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Health Care Reform

Discussion in 'All-Star Threads' started by bennyl, Dec 1, 2009.

  1. MoreCowbell

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    Read The Atlantic article posted above. It's worth the time.


    Also, I'm just glad Robert Byrd didn't die before the vote. I was legitimately worried for a while there.
     
  2. MoreCowbell

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    No. There's nothing 'theoretic' about it. You have representation in your respective legislative body. It's not really analogous at all.

    There exists a right to say that. There does not exist a right to expect anyone to give a shit.

    You do enjoy that right. Once every two or six years, respectively. In fact, you just enjoyed that right approximately 13 months ago. Also, the US Postal Service is still delivering mail to your representative's and Senators' offices. The phone lines are probably still working as well.

    Also, if you're going to hammer economics, do you really want to return to tariffs?


    The government is not analogous to a private contractor. However, a better analogy would be this: You live in a shared apartment with six people. the majority of them vote for a living room that you do not care for. While you may complain, you are still in fact required to pay rent to continue living there.



    That's actually not what the term Fourth Estate means. Based on the evidence provided, you do not appear to be a journalist.

    And for the Fourth Estate, the relevant text is actually "freedom of the press," not "freedom of speech."

    We pride ourselves on any number of things. These two are not anywhere near alone. Included is the guarantee of "life, liberty, and the pursuit of happiness." The current medical infrastructure impedes two of these.




    My personal view: the state of the medical establishment is detrimental to the overall health and well-being of American society. A society where people die because of the lack of payment options or obtuse technicalities is neither equitable nor efficient, and is clearly sub-optimal.

    There exist a great number of negative externalities associated with the current distribution of health care. To be frank, other people not getting health care makes me worse off, as an American resident and citize

    As such, I have no problem relegating a certain proportion of my income towards improving the state of said society by means of a better allocation and provision of health care.


    More easily obtained and equittably distributed health care will be a great boon for America as a whole, albeit not necessarily for each individual citizen.
     
  3. MoreCowbell

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    Won't let me edit the above.


    I don't want this to be taken as me insulting VI specifically. I have nothing against the guy, and don't think he's trolling or anything like that. It's just that several of the points that he raises are straw men or fallacious arguments within the context of a representative democracy. Especially if you mean one in the vein intended by the Founding Fathers, since you bring them up several times.

    You in fact have WAY more ability to voice your discontent than Madison, Hamilton, etc. ever intended or desired (maybe not w/ respect to Paine).
     
  4. The Village Idiot

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    And where did I say anyone had to give a shit about the content, they need to give a shit that people can speak their minds. The bolded portion above was my point. You can say it, and in fact, I would go further and say that it should be said.

    Now, you're getting all civicsy on me. The right to vote for a representative (House and Senate respectively) - yes, you enjoy the right once every two or six years.

    The right to say what you want about the political process? Yeah, you enjoy that all the time.

    No, but apparently you missed the context. When the government relied on tariffs for income, as opposed to taxes, they're not depriving you, the citizen of anything. Hence, I doubt highly anyone would care (and would in fact approve) if, under that scenario, the government said 'hey free health care for everyone, and we're buying with money you didn't give us! As opposed to the current scenario where you and I, and our children and grandchildren, will be footing the bill.

    And here is where your train comes off the rails. When the government enters the private sector, is it insane to hold them to the same standard? By definition they can't be a 'private' contractor, but there's a very good reason why most political theorists who advocate capitalism abhor government involvement in industry. And it's because they don't act like a private contractor BECAUSE they're not spending their money. For example, in many environmental cases I've worked over the years, when the State or DEP does the clean up, the costs go through the roof. When private industry does it, it's done for the best price available. And the ultimate point here is when the government enters a market, it is extremely difficult for private industry to compete. Just look at the state of health care now? The government, through Medicare and Medicaid has played a huge part in economically turning the system into what it is they are attempting to fix now. In essence, the fox is returning to the henhouse saying 'holy fuck, look at this mess, we better fix it, but uh, we're going to use your money to do it.' Meanwhile, the chickens are like 'wait a fucking minute, weren't you the same assholes in here an hour ago before it was a mess?'

