That being said though, with a pooling outcome you'd expect to see exactly the same price for everyone. The problem is that the healthy subsidize the sick. Furhter, you might also have...

The preferred pool, or community if you like, of most who support universal health care is the nation.
Of course any time you pool risk some will subsidize others, that is the nature of pooling risk. That someone does not think it necessary to make a listing of who is subsidizing whom is not indicative of ignorance on their part. It is at least as likely that they take it to be understood in the context of the discussion.

As it should be with regards to insurance...of any kind. Insurance only works when the bad state is unlikely to occur. If you can predict who is likely to have a probelm then you can't insure them.

So what is your answer for health care for people who require expensive treatment or are likely to require expensive medical treatment once you accept that private insurance companies will not or cannot insure them?

If you look at government run systems they are all in trouble as well. Britain, Canada, France, Germany, etc...

Yet every single one of them runs substantially more cheaply than ours. If they met us even halfway in per capita health care expenditures their financial troubles would be gone and some would have a surplus.
The British have what is probably the most troubled of the universal systems, but I don't see anyone seriously advancing their model for the US.

Now to be fair, there is indeed a problem with health care, but the idea that we can make it something like a right is just stupid.

...life, liberty, and the pursuit of happiness...

It shouldn't be a for profit business at all.

Funny I didn't see James' mention profits. And if you are not going to run the business for profits you'd still have to calculate risks unless you are a complete and utter idiot.

That being said though, with a pooling outcome you'd expect to see exactly the same price for everyone. The problem is that the healthy subsidize the sick. Furhter, you might also have the suburban and rural subsidizing the urban, or the poor subsidizing the non-poor, etc. The rate at which different groups within the population access and consume health care and health care resources is different and hence you could have cross subsidies in all sorts of different directions.

This is why when you have community rating there is alot of discussion of what comprises a community. Define the "community" poorly and you have one group subsidizing another group based not on health, but on where they live, or some other demographic variable.

That people like Tano and Tlaloc don't seem to be aware of this underscores a massive deficiency in their understanding of the issue.

This points to a fundamental weakness in the free-market approach to health insurance. Of course it would be totally irrational for a health insurer to offer a policy to someone who is highly likely to incur costs. Given the rapid advances in genetics, which will lead to all of us having our sequenced genome as part of our medical records in the near future, this problem is going to get a lot worse. If you are sick, or have a predisposition of disease, you cannot expect to get coverage.

As it should be with regards to insurance...of any kind. Insurance only works when the bad state is unlikely to occur. If you can predict who is likely to have a probelm then you can't insure them. It is like asking an auto insurance company to insure somebody who is legally blind. You know they will get into an acccident.

The issue of whether or not this is a market failure is interesting, but how far down this road are we willing to go? How about genetic tests on babies and those that fail are terminated whether the parents agree or not? Seriously, the parents unrestricted breeding is causing an external cost on the rest of society, so shouldn't society be allowed to intervene in this kind of activity? Or maybe there will be more development in genetic engineering to eliminate predispostion towards various health risks. Is that a good idea? And should it be mandated nation wide so as to reduce the external costs of producing babies that are physically deficient?

No, what I have is a realistic appraisal of which is easier to maintain a level of oversight on- the government or a few thousand individual corporations. I also have an appreciation of which has an incentive to do at least a competent job (the government) and which has an incentive to always short the job (the corporations).

Translation: We don't know what we are talking about.

If you look at government run systems they are all in trouble as well. Britain, Canada, France, Germany, etc. all have large and growing deficits associated with their government run health care systems. They are doing things like implementing waiting lists, allowing illegal private clinics to open, or simply denying certain types of care, etc. In places like England you have growing budgets and deficits but a declining number of beds and other measures of output.

Now to be fair, there is indeed a problem with health care, but the idea that we can make it something like a right is just stupid. We live in a world of finite resources and making things rights that shouldn't be is a recipe for over-consumption and/or under-provision. How many people who can afford legal counsel in a criminal proceeding go with the public defender? Why? Because public defenders are over-worked and and the quality isn't very good.

