is much harder to pin down. There is great truth to the benefits of economy of scale. A government or HMO has much more leverage to negotiate price than I as an individual do, so I as a single direct buyer may pay more for any specific medical procedure. How do I prevent that from happening? The beauty of capitalism is that I may take my business to anyone I choose. At any given level of service I choose I can select the doctor with the best price for any specific medical care and service level I desire.

If I prefer the free clinic and the medical care and service provided there, then I make my choice and go there. If I prefer an HMO I can choose to join. If I prefer, as I personally do, to have my medical care be only of the highest quality and service, then I make my choice and go to the best private doctors.


Item number 2):

I help manage a small business and certainly understand that administrative costs can quickly eat away at efficiency and profits. The example you gave only supports my preference for the truly private medical care system over either government intervention or the HMO/insurance system care. Please allow me to explain.

Your quote: "While public health services add administrative costs on the buyer's end, they can decrease administrative costs on the practitioner's end." But how? By having a single party to bill to. This makes excellent sense over having a confusing host of insurance companies to have to deal with.

But how does this compare to the truly private medical care I advocate? The method I prefer has no insurance companies at all. Each patient either pays up front, as I did for my LASIK, or if qualified receives bills, as I did for my kids dental care and braces. No fancy rules, no government forms, just collect the money up front, or print and mail a bill, and then collect the money.

Even though a government-paid medical practice can "submit all their bills to the same agency", that doesn't mean there isn't overhead and cost, it's just done by a government employee now. Someone at that agency must still be paid to verify the number of procedures performed by each practice, the amount the government decided it will pay for each procedure, direct the transfer of the payments to each practice, etc.

And don't forget that the very act of paying taxes innately wastes money due to the costs of collection.

Please define "superior." I thought we were discussing efficiency of funds.

Please see "apples and oranges" above. When discussing which system is better, we have included both efficiency and quality of care (i.e., "superior").

You have listed three procedures not covered by government run health care (at least not any government I know of -- does Canada cover braces?), and you have listed them without the prices you paid. How can I possibly compare a value I don't know (how much you paid) with one that doesn't exist (how much the government would have paid)?

What exactly are you requesting? Do you want me to dig through my old files and find the amounts I paid for my kids braces? The reason I gave those examples was not to address the efficiency discussion (the "apples"), but was to illustrate the quality discussion (the "oranges"). As those medical treatments aren't government approved in the US (I don't know about braces or glasses in Canada either), they were to show that the truly private medical care system not only exists, but exists at a higher available quality than is approved through the government's healthcare bureaucracy.

If by superior you mean "provides a wider variety of services," then, sure: private, individually paid for health care will no doubt always provide a wider variety of services to those that can afford them in the marketplace.

That is exactly what I mean. And part of a "wider variety of services" includes a higher quality level of services, medical care like wave-front LASIK.

Glad we could agree on this issue.

An individual can, of course, privately pay for any medical service public health care would pay for, but an individual can also pay for LASIK, plastic surgery, or voodoo. If few people need plastic surgery and many people need childhood vaccines, however, I am more inclined to ask how many childhood vaccines each system provides instead of how many different procedures they allow for.

But why would I want to pay for it twice? Once through taxes, and then directly by myself for the level of care I wanted in the first place? I don't want government level healthcare or service, and thus object to being forced to pay for it. I can think for myself, and prefer to make my own choices for myself. I don't need or want anyone telling me I can't have glasses, LASIK, braces, or - as it is my money after all - even voodoo, should I so decide.

You brought up childhood vaccines. Social engineering for the common good is a totally different issue for a different thread. We are discussing the efficiency of taxes to pay for government healthcare vs. the efficiency of direct payment with the truly private healthcare system, and the quality of care and service provided by both systems.

