You can't expect a Chihuahua to win in a fight gainst an American Pit Bull Terrier and you can't expect insurance markets to work with pre-existing conditions. Such expectations are unreasonable.

And so a free market system will leave people to die who otherwise would not have?

We are going to have to make do with less.

I just don't see how this is an acceptable solution.

We can't maintain the current pace.

You're undisputably correct here. Given projections in health costs to both government and employers, I can't disagree on this point.

1) Janis: sow. LOL. Point taken. Sorry. But I do shave every day.

2) Pre-existing conditions: Hi, I'm Drew. I want to enter into a risk pool contract with you. I expect to pay $100,000 in premiums over the next 8 years. Oh, by the way, I also expect, based on my pre-existing condition, to require $150,000 of payments.

Want to insure me?? Who wants a piece of that??????

Wake TFU people.

Exactly. The free market failed, or there was never a free market for health care to begin with, or maybe you can never profit when trying to save lives and we shouldn't expect to. Maybe that's what makes government the appropriate champion for health care. I don't know.

The market didn't fail it did precisely what it was supposed to do. You can't expect a Chihuahua to win in a fight gainst an American Pit Bull Terrier and you can't expect insurance markets to work with pre-existing conditions. Such expectations are unreasonable.

Further, it is inappropriate for the government to be stepping in to health care 100% when a much smaller presence can get the job done. You don't drive a 1 inch penny nail with a jack hammer. Further, doing so could be very problematic from a fiscal stand point. We introduced Medicare and a few decades later we have rapid growth in health care costs. Research indicates there is a link. Expanding Medicare to cover everyone would likely exacerbate the problem.

We are going to have to make do with less. Lower growth in health care services, lower rates of technological improvement and innovation, lower rates for introduction of new drugs, etc. We can't maintain the current pace.

Since the free market folk don't really have a solution for him, they must write him off somehow, or at least put the inconvenient truth out of their minds.

Exactly. The free market failed, or there was never a free market for health care to begin with, or maybe you can never profit when trying to save lives and we shouldn't expect to. Maybe that's what makes government the appropriate champion for health care. I don't know.

Now, ultimately, a lot of the concern is focused on the specific issue of the interaction between wages, health care, manufacturing jobs, and the status of high school educated workers. I suspect for many the issue of the competitive disadvantage of health care costs is a shorthand way of talking about the decline of U.S. manufacturing and the plight of blue collar workers, no?

The data that I've seen, which is not very precise, indicates that wages are growing at quite a bit slower rate than benefits. The only problem is if total compensation grows faster than productivity. If that happens then yes, there is a competitive disadvantage. I don't think that is the case though, and it is incumbent on those making the claim to put up the evidence. So far, all I've seen is claims and damn little evidence.

As for manufacturing jobs I think it is time to start considering that those jobs are going to go the way of the dodo. Why? Technological advancement. I know lots of peopel get their panties in a knot over off-shoring but I'd say that the largest "destroyer" of jobs is technological advancement. How many people work in the agricultural sector now vs. 100 years ago?

As such, getting a good job with the kind of preperation high school students get nowadays might become increasingly more difficult. Perhaps it is time to rethink how high school works. Maybe there needs to be a two track system. One for those who have the talent and desire to go to college and another for those to learn trades that pay well--i.e. skilled jobs that don't require a college education. For such a job having a grasp of chemistry and biology might not be so important. Just a suggestion, feel free to shoot it down.

Sam,

With all due respect, the two aren't really at all comparable. Conditions often exist that with proper treatment can prevent life threatening situations.

I think you are a bit confused, which is understandable. I agree with what you are saying, but insurance isn't the idea that your health care is paid for by other people. Insurance is where you enter into a contract where the costs of large an rare outcomes are mitigated by the premiums you and others buying the contract pay. As such, routine treatments should NOT be covered. That would be like having car insurance that covers oil changes, tires, and replacing a worn out radiator.

