The Truth About Health Care

Humans live in a finite world. The universe may be infinite, but the world of man is finite. There’s only so much stuff. Because there is only so much stuff, there’s always going to be a shortage of the stuff that people tend to like or need. It’s not always a desperate shortage, but there’s never enough so that everyone can take what they want. There’s always going to be one more hand reaching for the last item just after it is gone.

This is a basic axiom of life and one of the foundation truths of economics. It’s even a foundation truth of communism, which assumes scarcity can only be mitigated, but never fully eliminated, by the elimination of profit. Economists of all stripes work from the assumption that scarcity is an immutable fact of the human condition. The question they wrestle with is how to increase supply and distribute the results.

What this means is that all goods and services must be rationed. Since there’s never enough to meet the maximum demand, there has to be some way to say “no” to people demanding the goods or services. The most common way to do this is price. The poor guy who wants a Mercedes is told he cannot have a Mercedes by the big numbers on the price tag. This is how the supply of luxury cars is rationed.

The other way to ration goods and services is for men with guns to take control of the supply and create rules for who can and who cannot have access to the stuff.  Rocket propelled grenades are not very expensive. An RPG can be had for around $500 and the rounds are about $100. The government, at least in America, controls the supply of RPG’s and determines who can have them. In other words, the government rations the supply of RPG’s in America.

This is an iron law of economics. All goods and services are rationed. This is true for health care too. There are no exceptions to this law. Thus, the First Truth of Health Care: No health care plan or system can ever be taken seriously unless it addresses, up front, how it will say “No, you cannot have it” to people who want it. At some point, someone has to tell the patient they cannot have whatever it is they want or need.

In America, rationing is mostly done by price, but increasingly the state is taking over this role. In Britain, most people are denied services by the long lines for those services. The long wait times for basic services is a form of rationing. If you can deliver X per day and the demand is for 2X, you solve this by giving people numbers and having them wait a long time until their number is called. This is socialized medicine in nutshell.

The fact is, most people could pay out of pocket, for their health services. It is only when poor people get old or have accidents when they need someone to pay for their medical care. Most middle-class people should be able to put away a little every payday to reserve for their later years. That is, if they were not being taxed into poverty by the current system in America that has seen prices rise five times the inflation rate.

Thus, the Second Truth of Health Care: The current insurance model is just a wealth transfer from the middle-class to the health care industry, in order to cover the cost of poor people and the metastasizing layer of people who live off the system. Those is really just a tax. Most people use about 5% of their plan for themselves, the rest is used to pay for poor people and the army of people who work in the system.

That’s the thing politicians never want to discuss, which is the whole reason they are talking about health care in the first place. How does a modern society pay for the poor, who cannot afford needed medical services? How to we address the free riders on the system? More important, how much are we willing to pay for the health services to the poor? There’s a limit to all of this and that’s the question that always has to be answered.

Of course, one of the paradoxes of modern life is that you can get very rich off the poor, which is why liquor stores and furniture rental shops dot the ghetto. In the social welfare game, the point is to lay a massive guilt trip on the public, and grease the right political palms, in order to get the middle class to look the other way as their money is siphoned off for one program or another for the poor, always administered by a rich guy coincidentally.

Thus, the Third Truth of Health Care: Health services are a massive skimming operation. Today, the one area of the economy that “grows” is the health care industry. Every year, more and more people pile into that wagon, mostly in administrative roles. The number of nurses and doctors does not grow very much, but the number of bureaucrats grows like a weed.

Then you have the pill makers, machine makers, research people and lawyers. There are always lots and lots of lawyers. The health care industry is massive and government dependent. It’s why rub rooms are now called message therapy centers. They are angling to get it on the racket, by having their service declared an essential health care service. That way, you will be paying for some guy to get a happy ending.

That’s why reforming health care has become an impossibility. As soon as anyone makes any noises about fixing the system, the army of lobbyists, hired by every vested interest, shows up to bury the reformers. If they are not able to kill the idea of reform entirely, they set about corrupting it into another grift that their clients can use to get a free shot at your wallet. The only people not represented in these efforts are the voters. They get no say.

This is the main reason Trump’s efforts to address the problems of ObamaCare failed last week. What Ryan and the other crooks in the GOP were hoping to do is pass a bill that made it easier for their paymasters to skim money from the rate payers, while providing fewer services. Ryan’s bill was just an attempt to help the people feeding at the trough get a little fatter off the middle-class. Its failure suggests we have reached the end phase.

Talk to anyone responsible for paying health insurance premiums and they will tell you that the rates are reaching the point where they cannot be paid. When premiums are going up by multiples of inflation, there can be only one result. Once rates pass a certain level, people stop paying those premiums. You get black markets, non-compliance and a system that can only persist through brute coercion. Soon after you get collapse.

104 thoughts on “The Truth About Health Care

  1. Korea is the place I’ve been most impressed with. It is a government supported system but mostly privately run. Quite a lot of small hospitals. Relatively high deductibles prevents misuse. I had a mole removed when I was there last time and it was $5. Yes, $5. With a laser and everything. You’d think for that price they would have to get a dog to bite it off.

  2. I’ve been stewing about this excellent post since it came out, and finally decided to leave a lengthy comment about how government run healthcare works up here in Canada, just so you’ll know what’s coming at you if you don’t deal with it.

    In 2012 my father required an oxygen generator at home. The government got him one, rented from a private supplier for $331.00 per month, and my father’s share was $82.75 per month.

    Dad loved to drive and be driven about, so I started looking for a portable generator to replace his tanks, which were only good for a few hours. That led me quickly to the local branch of large American company, which supplied is oxygen concentrator. I called them and they told me they had only one portable oxygen concentrator and it would cost $4000.00. The “Sales Representative” made it clear that he had no interest in providing anything more than a blunt statement, that I had one choice and I could take it or leave it.

    Google quickly led me to a plethora of suppliers. I used the model name and number for dad’s in home rental machine in the search. The thing sold for $599.00 online.

    Charging $331.00 per month for a $599.00 machine is insane and utterly corrupt. The machines are cheap, easy to set up, easy to install, easy to maintain and nearly indestructible. They are all leased to people with bad lungs, mostly older people,who are not likely to damage the equipment, lose it steal it or abuse it, with the government picking up most of the tab. Credit risks are near nil. The private suppliers of these machines are making huge, gigantic, unfair, unreasonable, positively blood sucking profits, holy mother of God crucify them, and I’m a hard right wing supporter of free enterprise.

    At one point I spoke to a manager or administrator of some sort at the supplier, a middle aged woman (to judge by her voice) and I made some comment about the rental rates seeming way too high given the actual cost of the machines. This woman made it clear to me that she too was disgusted by what the government and her employer were doing. She told me she was required to “explain” to me that the reason for the high charge was “maintenance service”. There is almost no service needed, any idiot can do it themselves, and it takes 2 or 3 minutes to change a filter now and then. There are no safety or certification issues. The machines are all tested by either UL or CSA or similar. Maintenance is a lie, a vile lie.