Depending on the quality of life one demands for oneself, direct purchase can be a highly inefficient use of funds. Consider: you have a chance of contracting cancer at some point in your life. Now, knowing this, you can choose to ignore it and accept a decrease in your quality of life (that cancer, when it arrives, will kill you). If you're unwilling to accept that decrease, you must have some mechanism to provide for this possibility. For the sake of simplicity, let's stick with my above numbers (1 in 1000 people diagnosed per year, $100,000 treatment cost) and to give you the benefit of the doubt (and favor the direct purchase system), I'll even suppose that you have $100,000 on hand. Let's look at a 10 year time frame (this also should favor direct purchase). This gives you some choices:
1) You can participate in a public cancer-only insurance plan. This will cost $120/year (supposing a 20% markup for administrative fees), for a net of $1200 over the 10 years. Investing the remaining $98,800 at a (very) conservative return rate of 5% leaves you with a little over $160,000.
2) Keeping the $100,000 liquid means you have to invest it at a lower return rate. Again, being generous to your side of the argument, let's say that you can pull off a 3% annual return rate, which leaves you with about $135,000. You've just lost $25,000 even if you don't get cancer by not carrying insurance. If you do, you've lost much more (depending at what point during the 10 years you are diagnosed).
3) As a kind of a compromise, you can invest all $100,000 at 5% and risk having to withdraw it early. The return here is highly variable (whether the market is up or down exactly when you need the money, etc.), but the most important factor is whether or not you get cancer at all. You could come out deeply in the hole (if you were diagnosed very early and/or the market was down at that time) or slightly ahead of plan 1 at about $3,000 ahead). This is an increase of a little under 2% (total for the 10 years, not compound), which is actually pretty good, considering you only have about a 1% chance of contracting cancer in the 10 year period. This may seem like the best option, as it carries the highest return, but keep in mind that it also carries the highest risk -- neither of the other situations can force you into debt.

This example may seem small, but it only grows further in favor of insurance with the more diseases you include or the longer time frame you apply (to say nothing of realistic interest rates, which are probably going to be closer to 10% for the investment and 1.5 or 2% for the liquid). The more ailments you are worried about covering, the more cash you would need on hand to cover them -- nor do the ailments need to be life-threatening; you may extend this example to account for LASIK, braces, or anything else if you include them as part of your minimum quality of life. Even though a longer time frame means more insurance payments, as we can see in this short time, the compound interest quickly outstrips the bills. This is also without considering the impact of tax benefits for some forms of long term investment (IRAs, 401ks, etc.) or that public health care fees (and private ones, in the US) come from pre-tax dollars (though there are some ways to use pre-tax dollars for direct medical payments).

Of course, as I stated previously, there is certainly a much more efficient use of funds: accept cancer as a death sentence and invest all $100k in long term investments. Don't withdraw it early if you're diagnosed with cancer and pass it on as an inheritance. This depends on your age, however -- if you're under 55 or 60, your earning potential almost certainly outstrips the cost of cancer treatments (if you're over that age, it will depend on your salary). That is why, again, one must consider "efficiency" in light of the quality of life one insists upon.

Excellent point.

Direct purchase private healthcare can be inefficient, if the wrong choices are made.

With forced taxation there is no choice of any kind. You have taxes taken from you against your will, and are then told what treatments and level of care you are permitted to have your own money spent on.

With truly private healthcare there is choice. As your example nicely illustrates making the wrong choice is always a possibility. But as long as choice exists then all of the correct options are also available. If I choose to join an HMO, it's up to me. If I choose to purchase health insurance, it's up to me. If I choose to neglect my health and just die, it's up to me. If I choose to provide my family with a high level of quality medical care and services, it's up to me. I trust in my decision making ability, so I don't fear bearing the responsibility for my family's healthcare needs.


EDIT - corrected typo.

 

[trundle]

This has devolved into a rather silly conversation which I will now take my leave of. If you'd care to re-read the thread and understand that I have, at no time, claimed that capitalism doesn't exist or that private medical payments don't exist, feel free. I think you'll find that since the original topic was taxes, which segued into national health care systems, I was and am discussing the systems which account for the bulk of health care in any given country. Further, I think you'll find that, since the start, I've accounted for the fact that completely privatized systems do exist in various third world nations: my claim that nothing on Earth existed was in direct reference to private systems (which, according to your arcane criteria, excludes HMOs) we might use as a comparison for the Canadian system.