    But you would not be required to pay MORE rent because they did what they did to the living room. You don't want to remodel, you say 'no thanks' and pay the same rent you paid before. To follow your analogy further, would you have an issue with the other five saying 'hey, Mr. Six, pay up for the living room, or else!' I would. Yet, this is precisely what is happening. The government is passing a bill that is going to cost all of us a lot of money. If we don't pay, we go to jail.

    Both are derived from the same thought, the idea that political speech (printed or spoken) is protected. No matter whom it is promulgated by.

    Again, derived from the same thing. If I could remember off the top of my head, I believe this is all derived from the Zenger case in New York, but I'll have to look around.

    Incorrect. The forbearance of certain urges is the cost of living in civilization. When people band together to create a 'civilization' theoretically, they agree on certain ground rules. You don't kill me, I don't kill you, etc. Taxation is not a prerequisite to civilization.

    I'll take Civilization. As noted above, taxes aren't necessary. Taxes can become 'necessary' (and this is a stretch) if the government has to provide something. For instance, a military - though keep in mind, this country did not have a standing military for a while. The citizens were required to serve.

    This is a throwaway garbage argument and usually a last ditch effort. One should not be required to leave that which they are a part of due to a disagreement over policy. And ultimately, lest you forget (with all that crazy taxes are a necessary part of civilization stuff) this government's power is ultimately, and as stated, derived from the people. Us. Somewhere along the line, we've begun to recognize a line that probably shouldn't be there. The government, at least as it was initially set up, is there to serve the people, not the other way around.

    Ok, I agree. It's fucked up.

    Ok, let's say the above is correct.

    Whoops, don't look now, but you already do. It's called Medicare and Medicaid, and it is a big part of what has fucked up the system. So what you're really saying is 'I'm prepared to throw good money after bad because the government fucked it all up, but they promise they'll do it right this time?'

    Yeah, I'm not prepared to go along for that ride, but as the central point of my posts should be clear, I really don't have a choice in the matter, do I?

    I can't figure out whether your invoking Carl Marx or Star Trek. Either way, it sounds really really nice, but scares millions of Americans, especially when it's called 'Socialized Medicine.' I make no comment on my personal take on this.

    And as far as your edit: I'm NOT (whoops, critical 'not' left out) taking it personally, because your arguments weren't personal, no clarifications necessary on your part.

    Tag, you're it.
     
  5. MoreCowbell

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    Honestly, I'm in a bit of a hurry, but I promise to give that the response it deserves at a later point in time.

    But quick answer:


    Neither, at least not to the best of my knowledge. I'm saying that I am of the opinion that there will be a large net utility gain, and in fact a utility gain for the majority of American citizens (even for some/many of those who experience a decrease in income in explicit terms due to the reforms).

    However, I realize that at the moment this is little but an unsupported assertion.
     
  6. grits

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    VI, can you please cite this from the bill?
     
  7. MooseKnuckle

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    Haven't we been doing just that for the past 50 or so years? To a limited extent (medicare and medicaid), we've certainly been investing* a certain proportion of our income with the guarantee that The State would better allocate and provide health care insurance. And as many people have pointed out, our health care system as a whole is currently highly regulated and supervised by the government. It seems to me, with tens of trillions of dollars in unfunded benefits to these government institutions, that the experiment has failed. Instead of throwing more money into a program (and overall mindset) that doesn't provide self sustaining results (that part is extremely important), why don't we search for a completely new way of doing things. Outside the box.

    If we're going to collectively chip in our money we should consider it as an investment in our country. I have no problem with pooling our money for certain things as long as the investment is going to yield a net gain. Considering we're over 12 Trillion dollars in debt, probably close to 25 trillion dollars in another decade, I'd say we haven't made good investments.
     
  8. Aetius

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    I believe he's referring to the fact that government power is predicated on the threat of force, and that they have demonstrated in the past a willingness to use that force in the collecting of taxes. Nothing specific to this bill, just general political science.
     
  9. grits

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    Of course that's what I think he means but that's clearly not what he said. With statements like that it's no wonder millions of Americans are scared.