    I have found at a government website, proudly displayed as an example of a Public-Private Partnership, an agreement or memo of agreement between some panel of corrupt or deeply stupid civil servants and the oxygen machine industry agreeing to these absurd rental rates.

    Another: 10 years ago my mother in law got an artificial hip. It was never any good. After 5 or 6 years and much complaining we discovered that at the time of her surgery she was given an artificial hip no longer acceptable in the USA, at the time of her surgery, because it was NFG. Not defective, just lousy. Our health care idiots bought the surplus cheap, probably never occurred to the dullards to wonder why, or maybe someone pocketed a ton of money.

  3. Skin for skin, yea, all that a man hath will he give for his life. – – – Satan
    Only now we find that mankind will take from others also in order to ‘save’ his/her life.

  4. RE: auto vs. health ‘insurance’

    It seems all would agree auto insurance does ‘work’ and is relatively stable as are prices for auto service. It also seems clear the analogy is a stretch at best; however I can’t help but observe:

    – I always see an estimate and a subsequent itemized bill for auto service of my vehicle, regardless of who is paying.
    (I paid out of pocket for an MRI recently and was charged less than half the initial ‘price’ – I was also able to negotiate the price of the dr. visit over the phone with the billing dept. yielding dramatic savings.)
    (A long time ago, at the campus health center, I had a skin growth frozen off. A month later I found out this was billed as a ‘surgery’ costing nearly $1,000 – twice what I paid for the recent MRI – and my insurance happily paid the total without any objection or, I assume, knowledge of what was actually done.)

    – I would guess paying out of pocket for auto services is quite common, but not so much for medical services.

    – Auto insurance does not cover all services a typical automobile requires.

    * Auto insurance premiums go up if you use it (with a few exceptions). This is also why people often CHOOSE to pay out of pocket – and may even shop around for the best prIce.

    – In my state, if you have a very poor driving record insurance can become prohibitively expensive. In extreme cases, the state suspends ur driver’s license in which case purchasing insurance is moot.

    * I would also like to note that in my state ONLY auto liability is required by law. They do NOT require you to insure repair of your OWN vehicle.

    I believe this last point is an important distinction to be noted by those who would use the mandated requirement of auto insurance as support for their arguments re: health insurance.

    Of course, an automobile and one’s only body are not really equatable in any way, but anyway…

  5. And I would add that the sooner we crash and burn, the better off we will be. A near-term high bottom is much preferable to a miserable slow slide to the deepest of bottoms, from which any resurrection may be all but impossible.

    The health care bubble is but one of many such societal cancers that are all precariously nearing a bursting point.

  6. Wait a minute: are you saying the gubmint will pay for my happy endings? C’mon Elizabeth Warren!

  7. I read an article yesterday about a doctor that found a cure for sepsis. It’s a big problem in hospitals. He tried using an IV to deliver high doses of vitamin C and hydrocortisone. It worked. He kept using it and wound up adding thiamine to the mix. He’s in the process of trying to convince other hospitals to do the same. But like he says “It only costs $60 to do this.” And that is why I don’t want a German style health care. My insurance will cover a pulmonologist. I’ve been working on the problem with a naturopath. I’ve had some success and he managed to do it without a bronoscopy. I could not see going through a procedure to confirm my doctor’s diagnosis. We have computerized medical records that do not take any use of what computer do. It should cross reference data. Doctor prescribes prednisone. He should get a reminder to order a bone density scan and provide support for the adrenals. We have doctors that charge you several hundred dollars, spend 15 minutes with you and can’t bother to look you in the eye. Or, it can be like my husband’s last visit to the doctor that did his hip replacement. Waited a year to see him and he didn’t bother to come into the room. He did say hi outside in the waiting room. A month later, he wanted my husband to make another appointment with him. I could go on, but we are getting very poor care for the money we are spending.

  8. This is an appropriate place to put in a plug for the Surgery Center of Oklahoma. Prices Posted. Payment terms: cash. No insurance accepted.

    Pricing is frequently 10% to 30% of prevailing costs. Not 10% to 30% lower.

    This is what happens when you let the market work.

  9. Within my lifetime, we have gone from being able to pay medical bills out of pocket to needing insurance to cut down costs. Consider what is happening with veterinary medicine. We are seeing costs rise, coincidentally with the rise of people having insurance to cover their pets. And I don’t think that animal hospitals are any more transparent about their costs. I think we can cover a lot of these costs for the poor with block grants and leaving to the state. It’s how my late husband’s medical bills were handled. I would have loved to have had him on my insurance from work, but I didn’t make enough to afford it. I will be picking up the tab for an emergency room visit, which maxed out my high deductible the first month. I want to see reform to HSAs. You should be able to put money into one and have it roll over each year. It should be something that can be inherited. As it is, I can’t put much money into one, because I have to use it by the end of the year. And with all that expense, the doctor couldn’t be bothered to come by and talk to me after the procedure. He wanted me to make an appointment a month later to see him. I am becoming convinced most doctors are useless, except for surgeries and emergencies.

    And here’s a useful tip, to understand what your local economy focuses on: look at the largest buildings in your town. They used to be factories. Now they are hospitals.

  10. The healthcare skim may end up destroying the government just like the Vegas skim did the Mob in the Midwest. When the Mob was content with a small skim, everything ran like a Swiss clock. But as they demanded greater and greater amounts of cash, it got to the point where everyone and everything — including the organization itself — would be sacrificed to keep the money coming in. They were able to kill enough people to keep it coming for a while longer, and to hide it for a little longer still, but soon enough, everything fell apart, and entire families were exposed and destroyed.

  11. “This is the main reason Trump’s efforts to address the problems of ObamaCare failed last week.”

    Was this Trump’s effort or was this Trump killing Ryan’s corporate written effort?

    Let’s see what happens next.

    It strikes me that Trump is perfectly prepared to “lose” in the short term if he ultimately wins.

    • Agreed. Part of me thinks one goal was to mortally wound Ryan and get him out of the picture as soon as possible. As is being said of Trump, he seems to be good at giving people enough rope and opportunity to hang themselves.

  12. I’m inclined to agree with Karl Denninger on this one. Start enforcing the antitrust laws which apply to health care just like they do to every other industry, save the dullards in sportsball of course. Send in the US Marshals to frog-march a couple of major hospital chain, drug and insurance company CEOs and about 1/3 of the problem evaporates in less than a month. And it needs to be more brutal than just sticking the shareholders with some fines with no admissions of guilt. Exexcutives and boards of directors need to get real time in real federal prisons, assets need to be stripped, their kids trust funds need to be pierced and confiscated. Threaten to prosecute their spouses and parents, too to force guilty pleas in the time honored way DA’s have been doing to us rabble for decades. Too harsh…? That’s nothing compared to what comes down the road if this shit doesn’t stop fast.

