I'm really not trying to be a jerk or cruel here (just explaining the way insurance works), but your son is not insurable. If you have a medical condition then you cannot get insurance since insurance works for events that are costly and rare.

I've met people who are jerks about this, and believe me you're far from that. You're wrong, but for the right reasons. Autism is insurable because it doesn't make a person more likely to get sick or hurt, and there's no medical procedures that can do anything about it anyway. To date, my daughter has required more trips to the doctor than my son, and she's a year younger than him.

That being said, the issue is then one of does society subsidize health care for such people?

Ideally, no. But ideally, we'd only insure what you call insurable events, costly and rare. But we don't, we insure everything, which has the effect of making everything cost so much that it's no longer affordable without insurance. Antibiotics and stitches shouldn't require insurance, but you can't get either without a doctor, and that alone can cost you a couple hundred dollars if you don't have insurance.

Child birth/pregnancy is one example that probably accounts for billions of dollars every year. Lets go back to the concept of insurance: costly and rare. Child birth/pregnancy might be costly, but it isn't rare and usually people go out and get pregnant on purpose, and they give birth absolutely on purpose. You don't put car insurance on demolition derby cars, you shouldn't insure child birth/pregnancy.

Again, I agree that it shouldn't be insured, but once again it shouldn't require insurance to be affordable. In my case, it turned out to be both rare and costly, as both my children were born premature. My preference would be to have insurance cover the emergency cesarean and NICU expenses, since those fall into the "rare and costly" category, but for child birth without complications to be affordable out of pocket.

Again, insurance is for things that are costly and rare. If they are costly and common then it isn't really insurance but merely cost sharing, NOT insurance.

Cost sharing is essentially what we have in the US, is it not? If you are arguing against the current state of things, I'm with you, so long as your plan makes the common things affordable before you make them uncovered.

Or saving up until they could afford to have a child. When you get right down to it, what you are saying, in blunt harsh terms is: somebody else should pay for Mr. and Mrs. Jones' baby's birth.

Procreation shouldn't be a privilege obtained by money. I have serious ethical concerns about this proposal. I'm not saying somebody else should pay for anybody else's baby's birth, I'm saying that it shouldn't cost as much as it currently does for the Jones' to have their baby in the first place. I know a couple that had their baby at a mid-wife center instead of a hospital because they had no insurance. I don't know what that was like, but from a financial stand point it makes more sense than insuring child birth as long as there are no complications.

See that part where I noted that health care expenditures are growing at twice the rate of GDP? We are going over a cliff right now. As the late Herb Stein said, "Unsustainable trends are not sustained." We can try to do something about it now or we can let the things be and get yanked harshly off that trend. I'm thinking the latter will be by far the more painful choice, but maybe I'm wrong.

I am against the current system of high-cost insurance for higher-cost health care, because the ubiquity of insurance is making it easier to raise the cost of the care, and the rising cost of care is forcing the rise in cost of the insurance. But don't take that to mean I am in any way in favor of nationalized healthcare. I would much rather be able to pay for the health care I need out of my own pocket, with cheap insurance that only covered the rare and costly things that I will probably never need. But right now I can't afford to not have insurance that covers everything, and neither can the vast majority of Americans.

There is a very, very small portion of the population to which the pre-tax/post-tax difference matters. Usually employer-contributed insurance is all that is affordable, and in my case with an Autistic son, it is all that is available. Also, isn't private health insurance already tax deductible?

I'm really not trying to be a jerk or cruel here (just explaining the way insurance works), but your son is not insurable. If you have a medical condition then you cannot get insurance since insurance works for events that are costly and rare. Given that your son has a medical condition the rare part of the equation isn't there. That being said, the issue is then one of does society subsidize health care for such people?

Only a very, very small portion of the above-mentioned very, very small portion of the population would choose to move additional income into health care spending.

I disagree. Child birth/pregnancy is one example that probably accounts for billions of dollars every year. Lets go back to the concept of insurance: costly and rare. Child birth/pregnancy might be costly, but it isn't rare and usually people go out and get pregnant on purpose, and they give birth absolutely on purpose. You don't put car insurance on demolition derby cars, you shouldn't insure child birth/pregnancy.