In other words routine and planned health care issues should be paid by the individual and not covered under a health plan. For example routine check-ups should be paid for by individuals--completely. Eye exams, gynocological exams, and pregnancy to name some examples.

Now a person born with diabetes cannot get insurance because there is no probability associated with the event. Further, while routine care can reduce the probability of further medical complications it cannot rule all of them out. As such, the person with diabetes is going to be in a difficult situation when trying to obtain insurance. How do you determine if a given outcome is "bad luck" or due to the pre-existing condition?

As a result, in this case a market for health insurance will not cover these people. I hesitate to call it a market failure becuase this is what the insurance market is supposed to do. Now, what we do as a society to address this issue is a different question.

Now, the beauty of the group contracts is that the insurer is forced into allowing members coverage for pre-negotiated prices. But, because the majority of people of the group are relatively healthy profit factories, it decidedly mitigates the risk to the insurer.

This is a win-win because people who need it get covered, taxpayers are out of the equation, and insurers make money.

No it isn't. What you are describing is an insurance pool. In a market any pool like the one you described will be "broken" by seperation. That is, suppose you have a pool with 1,000 people in it. Suppose the expected/average cost for those 1,000 people is $1,000,000. Thus the premium is $1,000/person. But suppose there are 100 people in that pool whos costs are $500,00 and remaining 900 people have a cost of $500,000. Now another insurance firm could "skim the cream" here by offering an insurance contract to the 900 with a premium of $556/person. These 900 would immediately switch leaving the 100 people holding the bag for $5,000/person.

In other words, in your "win-win" the healthy are losing out by subsidizing the unhealthy. Now if we were in a situation were everyone started out healthy and poor health was a truely random event one could argue that initially such a pool might look attrative since nobody knows who is going to be healthy and who is going to unhealthy. However, we do not live in such a world. There are those with pre-existing conditions and poor lifestyles that can make pooling outcomes very hard to sustain without the coercive power of the state.

So to say this is a "win-win" is not accurate when you need coercion to obtain that outcome.

Odograph,

How does the market provide him cheap insurance through life, when it is easier to just exclude him?

Since the free market folk don't really have a solution for him, they must write him off somehow, or at least put the inconvenient truth out of their minds.

Once again, this situation is not one that an insurance market can address. It is like trying to drive a nail with feather. Insurance markets are for events that are costly and rare.

Your pacemaker example is undoubtedly costly, but it is NOT rare. Let me repeat that. It is NOT rare. It is an event with probability 1. A certainty. A fact. A truth. Beyond all doubt. You cannot expect insurance to work in that case just as you can't expect a match to work underwater.

Ideally, we'd like people to pay for expenses that they incur. I don't expect you to pay for replacing the breaks on my car. However, there are cases like your example. In those cases there needs to be a mechanism to deal with it. Insurance is NOT it. Those who favor things universal coverage should at least have the intellecutal honesty to say, "We are going to take your money--in effect part of your life--so that this person over here can get what he needs." To say we can get it without imposing additional costs on others is just a blatant lie.

I'd also argue that it shouldn't be something that covers everything. If a family can't afford to take a child to the doctor for routine check ups and minor ailments--e.g. ear infections--then perhaps that family should not be having children. To the extent that we reduce the costs of having children for those you can't afford to have children the more of these children we'll get. That is what subsidies do, they get you more of whatever you are subsidizing.

Since the free market folk don't really have a solution for him, they must write him off somehow, or at least put the inconvenient truth out of their minds.

People with prior health concerns are not eligible for insurance since insurance can't work in that case. You can't buy car insurance once you get into an accident. Same thing works for health care insurance.

With all due respect, the two aren't really at all comparable. Conditions often exist that with proper treatment can prevent life threatening situations.

Severe diabetes is one such case. But because of the reality of the hyper inflated market mostly caused by insurers, where those treatments are affordable through insurance, they are prohibitively expensive to individuals without it.

As a result, people aren't able to pay for proper medication or treatments, as necessary in the case of cystic fibrosis for instance, and they are forced to forego those treatments and succumb to death in an inhumanely excruciating fashion, or wait until their condition merits long-term hospital stays of which the tax payer shoulders 100% of the super hyper inflated costs associated with that.

