Sudden Confusion

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Yes, well-stated.

Also true. The Trial Lawyers Assn. is an active and effective opponent of tort reform, and huge contributors to Democrat campaigns. When they speak, Democrats tremble.

-- Cheers, James Arthur

Liability insurance. But, huge difference:

a. They do not pay exorbitant sums of money such as tens of millions for one case.

b. The lawyers are not allowed to siphon off 30-40% for themselves.

We all know that it has resulted in a massive number of ambulance chasers. The American way is the way of fairness, not the milking of the fellow citizen.

No, but the awards should be reasonable.

But the hyper-numerate James Arthur can't be bothered to tell us what that "trivial" penalty is.

This assumes that the free market optimises hospitals. It doesn't seem to do too well in real life. Hospitals are a bit too close to natural monopolies. Hospitals do better if they specialise, but patients want to be treated in a hospital near them, which sets up at least one dilemma.

Most societies allow the government to regulate hospitals in the public interest, which doesn't work perfectly either, but it does work better than idiot privatisation - as Thatcher managed to demonstrate in the U.K. It took years for Blair's Labour administration to undo the damage that Thatcher's half-baked privatisation initiatives had done to the U.K.'s National Health Service.

-- Bill Sloman, Nijmegen

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So medical incompetence and human error is different in kind from every other kind of human error?

That's what tort reform is all about. The courts claim that this deprives injured patients of their right to redress under law, which it does. Unfortunately, society would be better off with a slightly less equitable, but much cheaper, system of dealing with medical errors.

It helps if the young people concerned can be shoe-horned into the role of the tragic victim. Less prepossessing victims don't do as well.

This is universally true. US leaders do seems to be peculiarly susceptible to the "wining and dining" not to mention the other, more tangible benefits that the better-off seem to be able to provide - and without anybody mentioning the word "corruption" all that frequently.

-- Bill Sloman, Nijmegen

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That's the situation that every ambulance-chaser dreams of. In practice, they have to compromise, and take on some long-shots to keep themselves busy between sitting ducks.

They come pretty close to it if they restrict themselves to ugly patients. Better-looking patients can expect considerably more sympathy - and compensation - from the courts.

-- Bill Sloman, Nijmegen

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Which rather misses the point of medical insurance. If you unexpectedly get something that is expensive to treat (the usual situation), you may not be able to pay the doctor yourself.

The American way of medical insurance cost half-again more per head than the next most expensive system, and doesn't deliver proportionately better health care - granting that the USA has rather poor public health statistics, there's an argument that US health care is actually worse - overall - than French, German and even UK health care (and UK health care is quite a bit cheaper than the French and German systems).

-- Bill Sloman, Nijmegen

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Which misses the point that we're not buying insurance--that's now illegal. Obamacare means we're paying for comprehensive medical coverage, needed or not, plus the middlemen. That costs more.

--James

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Being merely numerate, I'm unwilling to even try to make sense of that, which isn't going to win any prizes for clarity.

"Trivial" is no less of a cop-out, and James Arthur is supposed to care about this sort of stuff - as opposed to finding it all rather comical (which happens to be my position - being the beneficiary of a health system that works).

He does seem to have snipped my comments about inadequacies of the free market as a universal solution for every possible question about distributing resources - his ideological blinkers may have prevented from perceiving the text at all, though it's more likely a consequence of his debating style, which amounts to argument by selective quotation.

-- Bill Sloman, Nijmegen

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"Coverage"? Meaning insurance cover. "Cover" on its own is usually restricted to describing what stallions do for mares.

In this context, "insurance coverage" is implied."National Insurance" is the term popularised by that dangerous socialist Bismark, and while national insurance may not be that much closer to regular insurance than the national socialism is to socialism, the phrase has been widely used for more than a century now.

The fact that comprehensive medical insurance in the USA costs more than it does everywhere else - and doesn't deliver any kind of superior health care, overall - hasn't got anything to do with Obama. The system was ridiculously expensive long before he got to influence it, and the long history of stupid choices that put you where you are today is going to take a long time to unravel.

In order to get your system a little closer to comprehensive cover, Obama had to make some expensive compromises with your rapacious and inefficient health insurance industry. With any luck he's got a plan which will let you eventually screw them as enthusiastically as they've been screwing you for the last century or so, but it's probably longer term than your feeble attention span can grasp.

-- Bill Sloman, Nijmegen

I'd say it's more correct to say that everyone *will* need medical coverage at some point in time, and while sometimes the timing is known in advance, in other cases -- which are often the rather expensive ones, such as automobile accidents, coming down with AIDS or cancer, etc. -- it's not. Someone walking around today who has the means to insure themselves but not the means to pay for medical treatment required to treat such catastrophic events (say, for instance, young engineers making decent money but without much in the bank yet) is really incredibly selfish, IMO.

I'm not too worried about the middleman: With private insurance there's one as well, of course (and unlike the feds, that middleman reasonably enough wants to make a profit on his efforts). If done efficiency, his cost should be almost negligible (I realize this is not the case today).