As for the solution I don't pretend to have any silver bullet, but I'm not convinced that the answer is to turn blindly or even with our eyes open towards government. Medicare in this country is seriously underfunded, yet we are supposd to expand this system to include everyone who is currently not insured? I'm sorry, but that is just insane. I've long thought that having a mandate for health insurance was the idea, but not I'm less ure.

And it’s simply idiotic to deny insurance companies the right to charge people different rates based on their existing health; the entire business is one of calculating risks.

Which, of course, drives the sick out of the insurance market and makes them entirely dependent upon emergency rooms for care, driving up costs for everyone.

Either we pool risk intelligently (probably requiring national scales) or we eliminate the requirement that emergency rooms care for all. Let them die in the street, and we can be economically efficient with privatized insurance.

But that is exactly what happens if you get your insurance through your employer. Insurance does not calculate individual risk, it calculates the risk for a pool of individuals.

It depends on the plan, no? Surely, an insurer for a small company is going to up the rates substantially if the company hires on someone with, say, HIV or on the kidney transplant list?

And it’s simply idiotic to deny insurance companies the right to charge people different rates based on their existing health; the entire business is one of calculating risks.

But that is exactly what happens if you get your insurance through your employer. Insurance does not calculate individual risk, it calculates the risk for a pool of individuals.

News flash Bit. God forbid, but you too could end up as someone who is helpless, has no assets, no ability to work, and is dependent on others to pay for their health care. If you don't realize this, you really need to grow up.

Why are those the options? We have to completely junk the system because a relative handful of people aren't served well by it? Why not just close the gap?

James you need to pull your head out of the clouds. It's not a "relative handful" of people who are not being served well by the present system. It's a significant percentage of the total population of the richest society in the history of the world. It's a fricking disgrace.

And I don't know about anyone else, but I am not at all happy about the 100%+ increase in health care costs under Bush. Especially when I read about the kind of profits companies like Wellpoint make.

Why is it you say it is inevitable that there will be short staffing when this does not seem to be a problem in the rest of the first world, all of which use some form of socialized medicine. I guess the inevitable takes a while sometimes.

Do you really have that much faith in the good intentions of the government,

No, what I have is a realistic appraisal of which is easier to maintain a level of oversight on- the government or a few thousand individual corporations. I also have an appreciation of which has an incentive to do at least a competent job (the government) and which has an incentive to always short the job (the corporations).

What happens when the inevitable shortages of highly skilled and educated people willing to work for below market wages makes it impossible to staff your good intentions?

Let's just say I don't buy your appraisal of the situation. Nor do I think that paring the medical field of those people who went into it for the money is a bad thing per se.

What happens when the inevitable shortages of highly skilled and educated people willing to work for below market wages makes it impossible to staff your good intentions?

I look through the yellow pages at "physicians" and find it hard to believe that there is a shortage of people in the medical profession.

In my case, I can't buy private health insurance for my son, so my choices are to work for an employer who offers group coverage, or take him to the emergency room for even minor things because they can't refuse to treat him there. I'll rack up huge bills from the ER, but I don't have to pay them before I get treatment, and the ER will write much of it off as a loss. And guess who's subsidizing the ER? That's right, it you, and Bithead, and James, all because the freemarket left gaps and even with a relatively well paying job, I can't bridge those gaps on my own.

I must respectfully disagree with Tlaloc. Everything is a for profit business. Even non-profits and governments reap a type of profit that is paid to employees and grows the organization. It's not quite like a corporation but each protects their interests and looks to ensure it's viability over time.

Of course every group looks to it's own interests but when are a service provider and those interests are profit they are often served by slighting anyone and everyone they can.

in a field like medical care where you need a lot of schooling to be reasonably fluent in the field it's pretty easy to slight most people.

A government program absolutely is going to try and take care of their needs. But what they need is public support so that politicians are eager to carry their water in budget discussions. How do they get public support? By providing their service well. It's a positive feedback mechanism whereas profit is a decidedly negative one.

Of course it will require oversite, plenty of oversite with real power to correct issues.