Until you're willing to understand that, I'll have to bid you to have a nice day. I do have one more question, though, because I'm sincerely curious:

HMOs are told by the government what procedures the government will pay them for, how much they will be paid, etc., so they are not the truly private, direct medical care system I advocate.

Do you have any references for this?

 

[Sahkuhnder]

This has devolved into a rather silly conversation which I will now take my leave of. If you'd care to re-read the thread and understand that I have, at no time, claimed that capitalism doesn't exist or that private medical payments don't exist, feel free. I think you'll find that since the original topic was taxes, which segued into national health care systems, I was and am discussing the systems which account for the bulk of health care in any given country. Further, I think you'll find that, since the start, I've accounted for the fact that completely privatized systems do exist in various third world nations: my claim that nothing on Earth existed was in direct reference to private systems (which, according to your arcane criteria, excludes HMOs) we might use as a comparison for the Canadian system.

Until you're willing to understand that, I'll have to bid you to have a nice day. I do have one more question, though, because I'm sincerely curious:



Do you have any references for this?

You don't know how Medicare and Medicaid work? Yet you try to tell us government healthcare is more efficient and provides better quality care?


Your requested links:

MEDICARE ANNOUNCES PAYMENT RATES AND POLICY CHANGES FOR HOSPITAL OUTPATIENT SERVICES

Medicaid - Payment for Services

Medicare Payment Rates Rise in 2004 Reimbursement Increases for Part B Services

Adjusting Medicare payments for local market input prices

Getting The Price Right: Medicare Payment Rates For Cardiovascular Services

Medicare's Physician Payment Rates and the Sustainable Growth Rate

Plenty more available upon request.




And I'm sincerely curious where you got your "maybe a few hundred thousand use in a year". I caught you making things up. No comment at all?

So sad you had to resort to that level to support your weak position. It's OK to admit when you are wrong. That prevents your current embarrassing position of fleeing the discussion from the disgrace of a lie.

 

[trundle]

Oh, I'm well aware how medicare works.

Your requested links:
...
Plenty more available upon request.

And none of these links back up your claim -- that medicare/medicaid account for most of the funding for HMOs and thus determines the benefit levels available to private purchasers.

Only some 26% of Americans were eligible for medicare or medicaid, while nearly 70% were insured privately (through their employers or personally) in 2005: source. So even assuming that every single medicare/medicaid participant receives his benefits through an HMO (which isn't necessarily true), they would still have to be contributing three times the funds per capita that private purchasers are. Given that private plans run the gamut of benefit levels, I would assume that the privately insured contribute more per capita, though I have no idea how much more.

So if you do have references that show what you claim, I'd be happy to take a gander.

As for the rest, see above.

 

[Sahkuhnder]

Oh, I'm well aware how medicare works.

And none of these links back up your claim -- that medicare/medicaid account for most of the funding for HMOs and thus determines the benefit levels available to private purchasers.

Only some 26% of Americans were eligible for medicare or medicaid, while nearly 70% were insured privately (through their employers or personally) in 2005: source. So even assuming that every single medicare/medicaid participant receives his benefits through an HMO (which isn't necessarily true), they would still have to be contributing three times the funds per capita that private purchasers are. Given that private plans run the gamut of benefit levels, I would assume that the privately insured contribute more per capita, though I have no idea how much more.

So if you do have references that show what you claim, I'd be happy to take a gander.

As for the rest, see above.

Bold by me.

Any HMO does receive money from the government, and with it comes the government restrictions and government inefficiency. The links show the HMO-government payments, types of treatments the government allows, government dictated payment amounts, and thus government influence and control connection. Not "truly private" in any way.

As long as HMOs do receive government funds from Medicare and Medicaid, just as I said they did, and have the government restrictions forced upon them, just as I linked to, then they are not the truly private, I decide completely for myself, I pay completely for myself, no government involvement, medical care I have consistently been talking about this entire discussion:

...It just means non-socialized medicine. Pure capitalism. I walk in and pay 100% of my bill from my own pocket and the doctor gets no government payment at all.

...I am not advocating HMOs. I only advocate my being allowed to chose and pay directly for my own medical care. I have no desire to join an HMO.