  13. Charles Hugh Smith (excellent economics blogger BTW) has written extensively about health care:
    And in fact, did so today:
    What a lot of the ‘nattering nabobs’ especially on talk radio don’t realize or understand is about 2/3rds of the US is actually on ”public healthcare”; Medicare, Medicaid, the gold-plated plan Congress is on and, of course, the VA. Also, due to a Reagan-era law:
    Anyone that shows up at an ER must be treated (or mother in labor…) regardless of ability to pay/insurance. A hospital can refuse to participate in EMTALA, but means they become ineligible for Medicare Part A as well.
    I’ve said before, like it or not, it will evolve into a system much like public schools, mediocre at best, but available to all with an ‘opt-out’ for those who can afford it.

    • Fraud, playing the system has to be one of the biggest drains on funds there is. And yet no one talks about tackling the sanctity of Welfare benefits by going after fraud. I have two sisters who worked at county hospitals and they tell me story after story about the degree of fraud perpetuated by all classes of people, including those who “could” opt out and pay their own way, but are too cheap to do so.

      Of course, as YIH says above, their personal ability to do anything about it was severely hampered but they would do their best to shame the people, if they understood English well enough, or even cared to listen. This was in CA. The system is broken but in these kinds of cases, no one wants to be bothered because … racist! Gotta be billions of dollars being scammed, not by politicians or lawyers, or corporations but by the public just playing the system and the playing is good! Better than the casinos!

  14. US healthcare policy hasn’t decided whether it is insurance or a tax/welfare scheme. It has elements of both, which is likely worse than either one or the other.

    Healthcare needs to bill the user for each interaction, even if it a token amount. “Free” creates overuse. Mostly cover the big stuff, so people don’t lose their homes because of an operation, but cover less of the small stuff, so people self-regulate their use of the system.

  15. Ignoring for the moment whether or not healthcare is a right, I think we all can agree that any healthcare system must not be corrupt. Our American system — based on spending growth and employment patterns alone — most certainly is and seems to be another one of these physics-defying plates spinning long after common sense and gut-feel tells us it should be on the ground in pieces.

    I will leave it to Z man’s European and Asian readers to determine if their own health systems are corrupt. But with defense spending being squeezed out and national debts growing at very high rates, I believe they are.

    I am at a loss as to whether market discipline will restore fiscal responsibility to the health system. This is something new. We’ve never had the ability to restore health and extend human lifespan to this degree in any previous era. The marginal price that consumers seem to be willing to pay for one day of additional lifespan is quite high and therefore demand is extremely inelastic. My guess: health systems will have to collapse a few times before we have the cultural (mores and beliefs) and societal (laws and regulations) that will allow for a health care system (market?) to function in a sustainable way.

    • “But with defense spending being squeezed out ”

      What is it with you clowns?

      There is no more corrupt segment of government expenditure than “defense spending”

      • Interestingly, my post does not infer whether defense spending is corrupt or not. It merely states a fact that it is being squeezed out by health care spending.

        Amazing how you dunces can’t comprehend English.

        • On thr contrary squeezed out clearly infers reluctance.
          Value nuetral terms would be cut or reduced.
          Not a native English speaker, are you?

      • Tell that to all the loons around the world who have been pulling up their pants, putting on their hats and strapping up during the Obozo years, and are running loose creating havoc. All we tend to hear about is the corruption in DC these days but things are pretty dicey out in the hinterlands to which you seemingly prefer to ignore and not spend on defense.

        Now don’t get me wrong. I do not like the MIC anymore than you, but there is a valid reason to heed the saying “Si vis pacem, parabellum.”

    • @ El_Baboso – I am not saying German health care is perfect, but I can say it works and it works very well. It works because everyone participates and we enforce the law that everyone is required to participate. It’s a social contract. In order for any social contract to work, whether for a local fire department, police department or public school, everyone must contribute. Sure, not everyone’s house will catch fire, and not everyone’s house will be burglarized. But still, everyone pays regardless of how much of that system they use.

      This is a age old concept that goes back to early man. To prevent the village from starving, everyone contributed to the community grain storage unit and the local government regulated distribution. It’s just that simple.

      I agree there is graft, corruption, scams, mis-use and abuse in Germany just like any large scale system. We’re not perfect and I never implied we were. But at least look at systems that are working for the majority of a population and take the parts that work and figure out how to incorporate them into your own system. If not on a Federal scale, at least on a State scale. If 300-million German citizens can get good healthcare that’s affordable, I’m sure other nations (and states) can too.

      And to the example of public school tax, sure, it seems “unfair” that a single couple without kids has to pay school taxes, what do they benefit? Just like young people paying for health insurance premiums now when they hardly use any health care at all. The overall benefit to society is better educated kids who are successful, well adjusted adults later in life who are less likely to end up on welfare. For those young people paying premiums now, the money is there when then do need health care as they get older. And they will. And as long as this continues, and people are legally required to contribute, it works.

      But when you allow people to break the law, and get into the discussion of “what’s fair”, and then provide unlimited health care to people who are illegally in your country and never contribute anything to the system, you get what you have now. If you see cost control as “anti-capitalistic” and more “pro-socialist” then you get to pay $15 for a single aspirin and eventually health care becomes unaffordable no matter how many contribute.

      Again, I’m not saying our system is perfect, but it works.

      • Karl, setting aside for a moment that like many conservatives from the Anglosphere, I don’t believe in positive rights, I am willing to accept that health care – especially the preventative sort – is a public good. Therefore, some public subsidy is justified to pay for it.

        I don’t know if you are familiar with the work of Gert von Hofstede. But if you are, you know that American culture is an extraordinarily individualistic culture. We also have a very low power distance. Our societal models don’t export well and our Progressives’ attempts to graft European practices that work in more communal, higher power distance cultures on to ours generally result in disaster here.

        Until the Great Society, we had a pretty good, three-tier system to ration health care. People who worked for large firms in the private sector or the government had some sort of health insurance (with all of the qualifiers others have pointed out throughout the comments). The lower end of the working class and the upper end of the dysfunctional poor went to state, county, and city facilities that were subsidized by sales and property taxes. The lower end of the dysfunctional poor went to charity hospitals funded through donations. Under that system, we did not have mentally ill people living in the street.

        Describing what went wrong would fill up a very long post, indeed. Here I would direct you to the work of the Peruvian economist Hernando de Soto. He points out that in an evolved system like the old American health care system I outlined above, understanding why it succeeded is sometimes very difficult. The converse is likely to be true as well.

  16. Along with making explicit when NO comes into play, I think that the other question to answer is what, explicitly, is charity-care going to look like. Maybe that’s what you mean. The Prog scam has been to weaponize charity-care to gobble up normal medicine using secularized Western Christian social mores with coercive means.

