Wednesday, April 13, 2011

Reality vs. the right wing

  • Reality: Health insurance for a 61 year old man costs over $2,000 per month, or $24,000 per year. And more expensive for every year over that.
  • Paul Ryan's universe: An $8,000 per year voucher for everybody age 65 and older will suffice to buy them health insurance on the free market. And a pony.
  • Reality: Health insurers prior to the passage of Medicare in 1965 had no desire to provide major medical insurance to the elderly and basically the only way you could get health insurance in 1963 if you were elderly was if you were retired from a job with a major corporation and got it as part of your pension plan. Insurers make their money when insurance isn't used. The elderly (who are approximately 13% of the population) use half the healthcare used in America, because they're engaged in the process of dying (duh), and thus aren't a profitable market because you can't charge them enough to make a profit (because they use half the health care but do *not* earn half the income because, well, they're in the process of dying, duh!).
  • Paul Ryan's universe: Health insurers are eager, eager I say, to provide health insurance to the elderly for the bargain basement price of $8,000 per year, because they're just nice people and are charities, not major corporations with stockholders demanding massive returns on investment!
  • Reality: The United States is the wealthiest nation on the planet, wealthier than every nation that provides top-quality health care to every single one of their citizens.
  • Paul Ryan's universe: The United States is an impoverished third-world backwater which cannot afford to provide health care to every American, so those Americans who aren't rich will just have to die. Sorry, they're just surplus population, so they're going to have to make room for their betters. Just a fact of living in a third world nation where nobody has any money and everybody lives in mud huts and the only doctors are witch doctors and the only medicines are whatever herbal remedies you can find in the country side, y'know?
There's only one question I have left after making up this list: What color are the unicorns in Paul Ryan's universe?

Alrighty, then!

-- Badtux the Snarky Penguin


  1. I can see his unicorns through the security fence. From where I stand, they look to be bullshit brown.

    The mechanism for removing seniors from the ranks of the insured is simple. When I bought the policy you speak of, at about age 40, it cost about $140/month. By the time I ditched it at age 59, it had indeed just been raised to $2000/month. I am now almost but not quite uninsured: my doc has one of those "VIP" deals in which I pay a fixed amount every quarter for as many appointments as I need... with him... during that quarter. It's great, if I can just manage not to need anything for which I'd have to be hospitalized.

    I don't resent it too much until I start looking over another fence, the one between the US and every other more enlightened first-world nation that provides its elders real health care at reasonable cost to them. Then I get really angry... good thing I don't have heart disease, huh?

  2. If the republicans get their way, Ryan's universe will be our reality.

  3. I don' t know what color the unicorns are, but we need to stop feeding them beans. The rainbow colored farts don't smell as good as they look.

    That does seem to be what holds GOP parachutes aloft, however...all the hot colored air.

  4. Can you train a unicorn to drill Lyin' Ryan a new asshole?

  5. Well, my mother will be 90 in a month, and she doesn't seem quite ready to check out yet.

    More to the point, the fact that in the long run we're all dead is only a secondary reason why for-profit health care insurance makes no sense. Back in December, I said this:

    Consider the business model of health insurance; it's really pretty simple. Income is from insurance premiums. Expenses are payment for the health care services used by customers of the insurance company. In this scenario, there are two ways to effect profitability. On the income side, you raise rates. On the expense side, you refuse to pay for services, and/or eliminate high-cost clients from your cost structure by terminating their coverage.

    That's it. There are no other possibilities. Opportunities for competitive advantage by improving efficiencies are severely limited, and would not be proprietary. Opportunities for competitive advantage by taking better care of your customers would result in increased outlays and thus reduce the bottom line. The clear, simple, and obvious message is that for-profit health insurance does not fit a rational business model. The profit opportunities and the customer-care needs are in an absolute and irreconcilable conflict.

    That all came out of my little pea-brain. Do you ever see any discussion of this, anywhere?