I am defending the truly private, personal, out of pocket, I think for myself and pay for myself system.

The US HMO system is not private. It relies heavily on Medicare and Medicaid, government run, taxpayer funded, non-private healthcare. Your "I view the US medical system as private" doesn't change the fact it get most of its payments and funding directly from the US government. This is not the system I advocate, nor wish to defend. Please don't make me say this to you again.

One final time: I AM NOT ADVOCATING HMOs. PLEASE STOP BRINGING THEM UP. I only advocate the truly private medical care system, with no, as in zero, government involvement. No more taxes for healthcare, no more government bureaucracy, no more Medicare and Medicaid dictating to HMOs what treatments they will pay for and how much they will pay. Get rid of it all, trim the fat and improve the efficiency. None of it is needed in order to buy medical care. Only leave me to think for myself and decide for myself how I wish to spend my own healthcare money.




I see you're ignoring my request to link to your phony made-up statistics:

So, again, in order to compare a public health care system with your "truly private" one, we would need to compare it to a fantasy: the fantasy of greatly extrapolating what limited direct private payments currently exist. We cannot compare something 220 million people use in a year with something that maybe a few hundred thousand use in a year and expect a meaningful result. This is the same folly those on the other side of the aisle use, in suggesting that we can draw a direct comparison between the U.S. system and those practiced in various Scandinavian nations (the difference in scale is too enormous).

Gotcha.

You made those numbers up out of thin air. Prove me wrong and provide the link to your data.

No link? Let's just use common sense to analyze them then shall we?

Your quote about private medical care: "maybe a few hundred thousand use in a year". Lets say that means 300,000 people. The country has 300 million people, so you would have us believe only one person in a thousand uses private medical care? Look around, how many people are wearing glasses? Who paid for those glasses? Hint: They did, using the truly private, out-of-their own pocket, medical care system.

Let's just take a couple common branches of private medicine, dentists and optometrists. In the USA there are about 156,000 dentists and 40,000 optometrists. Are you sure that those almost 200,000 doctors only have an average of 1.5 patients per year? That doesn't count private practice general practitioners, cosmetic and reconstructive surgeons, and who knows how many other branches of medicine that have private patients. Your numbers are blatantly false and I'm calling you on them.

I'd even bet that you, unless you came from a very poor welfare poverty family (and even then) have had private medical care sometime in your life. Did you ever have your teeth checked or cleaned? Ever have a cavity? Ever get your eyes checked at a doctor's office? Ever wear glasses or contacts? Your parents no doubt took you to a private doctor at some time, and then simply paid - out of pocket - for your medical care. Congratulations - you are a participant in the truly private medical care system.

 

[.Shane.]

Supposedly there is no fedral income tax law for employees. I just saw a movie about it (see the movie thread).

Yes, and, supposedly, there was no Holocaust.

Seriously, it has about the same intellectual merit.

 

[trundle]

Any HMO does receive money from the government, and with it comes the government restrictions and government inefficiency. The links show the HMO-government payments, types of treatments the government allows, government dictated payment amounts, and thus government influence and control connection. Not "truly private" in any way.

You haven't shown that when an insurance company serves both medicare and non-medicare patients, that the private plans are in any way impacted by medicare's rate structure. Your links do indeed show that when medicare is administered through an HMO, that HMO must adhere to the government restrictions for that patient: something, that again, was never in question. You do understand that one can participate in an HMO when one is not on medicare, and that several (almost certainly "most," though I'm not willing to do the statistical research to back that up) HMO plans are not available for medicare recipients, right?

As long as HMOs do receive government funds from Medicare and Medicaid, just as I said they did, and have the government restrictions forced upon them, just as I linked to, then they are not the truly private

One could, and indeed I did, say the same thing about any doctor who receives any money from medicare (or, according to you, any HMOs). In which case, I'd wager dollars to donuts that all of your earlier examples are moot. My insurance plan, provided by a company that offers both HMO and PPO plans, will cover all of the procedures you listed -- if the doctor in question doesn't accept insurance payments, they will reimburse me directly. Thus, they are receiving a portion of their funds from the same source: are your doctors "truly private" or not?