Note that private insurers today save an *incredible* amount of money (many millions per year) by virtue of all the work medicare has done in attempting to standardize procedure and diagnosis codes, billing submission procedures, etc.; their "efficiency" would actually drop a noticeable amount if we completely removed the government from health care.

---Joel

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After phase-in the penalty is (generally) max(($695 per person, max 3 per family), 2.5% of income).

It wasn't a cop-out--I gave you the cite, I just didn't feel obligated to explain the law to you.

It's full of tricks and wrinkles, all complications of divining the needy from those of ability.

Subsection (g)(2)(A) provides that there are no criminal penalties for not paying the penalty.

-- Cheers, James Arthur

No they won't. Most people won't. And, if they did, the whole insurance thing would collapse. Insurance only works when only a few need it. If everyone needs it, it's financing, not insurance.

If protection against calamity is the concern, the Dem's should've made Obamacare step in (or make a voluntary program) for cases of calamity, and let people handle their own day-to-day needs.

That, however, is not the goal of Obamacare. The goal of Obamacare is to get young healthy people's money, to pay for everyone else. Young healthy people don't use much health care. You wouldn't need to force them if it were a good deal for them; the goal is to get their money.

The govt's argument that it needs the mandate to pay for Obamacare wouldn't make sense if the mandated people were a net drain. They aren't.

The government is now banning the ability to "be responsible" and insure one's self against calamity. Obamacare makes that illegal.

But it's fully legal to simply skip until you need it, then buy it from your hospital bed. The rules and incentives encourage it.

That's so far from reality I scarcely know where to start. Medical care could cost 1/3rd of what it does today, if people shopped and spent their own money. Adding middlemen adds cost, moral hazard, and more, creating the whole mess we see today. Obamacare takes that to its maximum extreme.

If the paperwork's so efficient and improving, why aren't costs falling dramatically, or productivity rising?

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I take it you've never engaged in Medicare transactions, nor counted the man-hours per office visit devoted to non-medical nonsense.

Really, I think you're off by a factor of two, maybe three.

-- Cheers, James Arthur

Tort reform limits "pain and suffering" damages -- the difference between the life they would have led without the injury and the life they now have to look forward to. There is no punishment for negligence. All doctors have to do to avoid a payout is not be negligent.

Now if the doctors deliberately injured their patients, then the patient could collect punitive damages.

Do you not see why a lifetime of pain is more significant for someone injured at age 20 than one injured at age 70? Why is it fair that they each get paid the same amount for their suffering?

How do you define the difference between:

"doctors deliberately injured their patients"

and

a doctors "incompetence"

Either way, the patient lives with the doctors injury to them.

Even a dog can tell the difference between being tripped over and being kicked, though the result to him may be the same. Damages for negligence are intended to make the victim as whole as possible, not to punish the defendant.

I really don't think that's true. I can't think of anyone I know who has *never* been to a clinic, urgent care center, or emergency room. (Heck, I'd wager that over 90% of babies in the U.S. are born in hospitals today...)

I mean, sure, I'll grant you such people exist -- I just suspect they really are one in a million.

Well, um, we were talking "coverage" -- kinda more generic than "insurance." I agree with you that people commonly call the health coverage benefit their, e.g., employer provides "insurance" even though, yeah, it's really a combination of pre-paid coverage and true insurance.

Strikes me as potentially inefficient, but sure, that's an entirely reasonable proposition.

I thought it was to get EVERYONE'S money, but I agree with you that, yeah, younger people are far more likely to not require medical care equal to what they've paid in compared to older people. I don't see anything inherently wrong with that... (...anymore so than people without kids having to pay for schooling their neighbors' kids, for instance...)

I would support being able to opt out of Obamacare if one could demonstrate they had their own private coverage or a certain (rather large) amount of money in the bank; I'm under the impression that some other countries with socialized medicine do offer such an option.

Doesn't that only apply if you're poor? I thought that either your employer would be chipping in to Obamacare, and if not you'd be taxed to pay for it.

That 1/3 number seems highly optimistic, but sure, I'd grant you it'd be cheaper if everyone were spending their own money... but I also suspect that the quality of health care in the country would suffer as a result, and we'd actually end up spending more than we already do to cover people who simply don't have the money to pay for their own care.

My optimistic number is that with Obama, the costs for given procedures might become 2/3 what they are today.

Because paperwork is only part of the problem... maybe 5-10%? Nevertheless, I'm under the impression that if you solely focus on the paperwork, costs very much have fallen and productivity has reason.

Maybe. Seems like it's worth throwing the dice and seeing what Obamacare brings, perhaps -- I realize it does have plenty of problems (the restrictions on HSAs seem ridiculous), but assuming the Supreme Court doesn't toss it out, most of it will take effect in 2014, so we'll have two years to see how well it works before the Republicans most likely take the White House in 2016. If it really ends up being worse for most people than what they have now, I'd say it'll be gone by 2018.

---Joel

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You just wish that is was that straightforward with all the competing interest groups involved, all with financial stakes to protect.

?-)

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Maybe, maybe not. How about you really look into at least a few of these lawsuits rather than spout party line? It could really change your point of view.

?-)