Romney Outlines Health Care Plan Using the Consumer Model

[WhyteRain]

At least he has a plan, and actually a pretty decent plan, at that.  Before he was decrying ObamaCare with no plan on his own to back it up.  The current system is not working, and Romney knows that, so I'm glad he put his plan out there on the table.

And his "plan" is absurd. Inefficient healthcare with an outrageous price tag.

How will the government make healthcare -- or indeed any human endeavor ever before seen in history -- more efficient and less expensive?  Examples please.

[WhyteRain]

How will the government make healthcare -- or indeed any human endeavor ever before seen in history -- more efficient and less expensive?  Examples please.

See my post above yours. Of particular note is the Singaporean example. It's certainly quite subjective whether you would consider it more "efficient", but it's a mathematical fact that it's less costly.

I think you're confusing "less costly" with "less pricey".  Let's see if I can give an example.

We'll take all of your figures as true:  The U.S. spends 16% of GNP on healthcare while other countries spend 12% or 8% or 4%.  These facts tell us exactly zero about the cost of healthcare in the various countries.  Why?  Because they assume demand is exactly the same in all countries -- which we know it is not.  It is like saying:

Bob's car needs $30 for a gasoline fill-up
Jack's car needs $45 for a gasoline fill-up
Mary's car needs $70 for a gasoline fill-up
Jill's car needs $105 for a gasoline fill-up...

...and then concluding that gasoline is more costly where Jill is.  What if Bob's car is a sub-compact, Jack's is a midsize, Mary's is an SUV, and Jill's is a full-size pick-up truck?  Then not only may the gasoline per unit cost the same but Jill's could actually be cheaper, right?

Demand affects the price of every kind of good and service, not excluding healthcare.  Americans spend more on healthcare because they demand more.

Btw, do you notice that when throwing out numbers like this, people usually don't ask, "Well, if the Singaporeans are spending only 4% on healthcare ... then where's the rest of their money going -- that 12% of GNP that they aren't spending on healthcare and that American are?  Food?  Shelter?  Entertainment?  Energy?"

[WhyteRain]

How will the government make healthcare -- or indeed any human endeavor ever before seen in history -- more efficient and less expensive?  Examples please.

See my post above yours. Of particular note is the Singaporean example. It's certainly quite subjective whether you would consider it more "efficient", but it's a mathematical fact that it's less costly.

I think you're confusing "less costly" with "less pricey".  Let's see if I can give an example.

We'll take all of your figures as true:  The U.S. spends 16% of GNP on healthcare while other countries spend 12% or 8% or 4%.  These facts tell us exactly zero about the cost of healthcare in the various countries.  Why?  Because they assume demand is exactly the same in all countries -- which we know it is not.  It is like saying:

Bob's car needs $30 for a gasoline fill-up
Jack's car needs $45 for a gasoline fill-up
Mary's car needs $70 for a gasoline fill-up
Jill's car needs $105 for a gasoline fill-up...

...and then concluding that gasoline is more costly where Jill is.  What if Bob's car is a sub-compact, Jack's is a midsize, Mary's is an SUV, and Jill's is a full-size pick-up truck?  Then not only may the gasoline per unit cost the same but Jill's could actually be cheaper, right?

Demand affects the price of every kind of good and service, not excluding healthcare.  Americans spend more on healthcare because they demand more.

All of this is of course entirely true. In fact reducing demand for healthcare has been a cornerstone of Singapore's state policy for reducing health expenditure- they've done that primarily through heavy co-payments for public funded healthcare(with private sector also mandated to make heavy use of them), thus giving consumers a strong incentive to restrain their consumption. Also by making medical treatment a thoroughly unpleasant experience(overworked and underpaid doctors, long waiting times, public hospitals that make hospitals here in Australia look downright pleasant).*

But I don't think you can reasonably say that lower demand explains all of it. Singapore has lower public health expenditures(3.3%) then the most comparable nation, Hong Kong(6%). Hong Kong happens to have a fairly strict cost control regime as well. All other developed countries have higher health expenditures then Hong Kong. So consider that... Singapore has half the expenditures of its closest competitor.

*You might of course say that this is too high a price to pay for reduced healthcare expenditure. I don't necessarily disagree, and I'm not specifically advocating the Singaporean system. Just observing the fact that the government can potentially reduce health expenditure through cost controls and other measures... in fact America is unique in that it doesn't do so.

Thanks for your thoughtful response.

Yes, those are ways government can reduce demand for healthcare -- though I think if American culture didn't have this belief that if we only ate and drank just the right things (which makes many of us fanatics for the most stringent environmental laws no matter the "cost-benefit") and if we only exercised just the right way and just the right amount and, and, and ... then maybe we wouldn't really have to die.  Believe it or not, in discussions of healthcare with Americans often the first thing you must overcome is their deep-seated resistance to the idea that no matter what we do, no matter how much we spend, everybody is going to die -- so that we are not talking legislating and spending for "solutions", only "delays".

In the meanwhile, in the U.S. experience, government intervention in the healthcare system -- which has been almost entirely been done by "cost-shifting from patients to taxpayers and insurance rate payers" -- has by concealing the real costs from patients and providers alike served only to increase demand, not decrease it.

[WhyteRain]

I'm uncomfortable with this. Quality will no doubt vary throughout the nation, a national plan is preferable.

Then you'll have low quality for all -- but you won't know it because you won't be able to compare state plans with each other.

You're a Democrat, right?

[WhyteRain]

Also, if you ok interstate sales of insurance, every insurer moves to the one state that makes itself "friendliest" to the industry and offers policies there. The other 49 states' regulation becomes a dead letter because no one's going to need to offer insurance to those standards when they can buy off the insurance commissioner in, say, South Dakota or Delaware and do what they want and sell across state lines.

Yes, you made that point before, and I parried with the obvious answer that yes, you need national standards governing a national market. On that one, the states should just butt out. Did I ever tell you that this is one Pub, who has little or no interest in states rights?  I never have from day one, along with the doctrine of "subsidiariness," to wit, that body closest to the people governs best. I "knew" that was BS as a teenager, and have not changed my mind since.

No to national (lowest common denominator) standards!

Of all the "conservative" ideas for reforming health care, the one about "buying insurance across state lines" -- while sounding good -- is the worst precisely because it will make inevitable another centralized bureaucracy and one-size-fits-all "national standards".