Further, the central claims I was questioning was not whether HMOs received somegovernment funds; I acknowledged that several posts ago:

I am aware that HMOs receive federal development funds (or at least they used to), but I've never read that these came with attachments as to what services they were allowed to cover.

I can see how that might be slightly unclear, so allow me to elaborate: when HMOs were really taking off (during the Reagan years), the feds issued seed money to insurance companies. This money served to help start private HMOs (in an effort to reduce overall health care costs in the US). Those are the development funds I mentioned: I'm not aware, however, that they came with any restrictions as to what benefits the HMO could provide. There is also a separate infusion of government money in the form of medicare-qualified patients who have their payments administered through private HMOs: these funds are limited to treatments (and rates) set by the government. Your claim implied that somehow these funds restricted HMO activity for all patients, not just the medicare recipients.

I was interested in seeing proof that HMOs receive most of their funds from government sources and that this restricted benefits or rates for their private customers. Please note the bolded word: I am uninterested in any demonstrations that HMOs receive some federal funds, or that the feds determine benefits for medicare recipients even when that money is distributed through an HMO. I acknowledge that these two items are true and agree to them. What I am interested in seeing evidence for is that HMOs receive a majority of their funding from medicare, and that this in any way restricts their benefit options when dealing with private customers.

One final time: I AM NOT ADVOCATING HMOs. PLEASE STOP BRINGING THEM UP. I only advocate the truly private medical care system, with no, as in zero, government involvement. No more taxes for healthcare, no more government bureaucracy, no more Medicare and Medicaid dictating to HMOs what treatments they will pay for and how much they will pay. Get rid of it all, trim the fat and improve the efficiency. None of it is needed in order to buy medical care. Only leave me to think for myself and decide for myself how I wish to spend my own healthcare money.

I care very little what you're advocating for. Since the beginning, I have disputed your claim that a private payment directly to a doctor in the current system can be "truly private" by your own standards if a private HMO payment on behalf of a non-medicare-patient is not.

This is a rough parallel for the portion of our conversation regarding HMOs:

You: Citrus fruits are more delicious than non-citrus fruits. Find me one non-citrus that's more delicious than a citrus! Everyone should eat citrus and we should get rid of all non-citrus fruit!
History_Buff: Really, I have this survey that says strawberries are more delicious than oranges.
You: An orange isn't a citrus fruit because it's too sweet. I'm talking about limes.
Me: Limes are pretty sweet, too, but that doesn't mean oranges and limes aren't citrus fruits. Anyway, oranges are better for most people because you can bite right into them after peeling.
You: No, oranges have sugar so they can't be truly citrus. Besides, limes are chock full of vitamin C, that's what makes them a citrus fruit.
Me: Oranges also have vitamin C. And all fruits have sugar -- I don't think there's any fruit on Earth that most people will eat that can meet your criteria for being a citrus fruit if you don't include oranges.
You: No fruit on Earth!?!? What about limes! They're citrus fruits!
Me: Oh, I know that limes are citrus, but I was saying that when you ruled out oranges from being truly citrus, you ruled out limes as well. Also, I think limes are kind of irrelevant, because so few people eat them that it's hard to get an accurate measure of how delicious they are to most people.
You: I'm not advocating oranges, why do you keep bringing them up. Anyway, you can make limeade from limes, so that's why they're the most delicious fruit.
Me: Okay, but you can make orange juice from oranges -- how is that any different? Strawberries aren't juiced all that often, but it can be done. Plus, juice isn't that important unless that's how most people consume their fruit. Besides, I thought we were talking about what was the most delicious, not which one can be juiced.
You: We're talking about both deliciousness and the number of ways you can eat them! And stop bringing up oranges they're not truly citrus, and I keep telling you I'm advocating limes.
Me: And I keep telling you that by all the criteria you've listed to rule out oranges, limes wouldn't be citrus fruit either. Also, I think limes are so sour that only a few hundred thousand people eat them straight in any given year anyway, so its difficult to compare which one is more delicious for general purposes.
You: HAHAHA! That's blatantly false! Millions of limes are sold every day! Liar liar pants on fire! And oranges have more than twice the sugar of limes per ounce, so that's why they're not citrus but limes are.
Me: Okay, well after that display, it's time for me to go. But I am curious, can you show me that oranges have that much more sugar?
You: Sure, coward! I can't believe this whole time you don't know anything about oranges at all. Here are some links saying that they have sugar.
Me: No, I know they have sugar, in fact I said that way back in the beginning of this topic. But I asked for proof they had as much sugar as you said.