    Few people know how much we'll have to pay or what the penalties would be for non-payment. I'd hazard a guess nobody on this board knows specifics. Making such statements without full disclosure might give one the impression that your statements are fact based.
     
  10. The Village Idiot

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    Yes, this is what I was referring to, the general power to enforce tax liabilities, either through substantial fines, and if unpaid, or shown to be deliberate, jail time. Sorry I wasn't more specific, 'jail time' is not in the bill, but any time a fine is instituted for a failure to comply with a statute, there is always the potential for jail time if the deficit from the taxpayer (or finee, as the case may be) remains unpaid.

    The article I cited above (CNN FAQ's) covers the fines that would be levied, as well as subsidized costs to people at 400% of the poverty level or less.
     
  11. manbehindthecurtain

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    I have much to say on this topic, but for tonight I will leave it at this.
    My wife is a doctor, and when I see what her and her colleagues in residency training go through in order to become a licensed physician - 4 Years of College, 4 Years of Med School, and anywhere from 3 years of residency to an additional 3+ years of fellowship training in order to become a much government maligned "specialist" - not to mention $200,000 in medical school debt, and hundreds of thousands of dollars of opportunity cost - if there is one thing missing from this bill that I would like to see, for my own family's sake, would be material tort reform.

    Instead, I am concerned that our government of lawyers cannot even keep their basic promises to "bend the cost curve" and in effect are teeing us up for an even greater population of poor, uneducated, and irrationally demanding patients who are not being asked to pay into the system, to add further strain to the healthcare system making a doctor's job even more thankless.

    In the meantime, I will continue to wait for my wife to finish her Christmas Eve shift, so that we can have some spaghetti and meatballs for our Christmas Dinner. Methinks every willing congressman is comfortably nestled in their homes after taking their tax payer funded transportation to their home district for the holiday.

    In short, the US Congress can go fuck themselves, and if the day ever comes that private practice is made illegal as in Canada, or that Doctors are required to work for the government, the lenders of this med school debt are going to have to pull me kicking and screaming into debtor's prison.
     
  12. MoreCowbell

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    OK. I'll give it a shot.


    My point was, your beef isn't with health care reform, it's with representative democracy. Here's other things you don't get to vote on directly: military expenditures, transportation bills, education bills, auto emission standards, financial regulation, etc etc etc.

    The fact that you don't get a 'say' is just part of the deal you get when living in a representative democracy. It has nothing to do with this specific bill.


    Secondly, you DID vote on it. When you elected your representatives and president. You knew what their positions were. You knew what they supported. And cast your vote accordingly.

    It sounds like you aren't exactly pleased with the tack taken. C'est la vie.


    Yes they are. With a few exceptions (I'm actually more pro-tariff than the economics mainstream. For intriguing arguments, see Joseph Stiglitz), they are depriving you of your economic well-being. They are funding their coffers with money taken out of your income.




    Maybe we fundamentally disagree on the proper role of government. In my mind, one of the central, in fact, I will say THE central, role of the state is to provide for goods that benefit society, yet are not paid for by the private market.

    What would happen to the state of environmental cleanup if the EPA and other assorted agencies were to step aside tomorrow? It would fall into a state of disrepair.

    Some times, the invisible hand fails. Even Adam Smith knew this. Sometimes, there exist market failures, and the state needs to correct them. Smith even advocates for this in The Wealth of Nations.

    In short, the FUNDAMENTAL reason that government exists is to correct for market failures. As such, they are not mere actors in a private market.

    Our inability to provide an efficient and equitable allocation of medical resources is a market failure. The private medical insurance market is not producing a functional equilibrium. Thus, there was a necessity for the state to step in.


    They often do. It's part of renting an apartment. It happens every day. Some times rent goes up, and some times you have to either pay it or leave.


    Apparently we have different definitions of civilization. I don't kill you, you don't kill me is not civilization. Assorted groups of hunter gatherers are not civilization.

    A world without armed forces, roads, clean water supplies, environmental standards, scientific progress, education, and well, everything else in the modern world would not be, in my opinion, civilization. And modern society would be impossible without a government involves in the provision of public goods, with public goods being defined in the economic sense.