  6. Jazz, I've mentioned pretty much the same thing, but in more practical terms. People then interject, "but if insurers didn't pay out claims on a regular basis, then nobody would buy insurance from them!", leaving out the issue that for 93% of people, employers, not individuals, make the decision of which insurance to provide the employees -- and employers make that decision based upon cost, not quality. The end result is a system which has perverse incentives to *not* fund medical care, if funding said medical care would cost more than the insurance company would be able to recoup in premiums from the employee and/or employer. A perfect example is Chiseler Permanente here in Californer. Chiseler Permanente is officially not-for-profit. But they were formed by employers to provide cheap health care for their employees, and are notorious for paying their doctors crap (meaning that most of their doctors don't speak English as their native tongue and graduated from Hyderabad Trade School and Medical College) and denying expensive treatment whenever they think they can get away with it. But they're cheap, so employers continue flocking to them by the hoard.

    The alternative would be the Swiss alternative, which bans employer-provided health insurer and requires everybody to purchase health insurance, but also requires transparency on the part of insurers insofar as percentage of claims paid, average claim size, etc. as well as requiring a certain level of basic coverage and a government appeals body where denials of claim can be appealed to someone outside the insurance company. In that case individuals can make their own decision as to whether to go with the insurance company that doesn't pay claims or not, based upon whether they feel lucky or not (.44 Magnum optional), and insurers that routinely abuse the government appeals process can be fined. But that's in a country with a functioning government, not ours.

    Critter: If the Republicans get their way, there will be a lot of dead people. But that's a benefit in their eyes. After all, sick people and old people aren't useful to them as servants, so best just take them out to the back pasture and shoot them like a sick horse, except, like, not *personally*, y'understand, cause that'd be icky... rather, by denying them medical care, then marking their deaths as "natural causes", when there's nothing "natural" about dying because some rich son of a bitch decided you weren't useful enough to him for you to stay alive. It's sorta like Jazzbumpa mentioned on his own blog, when there's labor shortages you have true serfdom or slavery where the lords of the manor are required to take care of their slaves or serfs... but if there are hoards of people available to take the place of those no longer able to work due to being sick, why, just shoot the sick and get some healthy young buck to replace them on the lord's manor. The fact that we call our lords "CEO's" and our manors "corporations" today doesn't change that reality, nor the reality that we have more people on this planet than are necessary to take care of the needs of our lords, thus serfdom or slavery is not happening -- instead, being discarded like rusty tools is happening.

    Montag: That would be unicorn abuse. PETA has been notified.

    - Badtux the Healthcare Penguin

  7. I think your basic problem is that you don't understand the difference between health care and insurance, AND you seem to think that elderly = poor.

    How about a system where most people actually pay for their own health care out of pocket, while using insurance to cover catastrophes (after all, that's what insurance is), and where people who can't afford to are subsidized to the point where they can.

    And stop talking about the prices of things like they are engraved in stone.

  8. msgnet,
    That sounds very much like Obama's healthcare bill. Many people now have health insurance with a high deductible. They pay for their health care and insurance kicks in for catastrophic care. Most people who don't have a high deductible get subsidized insurance through their work. The health insurance bill provides for assistance for people who can't afford insurance premiums.

    Glad to see you are a supported of Obamacare.

  9. MSGnet, I don't understand when you say "ignore price". Price is how capitalism allocates resources. You cannot ignore price in a capitalist economy. The problem is that, in this case, price allocates healthcare resources away from the people who need it the most. So either those people are dead, or some other mechanism has to allocate resources to them -- *not* capitalism.

    You did not, I see, address my point that the elderly consume 50% of the healthcare resources of America but do not earn 50% of the income of America, because a) they're only 12% of the population, and b) they're old, sick, tired, and retired. Insurance is not going to work for the last ten years of the average American's life because that last ten years, for most Americans, is one life-threatening illness after another until the final one. Insurance only works for *rare* events, not for events that are as certain as, well, death.

    In short, do away with socialist Medicare, and you do away with the last 10 years of most old peoples' lives. The millions of dollars of healthcare assets involved in that last ten years of life simply cannot be recouped by any sort of capitalist insurance system.

    - Badtux the Social Democracy Penguin


Ground rules: Comments that consist solely of insults, fact-free talking points, are off-topic, or simply spam the same argument over and over will be deleted. The penguin is the only one allowed to be an ass here. All viewpoints, however, are welcomed, even if I disagree vehemently with you.

WARNING: You are entitled to create your own arguments, but you are NOT entitled to create your own facts. If you spew scientific denialism, or insist that the sky is purple, or otherwise insist that your made-up universe of pink unicorns and cotton candy trees is "real", well -- expect the banhammer.

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