I see you're ignoring my request to link to your phony made-up statistics:

Indeed I have been. I'm not convinced that you're capable of reading my arguments without misconstruing them in a grand fashion, so I don't imagine explaining myself is worth my time or effort.

 

[Sahkuhnder]

I care very little what you're advocating for. Since the beginning, I have disputed your claim that a private payment directly to a doctor in the current system can be "truly private" by your own standards if a private HMO payment on behalf of a non-medicare-patient is not.

This is a rough parallel for the portion of our conversation regarding HMOs:

Bold by me.


We have found the problem, you don't want to address my position on truly private healthcare, but only want to endlessly drone on and on about HMOs.

I DON'T WANT TO TALK ABOUT HMOs. I DON'T LIKE HMOs. HMOs ARE HORRIBLE. HMOs ARE NOT TRULY PRIVATE AND ARE NOT WHAT I HAVE EVER ADVOCATED OR MADE ANY EFFORT TO DEFEND. WITH ALL DUE RESPECT, STFU ABOUT HMOs, PLEASE.

EITHER ADDRESS MY POSITION AND WHAT I ADVOCATE, OR DON'T, BUT ENDLESSLY BRINGING UP HMOs ONLY SHOWS EITHER YOU DON'T OR CAN'T UNDERSTAND MY POSTITION OR CHOOSE TO IGNORE IT FOR SOME REASON.

I do want to talk about - and ONLY talk about - truly, yes, absolutely truly, no government intervention, involvement, payments from, reliance upon, etc., healthcare that I pay for 100% from my own pocket directly to a truly private medical doctor or practice. Can you handle that?

The only way I have any interest in discussing HMOs is if you are willing to defend them and tell me they are better than the truly private direct payment system that I do advocate.

I never said I liked HMOs in any way. I clearly said I advocate not paying taxes for education and healthcare, including funding Medicare and Medicaid and supporting their intervention into the HMO system, but instead prefer the system of simply directly paying, out of my own pocket, on a case by case basis as needed, 100% of my own medical expenses, to a truly private medical vendor that operates without any government intervention of any kind, with the exception of rules enforcement such as the granting of medical licenses, etc.



Now PLEASE don't respond with another, "but HMOs are...."

Instead tell my how my preferred truly private, direct payment, no government involvement, out of pocket system would not be both the most efficient use of my medical care funds, and provide a higher level of medical services than any government bureaucracy tainted system can or does. Can you handle that? Am I asking too much of you? If you could see fit to actually address the issue under discussion we can have a much more meaningful conversation.

Indeed I have been. I'm not convinced that you're capable of reading my arguments without misconstruing them in a grand fashion, so I don't imagine explaining myself is worth my time or effort.

There is absolutely no misconstruing involved. You posted numbers you claim are true, I say back them up.


You said:

...something 220 million people use in a year with something that maybe a few hundred thousand use in a year

You made that up. Post a link to your numbers, or admit you created false numbers in an effort to support your position.

Your numbers are blatantly false and I'm calling you on them.

While you're at it feel free to defend your "vanity procedures" statement as well.

Sure, you have thus far demonstrated that a handful of vanity procedures (braces, resetting a broken nose, and lasik instead of glasses) were able to be obtained privately when the government was unable to provide them.

Much more than just a "handful". Not just LASIK, but even basic glasses too. Glasses are almost always a part of the truly private medical system and glasses are not a "vanity" procedure. Having cavities filled, root canals done, dead teeth pulled, etc. are not "vanity" procedures.

