I have always appreciated Ray Stevens. I grew up in a musical family--my sons are fifth-generation guitar players (along with other instruments.) And we have always had a thing for the comical songs. I grew up on Allan Sherman and Roger Miller.
On a more serious note, one thing that to me seems to contribute to the "Fortress" issue is the decline of independent doctors. I'm 74 years old. When I was growing up, our physicians had ties to hospitals, but they had their own separate offices. The ones I have seen since I went on Medicare all work out of clinics tied to hospital chains. The man who was my primary care doctor for most of that time once had his own practice; apparently the current circumstances forced him into giving that up. (I moved to another city last fall, and had to find new doctors.) But with less independence, there will be less free thinking, and less innovation.
You are absolutely correct! I struggled as an entrepreneur in the state of Ohio because there had to be two person groups to get insurance, and I was rated with "pre-existing conditions". I survived in the 90s because Kaiser Permanence was then in Cleveland area. In the early 00s insurance became unaffordable so I took a job just to get health insurance. So happy to be on Medicare. Tired of the "3 months to get a hip replacement" in Canada stories. The ultimate test of the success of medicine in a country is lifespans, infant mortality, etc. Been experimenting with Apple AirPods as hearing aids (very disruptive possibly). Next "frontier" is breaking down the data silos that prevent interchange of information between medical providers.
You were expecting government officials to extol the virtues of free-market approaches?
It might be different if there were a political party attached (1) to some principle altogether and (2) to some principle resembling a principle of the Founding Fathers. Gosh, wouldn’t that be nice?
Nicely done, sir. I was wondering how you'd connect Stengel and Stevens -- is "peripherally" fair?
Anyway, you've said before that we've been asking the wrong questions about health care, but it never clicked until your analogy with IT. To expand that, imagine a world where people rented their iPhones and desktops, paying mysterious fees for the equipment, bandwidth, and time used, all of it prescribed by computer science engineers, and most of it paid for from large communal funds managed by third parties who don't really understand it. Our machines would be the size of Dodge minivans and half as reliable. I can't imagine how to make Kaiser work like Apple, but maybe smart people like you can. I'm old enough to remember when the fancy new HMO's were going to save the day.
And I knew about the Dr Peabody song but had no idea it was that old. Ray appears to have invented the "fungus among us" phrase, where I thought it came from a TV commercial for an athlete's foot remedy. (Remember the Puritan guy intoning "Thou hast brought the fungus among us!"?)
The Ray Stevens song brings to mind PDQ Bach's "Do You Suffer?" (same idea in a classical style).
I wish there were a way to get health _insurance_, not prepaid health care. Insurance should cover the big expenses you can't plan for, not the everyday, expected costs. If auto insurance worked like health insurance, we'd bill Allstate for oil changes--and oil changes would doubtless cost twice as much because of the extra paperwork. But paying for healthcare yourself is almost impossible because of the pricing games that hospitals and insurance companies pay.
There is a good deal wrong with the way health care is provided in the US. First I would like to say that insurance doesn’t equal care. I spent an extra year as a fellow learning a sub specialty to treat post cancer and craiofacial patients. The reimbursements became so poor that even if covered I could no longer treat those patients. I would continue to see patients of record and lose money on every treatment. New patients I sent across state lines to the nearest large medical center.
The year my wife and I had our third child I we had only major medical insurance. Each time the older two and then the third one went to the pediatrician she had to take out the check book and pay the fee. This along with the deductible for the delivery added up to what my wife thought was significant out of pocket costs. As I had my own practice and I paid for medical insurance for myself and my staff I calculated that even with the three children and the birth it cost less to keep the major medical than to buy “regular” insurance. We kept the major medical for a few more years until our state outlawed it as junk insurance. That raised the cost for my family and every one of my employees. Instead of raises the next few years employee costs were mostly made up of increasing premiums.
I do not think that the Democrats care one bit about health outcomes for individuals. What they care about is winning elections. They concluded correctly that pushing legislation that was promised to improve healthcare for Americans would be popular with voters. If there were any adverse consequences from the laws, they could be blamed on right-wing opposition and be touted as reasons for yet more government meddling. This is why they also support gun control legislation. It gets people to the polls to vote for them because more proposals for gun control sends the message that they care about violence. When the laws don't accomplish anything, they return with demands for more.