    For what I consider to be 'civilization,' yes, a taxing government is a pre-requisite.


    I didn't say required. However, living under policies that you disagree with is a fundamental property of living in the modern world of sovereign nation states. It is what it is. Yes, you can dissent, but to expect otherwise is little more that naivete.

    Government serves the people, collectively. It does not serve individuals. Individuals may and often are faced with the choice of live under undesirable policies or leave.

    Secondly, I object to your certainty in declaring that the "people" oppose health care reform. There is no proof of this. YOU have drawn this supposed line. I see no proof that the people have not been properly served.




    Note the words 'improve' and 'better.'

    You're confusing correlation and causation. Medicare and Medicaid are becoming underfunded and potentially insolvent because of rising medical costs. Medical costs are not rising because of Medicare and Medicaid.

    Also, a substantial portion of the bill is Medicare and Medicaid reform. For example, the current bill results in Medicare and Medicaid being solvent for a projected seven to ten years longer. Longer, if it successfully bends the cost curve.

    See above post.
     
  13. MoreCowbell

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    I agree about tort reform and the necessity of the existence of private facilities and employees in the health field.

    But for what it's worth, Congress was in session today. All members of the Senate were in Washington.
     
  14. clkx88

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    I can see why not a single Republican could be convinced to vote for the Senate bill. As it stands, the bill is unethical in my humble opinion. There is an unfairly large burden being thrust upon those that will be responsible for paying the taxes that will fund this project. A big factor that is being ignored by the mainstream debate is the undeniable fact that the quality of care will drop, as will the supply of doctors. Socialized medicine does not even work that well in Canada or Britain, in terms of receiving quality care as well as receiving care in the time frame that we have become used to in the United States. The (condensed) problem with socialized medicine in Canada and Britain is that they implemented their systems assuming a certain level of population growth, then introduced immigration programs that changed the whole landscape of their populations, and then broke their healthcare systems with overcrowding.
    I call the proposed bills unethical because the United States has already gone through its immigration explosion, and socialized healthcare here will become overcrowded from day one, due to all the new people that can receive care. And while that situation will change, the number of people enticed to go through the rigors of medical school will start to fall off, due to the diminished reward for completing such an arduous task. Because of this, people at the income brackets that will be taxed to pay for the program will be giving up the quality of care they are used to, the quality of care they pay for, to improve care for people who would have less care or otherwise not have it. The rich and the "Cadillac" insurance plans as CNN likes to call them will be taxed completely disproportionately to the benefit they receive. Which would be none, by the way. We don't need to provide heathcare to everyone, it's not a good idea. I think there can be a bare bones universal plan that should help to lower prescription costs, and help out on hospital visits. But people should be able to buy the best possible care they can afford, without being saddled by the idiocy of the average and below average American.
     
  15. Aetius

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    Yes, the Senate held a vote on Christmas Eve... for the first time since 1895.
     
  16. Merle

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    I agree with you completely. Doctors, drug companies, and insurance companies have as much right to profit from their products as any other field. Welfare should cover the bare minimum need to live day to day meaning food, water, and some basic shelter. Hell I will even give into emergency medical care (meaning you were shot or broke a leg).

    I constantly see people in this thread talking about those blessed poor down on their luck. God help us if people living in the richest country in the history of the universe who cannot figure out how to pay basic bills cannot afford advanced medical care as a luxury, whatever will this nation do? But all the hard working people in the medical field who have sacrificed the better part of their youth studying and working relentlessly to make humanity better are all greedy assholes, right? Fuck them!

    I have no idea what experiences people on this board have gone through but every person I know who is on welfare has put themselves there with the exception of people who are legitimately handicapped. Every person I know from high school or is currently in my age group who is now on these programs always seems to have money for an ounce of weed or a handle of Jim Bean but never for insurance. People put themselves in the situations they are in the vast majority of the time. Here are all of the "poor" people who I personally know on welfare. I know a good deal more but not enough to 100% comment on them but I imagine it is more of the same.

    Person 1:
    In a drug fueled rage beat the shit out of his girlfriend and put her in the hospital for two days. Is still snorting cocaine like a fiend and shows no signs of stopping.