    To flesh this out, we need to back up and look at historical examples from other complex societies. Several points:
    – Even in primitive societies that we have records of, where medical care, such as it was, was usually provided by friends and family, there were ‘medical specialists’ who expected to be paid in some for or other for their services, both practical and spiritual. They were commonly called ‘witch-doctors’, which made sense if you believed that accidents and disease often had supernatural causes from specific agents in both the natural and spiritual worlds. And they used herbal medicine too.
    – Nobody outside of your extended family had any ‘right’ to demand/expect medical treatment as a duty with no reciprocity points conferred. Members of your clan or tribe might well have an expectation of treatment in exchange for reciprocity points, meaning that it would have to be balanced out somehow in the very near future.
    – For strangers and outsiders, just being allowed to live while yet in your power was considered worthy conduct even if a matter of questionable judgement. For them to be given costly medical treatment was the very pinnacle of compassion, hence the striking power of Jesus parable of The Good Samaritan. The people who passed the wounded, despised foreigner by were just doing business as usual in that day and age. The sting of it was that the Pharisees smugly supposed themselves to be better people but were not.
    – We can literally thank God that this is not our situation now, but the above is the basic human nature behind the debate and why so much compulsion must be involved.

    Re complex societies, Z Man is right that there are always tiers of medical care, usually three. They are, of course, defined relative to the state of medical knowledge, the wealth of the society in question and the social mores and power structure:
    – At top is ‘concierge care’ for the wealthy and powerful involving dedicated medical specialists and equipment on call 24/7/365. IOW court physicians, Bethesda Naval Hospital, etc.
    – For most people there is ‘normal medicine’ which consists of occasional interactions with medical specialists on an as-needed basis for usually standard compensation, starting with witch-doctors, going to medieval barber-surgeons and apothecaries, to the county doctors who ran country hospitals and their urban equivalents up to 50 years ago here in the US, largely as they saw fit, subject only to very loose supervision from state medical boards.
    – Charity-care for those few who are members of the society and yet are so lacking in family and financial resources that they really can’t (not just won’t) pay for ‘normal medicine’. In Christian countries, at least, there was always charity care but it was voluntary: I.e. provided at the medical practitioner’s discretion (i.e. a practical means test) encouraged by social pressure. In effect, their social status would be compromised if they refused all care to socially approved charity cases in the then not-so-secular local society but their economic status would be compromised if they did too much of it. Of course, this made charity care somewhat arbitrary.

    If there’s one thing intolerable to Progs, it’s arbitrariness by others than themselves. Hence the 100 year push for socialized, single payer, medicine. Ironically, one of the big reasons for AMA support at the time Medicare and Medicaid were proposed was that it allowed the doctors and hospitals (which they largely owned) to dump off the charity-care loads that they they were expected by the then not-so-secular society at the time to carry as a price of their position on to the backs of the taxpayers: Kept their status as demigods, cut their costs, what’s not to like. The added overhead was nominal, at first.

    • Al from de nort
      “– We can literally thank God that this is not our situation now, but the above is the basic human nature behind the debate and why so much compulsion must be involved.”
      Another way of considering the parable would be to walk on past, because “The downtrodden will be with us always”. The good Samaritan parable isn’t about caring for the poor and downtrodden, it’s about loving your enemy, the Samaritan in this case. Even Chuck Schumer became a Christian a day or two ago supporting immigration. Support Democracy when your side has the votes, quote the bible when it doesn’t.

      • Merrell;
        Schumer repented_?!! After all those soul-blackening years as a NY politician_? Halleluja_!!! A miracle has just happened right before our very eyes_!

        But seriously, the context of the parable was a smart-assed Pharisee (ancient Jewish lawyer) asking Jesus, “And [just] who is my neighbor_?”, right after Jesus admonition to “…love thy neighbor as thyself…”. So it wasn’t just or mostly about caring for the poor and downtrodden, although there are many other such admonitions elsewhere in the Bible.

        My possibly poorly stated point was that this was seen as an extravagant, even shocking, level of voluntary, charity medical care in those times but now it has somehow and bizarrely morphed into government mandated entitlement with no credit given for its clearly Christian religious origin.

  17. On the German/UK systems. You can approximate a market based system with a state run system by:

    – Actually having profit seeking companies provide the health care service. This could be at the insurance company or hospital level. In the UK you get an abysmal service – this is highly variable regionally, and in my experience tends to be better at the clinical than general practitioner (i.e. “family doctor”) level. Absent this, being ruthless with the unions and staff is necessary. As it is, the healthcare system is to a great extent an inefficient way of keeping government workers salaried.

    – Sufficiently large deductibles (these can be capped at maximums p.a. to ensure nobody gets impoverished) to discourage over-use. For the UK this would be a big quick win in terms of improving the finances of our health system, as currently there is no charge at all for going to see your doctor. Even £5 per visit would be enough to dissuade trivial use of the service.

    An alternative that would probably work economically speaking is to give everybody a voucher for the same amount of insurance, and this was based on the highest rate, but then allow insurance companies to refund individuals the difference between that and the true cost, which would then depend on the usual factors such as the health of the individual and the level of deductibles chosen. It would probably make sense to have more than one standard rate, to prevent a situation where the very healthy (and risk loving) are effectively paid to get health insurance.

    Going through Karl Horst’s list 1-4 in order:

    1. The only reason compulsion is required is because there is cross subsidy from under-users (i.e. the healthy) to over-users. This is not just. Removal of the requirement to have health insurance, combined with government subsidy of over-users would have exactly the same effect, except the tab would be picked up by the general tax payer. I’m not saying this is any more just – but it does disprove the claim that there is something special or efficient about the German system.

    2. No-one can be denied coverage on the basis of existing conditions. See above. Same thing at work. The cost has to be recouped somewhere and it’s either from the relatively healthy (mandatory insurance) or the relatively rich (tax).

    3. Regulating profit margins is totally unnecessary in a market based system. It is only necessary in a rigged system. For example, if the insurance industry knows that the government is picking up the tab, then it has little incentive to innovate on reducing costs. If government cash was scarce it would be a different ball game.

    4. Yes, the ambulance chasers are a problem but it’s hard to see that getting solved any time soon.

    Frankly it is very easy to design a system where the government can subsidise the poor and unwell to purchase the insurance they need within a private sector. Special interests and politics are the problem.

    • The reason it’s mandatory is because people should pay for what they receive. It’s just that simple. Of course some people will have higher needs as they age, just a young people have lower demands on the health care system. But that’s the whole point. Like a retirement plan, the idea is you put something in now so you have something later. But in order for everyone to benefit, everyone has to contribute. The few that don’t need much care will offset those who need more, but you can’t do that without unregulated costs.

      To that point, deregulation has crippled much of the US. Just look at what deregulation of the banking industry did. When you allow hospitals to charge $15 for a single aspirin pill, that’s price gouging, not profiting. Of course regulation is necessary. It’s why you can’t afford it now!