Most can barely afford the minimum amount they must pay for health care, moving more into that category may save them on taxes, but it will more likely just give them less grocery money. As a tax shelter, health insurance premiums suck.

Yes, but look at many health care plans they cover the things I noted shouldn't be covered. So this indicates that the issue isn't so clear cut.

Hell Steve, most of what we need health insurance for is regular, predictable stuff.

Again, insurance is for things that are costly and rare. If they are costly and common then it isn't really insurance but merely cost sharing, NOT insurance. Cost sharing tends to result in over-consumption. Which is why the U.S., Canada, the U.K. and France are having issues with their health care spending.

Health care spending, last I heard, was growing at 6% per year. Even if we are generous and have GDP growth at 3% per year, you can see that eventually there will be a problem.

My wife had 100% coverage when she gave birth to our first child, and we still came away with something like $20,000 in medical bills. If insurance didn't cover anything, either the state would pay for it, or getting pregnant would give most women the choice between abortion and bankruptcy.

Or saving up until they could afford to have a child. When you get right down to it, what you are saying, in blunt harsh terms is: somebody else should pay for Mr. and Mrs. Jones' baby's birth.

Until routine health care without insurance becomes affordable to the majority of the population, no amount of changes to insurance is going to keep us of from going over the cliff.

See that part where I noted that health care expenditures are growing at twice the rate of GDP? We are going over a cliff right now. As the late Herb Stein said, "Unsustainable trends are not sustained." We can try to do something about it now or we can let the things be and get yanked harshly off that trend. I'm thinking the latter will be by far the more painful choice, but maybe I'm wrong.

Part of the problem is the tax exempt status of employer provided health care. It creates a distortion against those that are self-employed. They have to purchase health care with after tax dollars while you are doing so with pre-tax dollars.

There is a very, very small portion of the population to which the pre-tax/post-tax difference matters. Usually employer-contributed insurance is all that is affordable, and in my case with an Autistic son, it is all that is available. Also, isn't private health insurance already tax deductible?

Second it creates and incentive to move additional "income" into the health care benefit catagory.

Only a very, very small portion of the above-mentioned very, very small portion of the population would choose to move additional income into health care spending. Most can barely afford the minimum amount they must pay for health care, moving more into that category may save them on taxes, but it will more likely just give them less grocery money. As a tax shelter, health insurance premiums suck.

Now watch some dimwit will come along and say, "Nobody is going to get open heart surgery that they don't need!!!" NFS, but they might add on coverage for things that aren't technically "insurable" like glasses, lasik, child birth & pregnancy.

Hell Steve, most of what we need health insurance for is regular, predictable stuff. I'd be thrilled if that stuff was affordable without health insurance, but it isn't for most Americans.

My wife had 100% coverage when she gave birth to our first child, and we still came away with something like $20,000 in medical bills. If insurance didn't cover anything, either the state would pay for it, or getting pregnant would give most women the choice between abortion and bankruptcy.

Until routine health care without insurance becomes affordable to the majority of the population, no amount of changes to insurance is going to keep us of from going over the cliff.

What would you propose to make our health care system more inclusive and cost effective while maintaining high standards?

There has to be trade offs. You can't have both, TANSTAFL, or health care for that matter.

But costs are 2/3s or less of ours and the growth in costs is considerably less as well. This means they are closer to sustainability than ours. So merely stating that there is a sustainability problem there to is not a real answer.

Total costs aren't that important in determining sustainability. What is important is growth rates and no country has a sustainable growth rate. Canada? No. The UK? No. France? No. The U.S.? No. That we might be driving over the cliff faster doesn't mean the others are following along behind us.

Re-introduce price in the consumer-provider equation.

In other words, move more towards the market. Oddly this was what sparked demonstrations in France when the French government suggested this very solution. And technically we already have France's model here in the U.S. Not identical, but a mix of public and private health care.

Michael,

Part of the problem is the tax exempt status of employer provided health care. It creates a distortion against those that are self-employed. They have to purchase health care with after tax dollars while you are doing so with pre-tax dollars. Second it creates and incentive to move additional "income" into the health care benefit catagory.