    Person 2:
    Currently 3 months back on rent while collecting welfare (He lives with a mutual friend who is nice enough to put up with it until his parents come bail him out time and time again). Smokes over an ounce of weed a week and goes out to bars twice a week.

    Person 3:
    Tried to steal over 150 from a friend of mine at a party because he said he NEEDED to buy a birthday present for his little brother. Showed up the party with a few joints.

    Let us look at the other end of the spectrum of people I know who are not on welfare:

    My ex-girlfriend lives Brazil. Her father was schizophrenic that sexually assaulted her entire family at one point. When I went to visit them two Summers ago the entire house was barricaded like a prison to keep out the father who lived down the road because he would go berserk and start trying to break into the house on a nearly monthly basis screaming at the top of his lungs that he would murder all of them. Oh did I say house? I meant quartered off square that could fit into most Americans' driveway or living room. Since she was 13 she has been going to school and working full time (simultaneously) in order to pay rent and food bills. She has been putting over 12 hour days for the better part of her life to afford the bare minimum (including insurance bills) because of the environment she grew up in. I assure you she had a shittier life than you growing up and she can afford insurance. She has never received a cent of government hand-outs.

    My dad just moved halfway across the country (My parents are together), like he did when we has 20, to live by himself to work because it is the only way to support himself and his family. Why the hell does he have to do that so some asshole can collect his tax money to live with his family? Hell if the company I am interning for does not end up hiring me full time when I graduate I am moving out there with him because it is cheaper to live out there and I feel bad since he made that sacrifice so my family and I could live well.

    Another of my friend's in college grew up with a father that beat the shit out of him on a regular basis after getting pissed drunk. His mother ended up leaving him (the father) and marrying a decent guy who passed away when my friend was 20. My friend feel into a depression at which point his mom was diagnosed with lung cancer and was on the way out too, she died last year. He dropped out of school when his stepfather died. Did he sit there and feel sorry for himself (which he could have)? No, he joined the fucking marines and is currently happily married and owns his own house and pays for all of his own bills. He is 24 now.

    One of my non-college friends works three jobs. He is in a band, he works for the public works in his town from time to time, and he works construction. He almost died of pneumonia two years ago and paid all of his hospital bills by working his fucking ass off. None of the jobs he has require anything other than a GED and a hell of a work ethic to get. He is the hardest working person I know.

    Why the hell should life be harder for the last 4 people I listed to improve the lives of the first three? The "Cadillac mom" is not a mythical beast like a yeti. It is an example to show how the vast majority of people wind up on these programs, sense of entitlement and no work ethic.

    Now before someone tries to shove words into my mouth I am going to clarify a few things. I do believe in a very healthy tax to support all aspects of government. This includes school/military/police/etc... I do support temporary relief for people who have lost jobs and even permanent relief if someone lost the main provider in the family due to an accident. As stated above I more than support welfare to get by with food, clothing, shelter, and emergency medical care. I even think there should be welfare protection for rape victims along with those who have handicaps even if it raises my costs. I very much support government regulation to ensure nothing unethical is being done.

    However, this attitude of insurance companies/doctors/drug companies being Disney villains that love fucking over the common man on advanced, expensive medical care is bullshit. They are doing the best they can to provide for everyone. As much as it sucks you cannot run a business without profit. If a person cannot afford their services it is in no way the insurance companies'/doctors'/drug companies' fault. I would love someone to explain to me how they think it is.
     
  17. carpenter

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    Cancer. The big "C". The scariest motherfucking thing in the jungle.
    If you've ever seen anyone die from this, your entire outlook on everything changes. And like everything, some people make a lot of money from other people being treated for cancer.
    It's a big business, like everything nowadays. I'm sure there's no one out there wishing cancer on anyone but, the amount of money that's been thrown at the cure for cancer? This disease should have been squashed like a bug.

    On the Adam Carolla podcast earlier this month he talked to Suzanne Somers. Who didn't sound like an idiot, surprisingly.