As for Republicans, they calculate that full-scale opposition to the Democrats' on health care would lose them voters and therefore compromise with the least damaging aspects of the statist agenda.
Megan McArdle convinced me that the original sin of US health care was in the Roosevelt administration, when they allowed firms suffering from the WW2 wage freeze to offer insurance as a perk to entice people to switch jobs.
It is difficult to imagine a plausible way to undo that. Well, difficult for me – perhaps not for you.
The Unsettling of America: Culture and Agriculture, published in 1977. It is the only book of his I have read. People I greatly respect praise some of his fiction. He has taught at the University of Kentucky for years. He has published many books. I’ve spent my whole life in an area bounded by Muncie, Indiana; Cleveland, Ohio; and Athens, Ohio; consequently I appreciate all things rural, even though I never lived on a farm.
Please steal this idea. It won’t solve all our healthcare cost problems or all the regulatory problems interfering with your Frontier, but imo it would go a long way.
Eliminate the “but buying healthcare is not like buying television or hotel rooms - it’s life and death, and no one should be bankrupted for it” problem by:
1) socializing catastrophic care [the federal government pays 95%-99% of healthcare costs above some relatively high annual amount, with the exact amount based on income]
2) only “high deductible” plans (where the consumer has skin in the game) are eligible for tax benefits
3) deregulate everything else about health insurance (with the exception of the “with continuous coverage your insurance rate cannot be jacked up massively for ‘pre-existing condition’”).
No mandated coverages, and if a state imposes them, that state’s residents no longer qualify for the socialized catastrophic care money.
This gets the incentives right.
Catastrophic care is socialized, everything else is a free market like televisions and hotel rooms are (though yes we’ll still need to provide Medicaid…).
I have always appreciated Ray Stevens. I grew up in a musical family--my sons are fifth-generation guitar players (along with other instruments.) And we have always had a thing for the comical songs. I grew up on Allan Sherman and Roger Miller.
On a more serious note, one thing that to me seems to contribute to the "Fortress" issue is the decline of independent doctors. I'm 74 years old. When I was growing up, our physicians had ties to hospitals, but they had their own separate offices. The ones I have seen since I went on Medicare all work out of clinics tied to hospital chains. The man who was my primary care doctor for most of that time once had his own practice; apparently the current circumstances forced him into giving that up. (I moved to another city last fall, and had to find new doctors.) But with less independence, there will be less free thinking, and less innovation.
You are absolutely correct! I struggled as an entrepreneur in the state of Ohio because there had to be two person groups to get insurance, and I was rated with "pre-existing conditions". I survived in the 90s because Kaiser Permanence was then in Cleveland area. In the early 00s insurance became unaffordable so I took a job just to get health insurance. So happy to be on Medicare. Tired of the "3 months to get a hip replacement" in Canada stories. The ultimate test of the success of medicine in a country is lifespans, infant mortality, etc. Been experimenting with Apple AirPods as hearing aids (very disruptive possibly). Next "frontier" is breaking down the data silos that prevent interchange of information between medical providers.
You were expecting government officials to extol the virtues of free-market approaches?
It might be different if there were a political party attached (1) to some principle altogether and (2) to some principle resembling a principle of the Founding Fathers. Gosh, wouldn’t that be nice?
Given that the game is not “heal the sick” but “fleece the taxpayer,” the major league teams are astonishingly good, year in and year out.
Nicely done, sir. I was wondering how you'd connect Stengel and Stevens -- is "peripherally" fair?
Anyway, you've said before that we've been asking the wrong questions about health care, but it never clicked until your analogy with IT. To expand that, imagine a world where people rented their iPhones and desktops, paying mysterious fees for the equipment, bandwidth, and time used, all of it prescribed by computer science engineers, and most of it paid for from large communal funds managed by third parties who don't really understand it. Our machines would be the size of Dodge minivans and half as reliable. I can't imagine how to make Kaiser work like Apple, but maybe smart people like you can. I'm old enough to remember when the fancy new HMO's were going to save the day.