      Cost control (regulation) is what every industry does in order to remain competitive. But when health care is unregulated, you get runaway, uncompetitive costs that bring you to where you are now.

      • Karl I respectfully have a serious question. What happens in Germany if a guy simply refuses to pay his part, then while hanging out and drinking, he gets shot up. Goes to hospital and is fixed up at tremendous cost. Then when he can walk out he flips the bird at the staff and says he’s not paying a cent. What happens now? What happens when he gets hit by a baseball bat the next week, then has another cost but simply won’t pay? Im not being provocative, I’m genuinely curious.

  18. The Z Man is right that Obamacare and health insurance in general are a huge tax increase in the form of raised deductibles and premiums. BCBS raised my company’s premiums 31% this year. That has followed double digit increases the past few years as well. And deductibles are up to $5,000 from $2,500. This is a huge tax on US employers.

    • Five years ago, I had a plan that cost me $235 per month with a $5K deductible. My plan is now $500 per month with a $15K deductible. I now get free vagina inspections, but that’s really not doing me much good as a 50 year old man.

      • Free vagina inspections are GREAT!
        I usually have to spend a small fortune taking her out to dinner.

      • Yes, my old policy cost about the same.

        The new (mandated) one cost $625 and included pediatric childcare, birth control and yes the ever popular and useful gynecological coverage .

        As a 60-year-old man who was recently widowed and out of work I thought that was just great.
        And the local restaurants I wasn’t going to as often, the car dealership that waited a few more years for me to come in and so forth; they think it’s great also.

  19. A small change.

    “The IRS indicated that it will accept tax returns lacking this information in light of President Donald Trump’s executive order directing agencies to minimize the ACA’s regulatory burden. While the requirement to have ACA-compliant coverage or pay a tax penalty has been in place since 2014, starting this year the IRS was to have begun automatically flagging and rejecting tax returns missing that information.”

    The IRS reserves the right to come back and assess penalties later, but they are acknowledging that ACA might go away. I also think it might.
    But what will replace it, I can only hope. If some things could get changed; buying health insurance across state lines, tort reform that reduces the sky-high cost of doctors and practices costs, stopping the federally mandated explosion of paperwork and doctor tracking of every step of the treatment process that reduces the time a doctor has to ACTUALLY treat the patient!
    In other words, stop shooting ourselves in the foot!

    • The reality of what faces the reformers is this. On the one hand, they have this rapacious skimming operation that is able to buy a lot of politicians. On the other hand, they have a political class that will naturally opt for more government.

      The right approach is to target specific items and focus all energy on those narrow items. For instance, opening up the insurance markets to innovation. If people can “opt out” of the system, so to speak, and buy a limited policy but pay cash for everything else, then you start to see other parts of the system open up to reform.It’s really about pulling one snout at a time from the trough.

  20. I’ve read that, in the old days, you could speak to a medical doctor on the phone and he would even come to your home if you were too sick to go to his office. Not in my lifetime of course. I don’t know; it sounds utopian.

  21. I’d suggest a fourth truth about healthcare (in fact reality): you cannot insure against certainty. People have the bizarre notion that one should be able to buy healthcare “insurance” that covers preexisting conditions. It’s absurd. It’s like offering car “insurance” that covers accidents that you had last week. If this was for some reason mandated, what you’d see is (a) nobody can afford car “insurance”, because it is absurdly expensive, except (b) everyone who has an accident buys it.

    • Correct. What we call insurance is just a taxing scheme, with a lay-a-way component. If we removed all government regulation, the result would be insurance against things like getting cancer or being hit by a car. No one would “insure” trips to the dentist or annual physicals. You would pay for those on your own.

      Of course, those services would be cheap and done by people trained at four year colleges and apprenticeships.

      • Insurance is simply legal gambling; you put money on the table betting you will get sick. The insurance company takes the bet knowing from their studies that the odds are in their favor that you won’t based on age, lifestyle habits, etc. This is why they’re in business. The house always wins.

        Is the car insurance industry going broke? No. Is the home insurance industry going broke? No. What’s killing the health insurance industry isn’t people using the services, it’s the uncontrolled profits from ridiculous doctors salaries, inflated pharma costs and unregulated profits.

        Go look up what doctors get paid, then ask yourself if you’re okay with that. And when you tell me, “Oh, but it’s because they have high insurance premiums.” then ask “Why?” Because your legal system encourages people to sue hospitals and doctors for every imaginable problem.

        Do you now begin to understand what’s really behind these high costs??

    • The problem is that *all* health issues are certain; the only question is one of distribution. I might get diabetes, while you might get cancer, but eventually, both of us will get something, and — if we live long enough — more than one something.

      Comparing health insurance to any other form of insurance doesn’t work very well. Car insurance, for example, covers stuff that *might* happen: collisions, theft, etc. Same thing with home insurance or flood insurance: you might get flooded; you might have a fire, but it isn’t certain that you will.

      It is a dead certainty that everyone *will* have health problems.

      • @ FaCubeItches – True. But statistically the need for health care increased with age. That means if younger people are paying for it, but not using it, it’s like a savings plan for when they do need it as they age. But you have to start and everyone has to be involved. Otherwise the system doesn’t work – like in America.

        Do the research yourself, German health insurance works because we’ve had a 125-year head start going back to when big industry came into being. However this was not the case in the US or the UK where industry refused to provide any sort of health care for their workers. In Germany and most of Europe, everyone contributes, and everyone benefits from what they contribute. Why do you all see that as a bad thing?

  22. Trump and Schumer will get together and edge us toward a single-payer system. The easiest way would be to lower the Medicare sign-up age and at the same time raise the income max at which people are eligible for Medicaid. Both done in increments. Eventually they will meld into one big government run program. This will result in ever increasing de facto rationing and will eventually bankrupt the country, but that will take a while. We’ll all be dead, our grandchildren will have to deal with it.

    • “We’ll all be dead, our grandchildren will have to deal with it.”

      Looks like we win.
      – Curly Bill Brocius

  23. Healthcare is a mess in this country and it is a pity that most people do not understand why. Perhaps it is because they are no longer educated in our schools, but indoctrinated into accepting the socialist and fascist systems that currently control our government.
    I am looking at Trump making a play at the Ryan plan as both a mistake and a boon. It is Trump’s first attempt to be a politician, rather than act as a CEO or dictator through executive action. He came off being called incompetent rather than being accused of being a Nazi. Oddly enough, his failure change the mainstream media narrative. That may have positives in the future but it looks really bad today.
    Obamacare is going to fail one way or another. It is a fascist system that can not support itself. I put together my thoughts on this process in this article that I just posted,
    I agree with your entire diagnoses of our healthcare system, but it may take a crash of spectacular nature to occur before free markets can be tried again. It is a pity it always comes to that.

  24. You got it right. Free-market healthcare works. Single-payer healthcare sucks, but it works. The hybrid model that is Obamacare and the crap Ryan tried to pass last week, doesn’t work at all.