    <a class="postlink" href="http://www.adamcarolla.com/ACPBlog/2009/12/10/adam-and-suzanne-somers/" onclick="window.open(this.href);return false;">http://www.adamcarolla.com/ACPBlog/2009 ... ne-somers/</a>

    Sure, I'm not going to take it as gospel but, she makes a few good points.
    I agree that there's a lot wrong in America. But, I also believe that we do more right than we do wrong, and at the end of the day we can collectively say that we tried our best.
     
  18. manbehindthecurtain

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    I don't have the medical background to discuss your comment as to whether cancer is curable by throwing money at it, and it is likely you don't either. However, I can share my experience of having cancer as a 25 year old, and I can tell you the way my doctors dealt with not only my disease but all the other patients in the clinic, they had it down pat.

    I have a good job, and at the time, the perfect health insurance for dealing with a cancer diagnoses - a catastrophic policy with a high deductible and then limited out of pocket expense after that deductible. In the end, I ended up paying about three thousand dollars out of pocket for probably close to a hundred thousand dollars of insurance and employer payouts worth of surgery, chemo, tests, scans, etc. Of course the "billed" amounts were multiples higher, but as anyone who has ever looked at an explanation of benefits form from their insurer, you get a funny feeling when you see the doctor who just saved your life getting paid a hundred bucks for a surgery he billed for three grand. A friend of mine, a doctor in training actually, had an HMO when he got sick with a pancreatic disease. Since he surrendered his medical decision making process to an insurance company, he had to spend nearly 15k out of pocket to coordinate his own care, in a very disjointed delivery system, which was the complete opposite of what I experienced as a cancer patient in a hospital system that clearly benefited from coordinated research funding and donations. Cure or not, I believe the funding that goes to cancer research and treatment made my experience far better than if I had some kind of obscure bowel disease or something.

    But, my overall point about your cancer post, is that I don't think the incentives are as mis-alligned as you do. There is nothing more that the oncologists, chemo nurses, and medical researchers want than to never have to treat another cancer patient ever again. I saw a lot of death in the chemo ward, but also a lot of hope and genuine care and support by the people who dedicate their professional lives to "squashing" the disease. My doctor is a leading researcher for testicular cancer, so not only was he treating me with the best and known effective methods, he also spends more than half of his time trying to understand how to predict, prevent, and detect earlier, testicular cancer. I was treated at a major university research hospital in Philadelphia, and the things they try there, are communicated out to other treatment centers around the country. The bones of the treatment process I underwent and saw every day were good, highly systemized, and efficient. The money that flows into cancer research and treatment funding is what makes the difference between an orderly treatment process and a scatter shot one, and in my view, University based hospital systems are properly structured and aligned to maximize treatment effectiveness with concurrent efforts for research.
     
  19. Merle

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    I definitely see where you are coming from about death and disease being terrifying. I am not pissed off that people want the health care. I am obviously not for the public option but that is not what drives me nuts. The main reason I am pissed off so much in my last post wasn't so much the politics but more the attitude of people. Let us say the public option passes and it works perfectly. Thats wonderful. But if that is the case it is not a matter of "we finally got those rich assholes to pay up." I see it as "good thing some people worked so hard in their lives they were able to care for complete strangers through the amount of wealth they acquired."
     
  20. Bendir

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    <a class="postlink" href="http://www.marginalrevolution.com/marginalrevolution/2009/08/consumer-drive-health-care-plans.html" onclick="window.open(this.href);return false;">http://www.marginalrevolution.com/margi ... plans.html</a>

    Cost-savings in the first year of instituting a CDH plan relative to a traditional plan ranged from 12% to 21%, remarkably large figures. Moreover, costs appear to grow more slowly under CDH plans than under traditional plans.

    Generally, all of the studies indicated that cost savings did not result from avoidance of inappropriate care and that necessary care was received in equal or greater degree relative to traditional plans. All of the studies reported a signficant increase in preventative services for CDH participants.

    So this is further evidence that lower cost medical decisions should be linked to the consumer. Health Savings Accounts coupled with Catastrophic Health Insurance. The private sector has made a significant shift from guaranteed benefits to guaranteed contributions (pensions to 401k). But partially privatized social security was destroyed in Bush's second term. It seems the government is unwilling to even consider this kind of switch.