For example, suppose you'd go out and purchase additional health care over and above what your employer provided. Suppose it it costs $100 dollars, and for arguments sake your tax rate is 20%. Now you'd have to earn $120 to purchase that $100. If your employer adds it to your existing benefits package and charges you only $100 you are ahead $20. This is the "gold plating" problem. This leads to an over-consumption of health care.

Now watch some dimwit will come along and say, "Nobody is going to get open heart surgery that they don't need!!!" NFS, but they might add on coverage for things that aren't technically "insurable" like glasses, lasik, child birth & pregnancy.

Sam,

No, I don't think there is a liquidity trap problem. There could be, but not at the moment.

Technically we didn't have a liquidity trap during the Depression, IMO. Once we went off the Gold Standard and the Fed was able to persue inflationary policies the economy started expanding again.

I'm not sure it matters a great deal. We live in a very different, very wide economic world today and we're not the only ones setting economic policy nor can we set the economic policy for the entire world.

While it's barely possible that a Bretton Woods II could have a positive impact on things, I'm inclined to think that's a long shot. Bretton Woods was decided by a handful of elites, mostly representatives of the WWII Allies, and there was more consensus among them than there is now. The institutions established then mostly still exist in one form or another and they've been sitting the current crisis out.

Additionally, I'm skeptical of attempts to plan the world economy, generally. Things move too fast, there's too much that's beyond the control of planners, and the planners have their own axes to grind. Alas, philosopher-kings are in short supply.

Re-introduce price in the consumer-provider equation.

Today, people consume health care services indiscriminately because its "free," never understanding that their employer or some other entity are paying, and that they will not sit still forever.

Well, not exactly. Most people don't see healthcare is "free" because insurance takes a large portion of every pay check, even if it is partially employer provided. My employer covers 50% of my insurance premium, but 0% for my wife and 2 kids. I pay roughly $12,000 annually out of my pocket for the insurance, plus another couple thousand on co-pays and bills that exceed what insurance will pay. That isn't "free" to me.

Now where your point makes a point is that I pretty much have the same cost whether I get unnecessary procedures or not. It costs me roughly $13,000 a year whether I am in the ER twice or twenty times, so your point about there being no incentive to forgo treatment remains.

What would you propose to make our health care system more inclusive and cost effective while maintaining high standards?

Why must we maintain the high standards?

Re-introduce price in the consumer-provider equation.

Today, people consume health care services indiscriminately because its "free," never understanding that their employer or some other entity are paying, and that they will not sit still forever.

grew at a 0.3% annual rate in the third quarter.

TYPO ALERT!!!

The GDP DECREASED by 0.3%, not grew.

And the point still remains, no country's system is sustainable.

But costs are 2/3s or less of ours and the growth in costs is considerably less as well. This means they are closer to sustainability than ours. So merely stating that there is a sustainability problem there to is not a real answer.

I've linked to the numbers before and can find the links again if you want them.

What would you propose to make our health care system more inclusive and cost effective while maintaining high standards? There must be ways to improve on what we are doing now.

Every other wealthy country spends less (GDP fraction) than us and gets better outcomes (healthier people) than us.

There are tremendous differences in reporting of statistics that alot of this is dubious. For example, the way other countries deal with live births vs. the U.S. Any signs of life in the U.S. and it is a live birth and heroic measures are taken if necessary. In many other countries, yes even in Europe, such births are not counted as live births. Search through the archives I've covered this before.

And the point still remains, no country's system is sustainable. They are all financial black holes.

So you can have all the unfounded irrational objections over the form of health care that you want to have, but the plain fact is that on a cost/benefit ratio we're the worst.

The issue of sustainability is not an irrational objection.

If we bring our system in line with other nations we'll spend less and be healthier.

Post hoc ergo propter hoc. Your reasoning assumes that lower health care spending results in a healthier population. There is little or no reason to believe that.

Doesn't matter how we do it.

Was that supposed to be serious? Okay, how about we set spending by half via government fiat. If we run out of money in 6 months we wont have health care for the remaining 6 months.

Still sure about the "how" not mattering?