    Not signing up next year to have $250 removed from every paycheck, while still paying for every doctor we see, is becoming very tempting.

    • No country truly has a single payer system. The rich always avail themselves to private, market based systems.

      Again, the threshold question is who says “no, you cannot have that liver transplant”?? Until that question gets answered, everything that follows is bullshit.

      • Some of the single-payers like the UK dodge the direct answer. Instead the use the wait times to kill off people they didn’t want to treat.

        Have a cancer diagnosis? Politely queue-up over here and wait. And if the cancer metastasizes while you are waiting, too bad.

        • Yet the outcome is that the UK has a two year life expectancy advantage over the US with a healthcare system that’s half the cost.

          The biggest single thing is that they don’t spend a quarter mill on the last six months.

    • Fortunately there are places like ZoomCare ( and the like who provide very affordable coverage for every day care.

      The problem with self-insuring is when you need hospital care you end up paying the PRICE ON THE DOOR. The insurers have negotiated the rates they pay. Only the very rich can afford to pay the posted rates.

      • Everyone knows the price on the door of a public hospital is fake. If you cry poverty, threaten to appeal to the state, and offer to pay half the bill they will gladly agree.

      • Correction. The rich do not pay the posted rate. I’ve witnessed the rich negotiate hospital rates and bills. They didn’t become rich by being dupes. The silly rates are a result of the insurance game. Medicos charge twenty to get ten. If they only get six they try charging thirty to see if they can get eight. And on and on.

    • My old boss (2003) from Canada had a father who was a Mountie, retired. His father broke his leg and made an appointment to see a doctor. The opening was 6months. His dad insisted on using the Medical system that he is in (his son, my old boss, was wealthy enough to to bring him to the US and take care of it right away – but he would not budge, he wanted to use the system he “earned”).
      6months later he went to his appointment, no waiting, right on time. They x-rayed him, and confirmed that he broke his leg, and that it set wrong, so they needed to re-break it and set it under surgery.
      It was 100% free….

  25. These are fundamental truths that should be self-evident. Unfortunately, what it all boils down to is do humans have the “right” to live. Well, do they? Not in reality. In a legal sense, a right is a power, privilege, demand, or claim possessed by a particular person by virtue of law. Law is refereed by some social organization that has the power to do so. Once a parasitic class has the “right” to vote themselves a transfer of wealth, two things will happen. One is that the parasitic class will grow because their perpetuation is guaranteed. The second is that the guarantor or that perpetuation will decrease their reproductive growth since they have been saddled with the responsibility for paying for someone who can’t pay for themselves. Because we have been socially conditioned to want to help those that can’t help themselves, we create an artificial system which will abrogate the laws of nature. Such as the law that says those who can’t take care of themselves will not live, This seems heartless, but is it? Biological and social systems will always benefit one group more than others. By artificially aiding a group that would not survive on its own, you introduce a variable into the system that will eventually have to be dealt with. It is our fear of death that makes us try to recreate Nature in our own image so that we can prolong life as long as possible. You have to make harsh decisions if you wish society to function in an optimal capacity. Harsh decisions like should we subsidize a parasitic group of people?

    • But we are such a rich country? Why should anyone have to suffer? Are you just a cruel and inhumane person? You must, must be one of those conservative, republican types! We must do it for the chillun’s. The Left/Liberals are more caring about their fellow man. /sarc

      Until they run out of other people’s money which is what will happen with ObamaCare. They the reality of Death Panels will make their appearance and the balancing of the budget will become a priority of the ruling class because the burden cannot be sustained.

  26. The time for “Social” healthcare for American is long overdue. Stories are well known even to Europeans how so many Americans have lost their life savings, retirement plans or even their homes to pay for medical bills. The fact that many Americans don’t even have basic access to health care puts the US well behind Europe, Australia and Canada and even some developing countries.These facts are indicative of a health care system that is severely broken.

    The German health insurance system has, in one form or another, been around for over 100-years and remains one of the best systems in Europe. It is not social, in the sense it’s free, but like the American Social Security plan, the law requires everyone must have health insurance and contribute from the day they start working. This is also true in Switzerland where you are required by law to have health insurance. It should be noted that unlike German which has government and private insurance, Switzerland only has private health care insurance. (1)

    In Germany, health care is not “free” at all. Rather we all contribute to either a state insurance plan or a private insurance plan (2). Both of which require a monthly premium just like American health care. And as with the American system, only the very poor can receive free health care and social benefits if they qualify.

    Another way we keep costs down is Germans can’t sue hospitals or doctors for malpractice as is so common in the US. If we can prove serious malpractice, then yes. But for trivial issues, no. And even if malpractice can be proven, the monetary awards are not tens of millions of Euros.

    To your comment on limiting profit, the German government controls what health insurance companies can charge for premiums and for what hospitals can charge for care. This doesn’t mean they are not allowed to make a profit, but I believe it is capped at around 2-3% over actual costs and this is also true for medical insurance providers. This is sufficient to keep both parties in business, and profitable, yet still providing excellent health care for the average German citizen.

    Before you decry the “Social” healthcare system here in Germany, it might be worth considering how it works, because for us, it works very, very well.


    • Try having 60 million free riders in your system. What works in one place won’t work in another.

      • 60 million? I wish! Medicaid/CHIP enrollment in 2017 is estimated at 74 million. Medicare enrollment is estimated at 57 million. That’s 131 million, which is approximately 40% of the US population, receiving free or extremely subsidized health insurance coverage.

        But wait, there’s more! Approximately 85% of the 14 million people who purchase insurance on the Obamacare exchanges will receive a subsidy averaging around $400/month. Just to make the math easy, let’s call it a total of 140 million, which is 43% of the U.S. population, receiving free or extremely subsidized coverage.

        When nearly half of the population is receiving free or highly subsidized health care it’s pretty hard to argue that the US lacks a “social” insurance system.

        • It’s not a social healthcare system if you have the insurance companies, who, let’s remember perform no health care services add massives costs, skim massive profits and act as gatekeepers.

        • In an unregulated, and extra points for non-credentialized (free) system, the prices being paid in general would be far less than what is paid to subsidize the medi programs are right now. In an actual free system medicine would evolve and not metastasize. Everybody wins, except government. Welfare would remain welfare and not be confused with insurance. Insurance would be insurance and not be confused with full medical payer plans. “Insurance” is as destructive to markets as government is,which is why they have become allies. See your vet for pricing. He’s not cheap but he is real.

      • The German system’s mandate for coverage eliminates the free riders, except for Merkel’s immigrants.

    • You can say that the German Healthcare system works only if you ignore the fact that the immigration system does not work. Germany is the totality of all the different divisions in German society. Healthcare cannot be separated from every other policy that the German government has imposed on the existing populace. The question Germans should be asking is will the system continue to work now that we have introduced lunatic policies that will guarantee that the people that created that country will slowly be strangled to death by the introduction of a parasitic group of people that have no interest in supporting these policies for ethnic Germans.

