It occurred to me...utterly randomly...after a recent debate on if and how Walmart's decision to change their job descriptions in order to deter the elderly from seeking employment with the company (since it cost the company more in benefits to hire such people) amounted to discrimination, that implementing universal healthcare would essentially sidestep the issue.
The reason that Walmart wanted to deter the elderly from applying was largely health care costs. The problem, regardless of how moral you regard such a move, is that Walmart has to shoulder some of the cost of the elderly's health care. If the cost were on the state instead, there's no incremental cost to Walmart, and they have no more incentive to discriminate in the first place. Granted, there are other similar costs of having the elderly employed (more sick days, etc.), but I think it would help.
See? Problem solved. I'm a genius.
Subscribe to:
Post Comments (Atom)
6 comments:
Hey, great idea! We should probably let the state handle pensions too! Maybe if the pension costs that GM and United Airlines are suffocating to pay were handled by some sort of Transportation Authority (Metropolitan or otherwise), they wouldn't have any problems either! I mean, when has the state ever had issues with covering large health care and pension costs for their workers? Surely they can take on the entire US workforce (and their kids and spouses and parents)...
:-P Jackass.
Yes, you're right...since letting the government handle something in one instance is a bad idea, logically (and by logically I mean because it fits my ideology) it must always be a bad idea, and clearly privatization is always a better idea. God bless you Kenneth Lay, you bastion of market efficiency...to wrest control back from fucktard HMOs who have empirically been delivering crappier care at higher cost would sully your great name and be downright un-American. Support our troops!
Hey, don't blame me for throwing the first stone of extremism. I wasn't the one who suggested that, if we moved private costs from private companies to the state, the private company would have no further incentive to save money (or, as you say, discriminate). Am I mischaracterizing the sentiment there?
Can you explain how it's not then logical to extend that argument to pensions? After all, we have a partial public pension program (Social Security) just as we have a partial public healthcare system (Medicaid). Isn't the universal salvation plan (Project Heal The World) just an extension of those?
Less, not none. Less is better than, you know, not less.
The advantage of centralizing health care is in eliminating the administrative overhead imposed by HMOs in their attempt to rigorously control what treatments are allowed for what ailments, and the redundancy in those beaurocratic machines when they are duplicated across every health care firm, plus the profit overheads. The problem with the healthcare system is one of basic inefficiency.
In contrast, the problem with the pension system is a problem of demographics. Having set up a system where todays retirees are funded by tomorrow's retirees, if demographics shift such that the ratio between the two falls, you're screwed. You are, in fact, screwed so badly that switching to a private system of 401ks (which generally makes more sense) only helps you in the long term. You're still screwed in the short term...doubly so, because if you shift today's retirees out of the pension system, you have nothing to fund the current retirees with.
Fundamentally different problems.
My primary issue is with the mentality that says, "X costs have become too much for YZA Corp to handle. The government should pay it." I'm not completely sure that's what you mean to be saying so please correct me if you also think that's a bullshit solution. Contrary to your dichotomy, health care is nearly just as much a demographics problem as are pensions. The older your workforce, the more they need even the basic screenings, let alone medications, disabilities, etc. Health care costs have scaled up at companies almost as quickly as the pension burden, both people keep living longer than nearly every public or private insurance and pension program expected.
I can (and will) take separate issue with the belief that nationalizing health care will automatically reduce administrative overhead. I'm sure everyone that has had to wait for a medical procedure or decipher a confusing "Explanation of Benefits" form is convinced that nothing could possibly be worse than the current system. I'm not convinced that handing the whole system to the same folks who've done such a bang-up job with something arguably easier like collecting taxes, is such a good idea. Without either a) setting up hard constraints about what's covered, individual circumstances be damned, or b)simply cutting out that pesky process of figuring out what procedures are okay to pay for, I don't see how involving the government makes the system better (except, of course, by eliminating those troublesome profit-making incentives the private companies now have. The government can just borrow more!). Nor do I agree that one mega-government agency adminstering health care to 300 million Americans is more efficient than 300 HMOs administering to 1 million Americans each, simply because you have to pay fewer light bills at HMO headquarters. Is there some other magic to the presumed government efficiency that I'm missing?
Okay, true, health care does suffer from demographic shifts a bit too. But as I said, the main problem really is a broken and inefficient structure.
As I've ranted before, what happened was that business guys walked into the health care system and convinced everyone of the false premises that health care costs too much because doctors were performing unnecessary procedures and because people were getting "too much" health care because extra doctor visits cost them very little. So they set out to impose strict controls on what treatments could and could not be used to treat different ailments.
This led to the exponential increase in paper pushers necessary to implement these draconian policies and the ridiculous administrative overhead we see today.
If I'm remembering the numbers right, something like 35% of costs go to administrative overhead, 20% goes to profit, leaving 45% to go to actual care. Assume for a minute the rule beaurocracy is necessary (it isn't, but I'll get to that). One beaurocracy is more efficient than multiple ones for a number of reasons. There are the direct redundancies like building costs, electricity, personel, support for those additional personel, etc., but perhaps more important are the secondary beaurocracies that hospitals have to incur in order to deal with the multiple insurance beaurocracies. Every insurance company has its own ridiculous rules, appeal procedures, etc., and hospitals need people to deal with that.
Those draconian rules, however, are fundamentally and philosophically flawed in the first place. A) You can't encode medicine into a bunch of straightforward algorithms...if you could, we wouldn't need medical schools, and those goddamn psycho premeds wouldn't exist. B) Taking the decision-making away from doctors is driving them out of the profession, which long-term is going to drastically degrade quality of care. C) To the degree to which unnecessary procedures are prescribed by doctors and to which people seek unnecessary care on their own at all, those overheads don't even come close to comparing with the overhead of the beaurocracies designed to combat them.
So let's get rid of the profit and get rid of the rule beaurocracies. Other countries with socialized(-ish) medicine like Canada and (I think) Sweden have (or at least had, before they had to start dealing with US insurance companies), administrative overheads of 10%. You've already cut out 45% worth of overhead.
I agree with you, though, that the logic that says "private industry is doing a bad job...we should let the government do it!" is flawed. That's not what I'm saying. You could, instead of centralizing, figure out a way to provide incentives to fix the private system. In this case, however, I would argue there are several reasons why privatization doesn't make sense. First of all, it's a service that everyone needs. A competitive market involves having players who screw up. The problem is that players who screw up in health care kill people. Second, there's not much room for competitive advantage. A sick person needs a doctor, and there really isn't a "more cost-efficient" treatment for that sick person, especially given that we, as a society, (claim to) put a premium on human life such that saying "we don't need to do a followup x-ray here because there's only a 10% chance anything serious is wrong" is unacceptable (though figuring out and implementing that treatment is a complex task that is different for every individual and must be determined by a doctor and can't be encoded in a computer...at least not yet). There is potentially room for competition in _applying_ those treatments (medical devices, etc.), but that's an entirely different market that operates regardless of whether health insurance is centralized or not.
As we've seen in the past 10-15 years, privatization of health care leads players to engage in PR campaigns to convince people the inefficiency and profit margins are necessary, not in better care at reduced cost.
Post a Comment