Take severe Crohn's disease for example. With insurance, it merely costs monthly premiums and the out-of-pocket maximum amount to pay for common treatment. This comes to around $5,000/year. Without insurance, the cost of medication can be around $30,000/year. Good luck getting covered without a group plan. Treatment can keep you a very productive taxpayer. Lack of treatment will likely end up forcing disability after painful intestinal resections, a high risk of cancer, and well, you see where that goes.

Now, the beauty of the group contracts is that the insurer is forced into allowing members coverage for pre-negotiated prices. But, because the majority of people of the group are relatively healthy profit factories, it decidedly mitigates the risk to the insurer.

This is a win-win because people who need it get covered, taxpayers are out of the equation, and insurers make money.

The problem is that this system puts an undue strain on small business to compete because of the contract terms. They don't have enough people to make it profitable so the premiums can be sky high.

And since most Americans are still employed by small business, this leaves a large majority of people who need coverage out on the street. This is the current disgusting state of health care.

So do we say "screw you" to the diseased and send them off to a valley somewhere to rot, or do we try to come up with a solution that doesn't only benefit the healthy elite?

The system we need is one that covers those who need it; it relieves the burden off small business in order to promote free market competition and entrepeneurship; it relieves the pressure from hospitals to write off inflated costs and thus eases taxpayer responsibility; and it standardizes and streamlines a bureuacracy that gives the government a run for its money.

What system is this? I haven't a clue, but I think this is the direction it needs to take.

Apparently getting something for nothing, JUST BY PASSING A LAW... isn't all that beneficial. Everyone getting something for nothing, has apparently broken our ability to get anything. Who would have thought it?

I'll retire my grammarian now.

Go on with your discussion.

Google has 643,000 instances of "led me to believe" ... which may not actually be enough these days to claim correct usage.

But yes ... the medium is not exactly composition. It is something above text messaging, IMO, not not that much higher.

I just started sewing again, and it's a lot more precise than anything you're doing here.

One sews shirts and dresses. One sows seeds and discord.

You reap what you sow. You wear the other.

The internet is destroying the English language.

(And the past tense of "lead" is "led.")

I wonder how many of us would be denied coverage, or only offered coverage at very high rates. if genetic testing was made a precondition of purchase?

FWIW, when I went through, and then off, COBRA, for semi-retirement ... the insurance companies thought up all kinds of crazy reasons not to cover me. They all denied coverage.

I had to write a letter and say each point was wrong, one by one, and then they said OK.

That led me to believe that, at least in that place and time (California around 2000) the default answer was "no." They wanted you to actually prove you were healthy.

(Because I'd been to a chiropractor once, and only once, to ask about my shoulder ... Blue Cross denied me and suggested I contact the California "major health risks" fund.)

I think the only reason most people don't know how messed up our system is, is that most people are healthy. You only find out if you get sick. That's a bit of a harsh catch-22, in my opinion.

Now obviously if total compensation rises high enough here, for whatever reason, that firms here are no longer competitive such firms would shut down. However, the reasons for this don't have to be related to health care. Cartels could cause this kind of result, for example.

Well, sure. It COULD be from any number of reasons, but the concern is that it is precisely health care costs that are the problem right now... And part of the reason is that wages are not perfectly adjustable. Indeed, with health care costs rising as fast as they are, we should be seeing actual downward pressure on wages, which is difficult for all sorts of reasons -- collective bargaining agreements, social expectations, etc. So the health care costs increase, wages stagnate but don't decline... and the end result is that potentially costs per working increase faster than productivity here, though not necessarily elsewhere.

Now, ultimately, a lot of the concern is focused on the specific issue of the interaction between wages, health care, manufacturing jobs, and the status of high school educated workers. I suspect for many the issue of the competitive disadvantage of health care costs is a shorthand way of talking about the decline of U.S. manufacturing and the plight of blue collar workers, no?