You may dismiss having my daughter's nose be straight as purely "vanity", but all that shows is that you are not a parent. Quality medical care includes your quickly dismissed "vanity" items, examples would be skin grafts for burn victims, facial reconstruction after an accident and dentures to fill in missing teeth. Those are all "vanity" items. Should they not be allowed?

Who are you to tell me what medical care I can and can't choose anyway? What gives you the right? It's my money, and my decision on how best I should spend my money. It's none of your business. The exact reason I don't like the government telling me how to spend my healthcare budget is because someone like you tries to make my private decisions for me.

When you post untrue statements, I will be happy to point them out to you and ask for verification.

 

[trundle]

Typing in all caps doesn't make your statements any more true.

My point from the beginning is that your contention is by its very nature unaddressable. You have asked us to discuss "truly private" medical care while claiming that private HMOs in the US are not "truly private." Your grounds for this claim would also make direct payments to providers in the US not "truly private" (as they receive government subsidies in various indirect forms, just as private HMOs receive government subsidies in various indirect forms). So, again, you have asked us to discuss something that from every available definition you've provided doesn't exist, at least in the US. You can type in all caps about not including HMOs all you like: it is the very act of discounting them that I have taken issue with.

I know we're both tired of repeating ourselves here, but this is, again, what I have been saying from the beginning. Indeed, it's the only reason I replied to you in the first place.

I hear you. I understand you. You don't support HMOs. I get it. Yes, I understand that your position is in support of direct payments to providers. However, part of that position, as stated, was that HMOs are not "truly private." I'm asking you to back up your statement that one is "truly private" in some capacity that doesn't eliminate direct payments to providers (with their own network of subsidies) from being truly private. Showing that some HMOs (those who facilitate medicare) receive government money doesn't do that: I'm certain most doctors also receive government money through one channel or another.

Please try to understand: I don't care if you think HMOs are horrible. I don't care if you prefer LASIK over glasses. I don't care if you prefer Dr. Smith over Dr. Jones. Your preferences are absolutely irrelevant: I was interested in your claims.

I have tried repeatedly to ask for clarity as to what makes one "truly private" and the other not. I thought maybe you actually had evidence for it (that HMOs receive most of their money from the feds). So I asked you to provide it, which you have yet to do. Your inability to rationally defend this arbitrary distinction only serves to further confirm my suspicions that it is not in fact a rational distinction.

Regarding the rest, and, in particular my claim of a "few hundred thousand," I will, against my better judgment, explain my position. Based on what I have witnessed thus far, however, I have low expectations that it will be taken in context.

It is true that my numbers are, as far as I know, unverifiable. However, I was not referring to any and all medical services privately purchased at any time and in any manner. I was referring to people who choose to purchase basic medical services (i.e. those covered by medicare or a standard HMO) out of pocket instead of using insurance. At first glance, there are actually some 46 million people in the US who meet this criteria, as that is the number of uninsured individuals. However, it is my belief (and here's where it becomes unverifiable) that the vast majority of those uninsured are those at the lower end of the income distribution. Consequently, they are far less likely to privately purchase any significant medical care, as they can't afford it. If major medical needs arise, I expect that the bulk of the uninsured are likely to engage in government-subsidized health care anyway (in the form of free clinics and the like). Again, I concede that this is unverifiable as far as I'm aware. I suppose one way to figure this out would be to choose a handful of procedures that are almost universally covered (say an arterial bypass, resetting a broken bone, etc.) and figure out what percentage of them were paid for entirely out of pocket to a private practitioner (i.e. not at a publicly funded hospital or in a public clinic).

Since we were discussing the efficiency of two different systems, your claims as to dentists and optometrists are irrelevant. These are not private purchases that public health care (as it currently exists) is designed to replace. Again, this proves nothing about efficiency: it proves only that you may privately purchase something not covered by public or private insurance. I acknowledged this several posts ago. I understand that you wanted to bring in the fact that there are more available options via direct payment, but I conceded this fact long ago. (For what it's worth, I think it's also an odd way to promote private care as "better:" it's like saying that a lump of iron is better than a hammer, because you can someday make the lump of iron into whatever you want. The latter half of the statement is true, but if I want to pound some nails, a lump of iron is still an inferior purchase.)