    • The trouble is “social health care” violates some important laws of human nature and mathematics. You can only do this for so long, which is why Germany is rocketing toward bankruptcy. Without the US military, Germany would not be able to defend the Fatherland against an attack from Poland, much less Russia.

      Again, comparisons to Europe must take into account that Germany is the biggest welfare queen in the West, living off the US tit for going on three generations.

      • The German health care system works because –

        1. All citizens are required by law to have health insurance and pay for it.
        2. No one can be denied health care insurance and can not be charged extra for existing health issues.
        3. Profit margins of health care providers and insurance companies are strictly regulated by Federal, State Government and private consumer groups.
        4. We limit law suits.

        Here are some quick facts and questions –

        1. No German has ever lost their house or life savings because of a serious medical condition. Is that true in the US?

        2. No German has ever been denied health insurance because of a pre-existing condition. Is that true in the US?

        3. No German has ever avoided going to the emergency room because they were afraid of what it would cost. Is that true in the US?

        4. No German has ever paid $15 for a single aspirin pill. Is that true in the US?

        And what part of “you have to pay for it” don’t you Americans understand? The term “socialized” simply means everyone is included and covered. Unlike your system in which so many are excluded and denied coverage.

        But okay, if you want to believe something else that’s fine. But then don’t post these nonsense blogs about health care and when challenged, come up the same uninformed, non-arguments Americans have been spouting for decades.

        Why do Americans feel the need to cling to things that obviously don’t work, and then try to re-invent the wheel, when other countries have systems that have worked for decades, or in the case of Germany, over a century?

        At least have the intelligence to look at what does work before you disregard it completely out of hand because it has the word “social” connected to it. I guess you all better throw away “Social” Security and figure out a better way for force people to save for retirement. Good luck with that!

        • How do the millions of non-working Turks “pay for” their health services? They are not working, so how do they pay for the doctor visits?

          • @ thezman – The same way it works for all unemployed German citizens. Just as in the US, they are supported by social benefits or welfare. Considering unemployment in Germany is currently less than 5%, it’s not an issue. And with the recent cut backs in immigrant benefits, many are leaving when they find out how far € 220/month doesn’t go.

            Keep in mind all citizens in Germany must register in the town hall where they reside by law. This is true when you leave one town and move to another. It is virtually impossible for unregistered residents to use any social services. Without proof of residency, access to social services, including health care, schools and welfare, is simply not possible.

            This concept of registration is true in Germany, Austria, France and Switzerland. Without it, you get nothing.


        • “3. Profit margins of health care providers and insurance companies are strictly regulated by Federal, State Government and private consumer groups.”

          This is where the bulk of the money goes in the US healthcare system-to compensation for not just doctors and nurses but to all the administrators and lawyers who are part of the system.

          Additionally, the rest of the world free rides on the US healthcare system for innovation and R&D. This figure dwarfs the free ride the EU and Asia get from the US military budget. Europe hasn’t developed a new effective antibiotic in 20 years. Without the US drug industry surgery would be impossible.

          • @ Mike – “Europe hasn’t developed a new effective antibiotic in 20 years.” What total nonsense! Europe may not produce or develop as much as the US, but it’s a simple issue of scale, not lack of ability. Next you will be telling me the US produces more wheat than Europe – really!? Who would have guessed it?

        • “The German health care system works because –”

          Because the German government forces the Whites of Germany to make it work. What happens when more Germans decide they don’t want to pay for Abdul to have his sex change operation? Or to keep 95 year old vegetables in nursing homes alive? Your economy is teetering. The only reason the chickens haven’t come home to roost is because of the work ethic of White Germans. When they no longer support the government that was imposed on it by the WW2 victors, your “healthcare” won’t work.

          • @ AWM – If you did a little homework, you’d find out all European countries have a similar system to Germany. It’s why we all have health care and most Americans don’t. It has nothing to do with imposition by “US victors”, Germans have had health insurance since 125-years ago!

        • Karl;
          It is true that there are horror stories in your press about the US medical system. Note that they are largely about the financing of medical care. As mentioned above, the US has historically used prices to allocate medical care, however imperfectly. This is what’s under media attack.

          You use political means of allocation. Simply due the the nature of this fallen world, it is hard to imagine that there are NO medical allocation horrors in a country as large and complex as Germany.

          Those medical care finance horror stories you saw and cite were largely developed and hyped by the US media in aid of their masters’ urgent desire to gain complete control of medical finance plus allocation. These stories are actual news here because they are infrequent, and simply passed along without context as self-congratulation by your German media. We know for a fact that your German media actively suppresses horror stories from Germany that make the German elite look bad, at least about the subject of migrant crime. Hard to image that this suppression doesn’t happen in the other areas that your elite are so proud of themselves about, like medical care or the (non-financial) allocation thereof.

          • @ Al Nort – As noted previously, all European countries have a similar system as Germany. It works because everyone must have health insurance. Yes, it is not cheap and can be up to 15% of monthly income, depending on what one earns. Consider if German unemployment is 5%, that means 95% of the population has health insurance and is paying their monthly premiums. When you control what insurance companies and hospitals can generate in profits, it’s clear a system like this can and does work for everyone without failing those who need health care.

        • You might want to look up the definition of “insurance”. It certainly is not what you are describing.

          • @ Drake – Health insurance is exactly like car insurance. Tell me, is car insurance an option for car owners in the US or is it required by law?

            Everyone in Germany who drives has to have it and pay for it. And just as car insurance is required by law, so is health insurance…and you can pick any provider you want.

            The law simply forces everyone to comply (contribute) so everyone benefits. Your Social Security is no different. I doubt Americans can “opt out” of that.

            Now if you want to talk about a failed system in Europe, look at UKs National Heath System. That’s what happens when the government gets involved in rationing health care! It’s a tax system, not an insurance system.

          • I think Karl believes that insurance equals healthcare when it most certainly does not. Most people in this country (US OF A) have some level of Health care regardless of whether they have Health Insurance to pay for said care.

            I can give a few examples if need be.

        • I’ve been a doctor for over thirty years and have yet to see anyone lose a house over a health care bill. Most of the bankruptcies I’ve seen are ones where the couple involved (it never seems to be a single person) run up a bunch of bills, medical and otherwise before declaring. They tend to be bankruptcies of convenience that they then blame on their elective health care bills. I’ve only seen one after a cancer.

      • I continue to be amazed at this “defense” bullshit.
        The US occupies Europe to loot it, not to “defend” it.

        Defend it from what?

        • @ Bill Jones – As much as most Germans are very happy with our relationship with the American occupation forces (and the Brits and French by the way) we often ask ourselves why are Americans still here?