And I knew about the Dr Peabody song but had no idea it was that old. Ray appears to have invented the "fungus among us" phrase, where I thought it came from a TV commercial for an athlete's foot remedy. (Remember the Puritan guy intoning "Thou hast brought the fungus among us!"?)
The Ray Stevens song brings to mind PDQ Bach's "Do You Suffer?" (same idea in a classical style).
I wish there were a way to get health _insurance_, not prepaid health care. Insurance should cover the big expenses you can't plan for, not the everyday, expected costs. If auto insurance worked like health insurance, we'd bill Allstate for oil changes--and oil changes would doubtless cost twice as much because of the extra paperwork. But paying for healthcare yourself is almost impossible because of the pricing games that hospitals and insurance companies pay.
There is a good deal wrong with the way health care is provided in the US. First I would like to say that insurance doesn’t equal care. I spent an extra year as a fellow learning a sub specialty to treat post cancer and craiofacial patients. The reimbursements became so poor that even if covered I could no longer treat those patients. I would continue to see patients of record and lose money on every treatment. New patients I sent across state lines to the nearest large medical center.
The year my wife and I had our third child I we had only major medical insurance. Each time the older two and then the third one went to the pediatrician she had to take out the check book and pay the fee. This along with the deductible for the delivery added up to what my wife thought was significant out of pocket costs. As I had my own practice and I paid for medical insurance for myself and my staff I calculated that even with the three children and the birth it cost less to keep the major medical than to buy “regular” insurance. We kept the major medical for a few more years until our state outlawed it as junk insurance. That raised the cost for my family and every one of my employees. Instead of raises the next few years employee costs were mostly made up of increasing premiums.
I do not think that the Democrats care one bit about health outcomes for individuals. What they care about is winning elections. They concluded correctly that pushing legislation that was promised to improve healthcare for Americans would be popular with voters. If there were any adverse consequences from the laws, they could be blamed on right-wing opposition and be touted as reasons for yet more government meddling. This is why they also support gun control legislation. It gets people to the polls to vote for them because more proposals for gun control sends the message that they care about violence. When the laws don't accomplish anything, they return with demands for more.
As for Republicans, they calculate that full-scale opposition to the Democrats' on health care would lose them voters and therefore compromise with the least damaging aspects of the statist agenda.
Megan McArdle convinced me that the original sin of US health care was in the Roosevelt administration, when they allowed firms suffering from the WW2 wage freeze to offer insurance as a perk to entice people to switch jobs.
It is difficult to imagine a plausible way to undo that. Well, difficult for me – perhaps not for you.
The politicians and medicrats believe 'money is the root of all fixes'.
The Unsettling of America: Culture and Agriculture, published in 1977. It is the only book of his I have read. People I greatly respect praise some of his fiction. He has taught at the University of Kentucky for years. He has published many books. I’ve spent my whole life in an area bounded by Muncie, Indiana; Cleveland, Ohio; and Athens, Ohio; consequently I appreciate all things rural, even though I never lived on a farm.
Please steal this idea. It won’t solve all our healthcare cost problems or all the regulatory problems interfering with your Frontier, but imo it would go a long way.
Eliminate the “but buying healthcare is not like buying television or hotel rooms - it’s life and death, and no one should be bankrupted for it” problem by:
1) socializing catastrophic care [the federal government pays 95%-99% of healthcare costs above some relatively high annual amount, with the exact amount based on income]
2) only “high deductible” plans (where the consumer has skin in the game) are eligible for tax benefits
3) deregulate everything else about health insurance (with the exception of the “with continuous coverage your insurance rate cannot be jacked up massively for ‘pre-existing condition’”).
No mandated coverages, and if a state imposes them, that state’s residents no longer qualify for the socialized catastrophic care money.
This gets the incentives right.
Catastrophic care is socialized, everything else is a free market like televisions and hotel rooms are (though yes we’ll still need to provide Medicaid…).
To the Frontier…