          No one thinks the Russians are going to roll through the Fulda gap anytime soon. Most believe, and I would agree, it’s been a US ploy to spend billions on their industrial military complex. You should have listened to President Eisenhower.

          • @karl

            You might want to reconsider what you wrote about the Russians. BBC says they are invading south-east England this summer

    • Germany would be hard pressed to provide health care if the US pulled all its military bases out. The loss of US revenue from servicemen spending their paycheck locally and contracted work, with the added burden to spend more on their military to make up the ensuing gap would significantly impact their ability to sustain it.

      Europe has been riding on US tax payers foreign aid and military bases subsidy since the end of WW2. Same with Japan and South Korea. Cut them all off the US purse strings, and then see how well they can continue to be models of socialize medicines on their own dime.

      • @ Ron – US military bases have closed all over Germany with little if any impact on local residents.

        For example, the USAF hospital in Wiesbaden is now a police headquarters. Lindsey Air Station was turned back to the German government and converted into private housing. Rhein Main Air Base in Frankfurt was turned over and used to expand the Frankfurt International airport. Considering that most service members shop on the base where they pay no US or German taxes, they actually contribute very little to local economies in Germany, UK, Italy or anywhere else.

        Given the US spends upwards of $150 billion annually maintaining military bases all over the world, perhaps it would be money better spent providing Americans with affordable health care and education. Or is that too socialist for you?

    • Your system works in Germany because it’s full of Germans. A lot of other systems would work there too.

      America is increasingly full of Guatemalans and Senegalese and basically NOTHING works in Guatemala and Senegal. This is not a coincidence.

      Unless you stop Merkel and her coreligionists soon, your children are going to understand this problem very well.

      [That was a figure of speech, of course you don’t really have any children either. Europe is failing at the most basic level of biological imperatives defining living things and so should be a little cautious about criticizing.]

      • @ Blindman – It works in Germany because everyone has to have insurance. Just like car insurance. And it works in Switzerland, France, Austria and most European countries too.

        The big difference between the US health care and social services and German is we don’t provide free health care, education and benefits to illegal residence. And we regulate what hospitals and insurance companies can profit.

        • Car insurance is required in most states, and people still get into wrecks constantly with people who have no insurance. Just because you have a law doesn’t mean people are going to follow it.
          Try getting the twenty or thirty million here illegally to obey our laws. God you are a fucking idiot.

          • @ teaparydoc – What does people getting into wrecks have to do with the ability of people to get car insurance? Huh?

            And because you don’t personally know anyone who’s lost a house, doesn’t mean it hasn’t happened. What logic is that?

            The fact that you practice medicine in a country that cannot provide affordable access to health care speaks little for your industry.

            I’d rather be an idiot with excellent health care than an American doctor who can’t accept the fact his country’s health care system has utterly failed it’s people on just about every possible level.

            And for the name calling – a sure sign of a failed argument every time. Doctor, heal thyself.

          • Many people have already told you that you cannot apply what appears to work in Germany to other circumstances. You have ignored all of them. You say that your system works because you have laws requiring people to purchase insurance. We have experience with having laws requiring people to get insurance and see those laws ignored by huge swaths of our society in other instances.
            Your inability to be able to see how this applies to the argument that your system wouldn’t work here, at least not as well, is an act of stupidity.
            As usual your only argument is that of the typical Nazi. That your system is better and must be forced on everyone else.

          • As for Germany’s superior health system, I had a colleague from Germany once. Every year or two he would go to a specialty conference back home, and after a while we noticed that he stopped going and asked him why. His answer was that they kept talking about the same thing they’d been talking about for the past twenty years and he couldn’t keep up if he kept going to the meetings there. He quit going because his continuing education was being held back by it.

          • Doc;
            Give Karl a break. In Germany, having a law meant compliance. Why_?: Germany, until the last couple of years was inhabited by law-abiding Germans.

            What Karl doesn’t seem to understand is the the US is not anymore exclusively inhabited by law-abiding Americans. So while we may have laws like the Germans, we can’t anymore rely on voluntary compliance. Involuntary compliance is costly, and our elite must, perforce, ration enforcement. Hence, compliance is strategic and not universal. This is something Karl and his compatriots are too slowly finding out right now in the Moslem no-go zones.

          • Karl you have learned nothing about America. Which is ok because you’ve obviously forgotten nothing as well.

            Until you understand how social services, insurance, medical care, and illegal aliens in America you will continue to be pig-ignorant and absolutely certain you are right.

          • There is a natural gatekeeper when you consume healthcare: the provider.
            There is no such gatekeeper for the use of roads.
            Try not to be unnecessarily stupid.

  27. One more thing: if you can’t get a market-like means of rationing to work, the only thing left is to impose one. That, my friends is government health care.

    • But even that does not “work” in the sense of things actually working. The Brits have kept the plates spinning, but only at the expense of other areas. Making health services into a public good is like heating the house by burning the furniture. Eventually, you run out of things to burn and have ti burn the house itself. The Tragedy of the Commons is immutable.

      • The British have not kept their medical services functioning. Most public doctors are foreigners. Most people cannot afford access to the private system. Therefore the system serves to delay death rather than prevent it. It also serves to impose standards on the public. Break your arm but smoke, service denied. Overwight and break your leg, service denied.

        Think of healthcare as the VA. Would you wish to have to attend only the VA for healthcare?

  28. With most things the market and the ability to pay are what do the rationing. Two things prevent this, the monopoly power conferred by licensing, accreditation and regulation, and the widespread notion that everyone deserves equal access to health care resources.
    Unless market economics are allowed to affect what takes place in health care (note that I did not use the words “free market”, I begin to get nauseated when I see these words used together) there will not be a market regulated form of rationing.
    An example. Rural health care is a big deal. Small towns are losing or have lost their hospitals hand over fist. Young couples wanting to raise kids are afraid to live in places where obstetric services are not available. There are nurse practitioners and midwives that could run rural hospitals, but are kept from doing so by regulations. My solution would be to eliminate the regs by eliminating regulation in Togo by abolishing licensing, but the similar results could be accomplished by other forms of regulatory reform. The problem with this is the solid block of opposition one would meet from entrenched interests.
    None of this is new. Read the Apology and Treatise of Ambroise Pare. He went through this centuries ago in France.

    • Health care is a good place to see the internal contradictions of the One True Faith. Lefty dreams of that idealized world of the great cosmopolitan city. One reason they love to wax romantically in TV and movies about the immigrant neighborhoods of the early 20th century is they imagine that as something close to perfection. Gentrification is just an effort to recreate, without all the bad stiff, their idea of what it was like when great grandpa came over from the old country. Hence, public policy bends toward sucking all resources into the cities.

      The trouble with that is it means the people come with those resources and Lefty really does not want that. The result is a skimming operation that takes from the suburbs and the exurbs in order to prop up the gentrified cities. That results in shortages outside the city and those shortages must be addressed. Around and round spins the wheel.

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