On Ben Carson and Healthcare
Posted by TheRealBill 8 years, 5 months ago to Politics
I started this as a comment https://www.galtsgulchonline.com/post... on but it seems more appropriate for it's own post. So here goes my first original post.
In the linked article Ben Carson is quoted as saying:
"So, basically, I’m looking at practical solutions as opposed to political solutions. And I say in the book, “If the Golden Gate Bridge fell down, who would you get to rebuild it, structural engineers, or people who like to talk about building bridges?” Basically, that’s what we’ve done with medicine – just a bunch of people who like to talk about it but know nothing about it – and that’s why we’ve got what we’ve got now."
The underlying premise, that non-experts shouldn't be "fixing" things outside their bailiwick, is correct. Here is the rub. Healthcare isn't about medicine. Doctors can't fix it because the problem is not lack of preventative care or something doctors are doing or not doing. The problem is we turned health insurance into socialized medicine. Now, hear me out first.
First we have to realize what insurance is. Think of a car. When you buy insurance what does it cover? Essentially accidents and theft. The risks are an aggregate function of the theft-appeal of the car, where you live, your driving record, and to a lesser extent the cost of repairs and replacement. But what is specifically not something we expect or demand to be covered by insurance? Preventative maintenance.
Your car insurance does not cover oil changes. It does not cover changing your wiper blades, or replacing the fuse or relay which powers your horn. Nor does it cover cleaning your windows. Why? Those are not what insurance is designed for. What/How is insurance properly designed?
Simple. Sort of. We can not calculate your specific risk of getting into an accident. Don't listen to anybody who tells you otherwise. Insurance companies look at what aggregate groups you fall into and basically make a judgement call (mostly algorithmically) on your risk given where you fall on aggregate risks. Because we can make risk assessments in the aggregate. We can say that out of X people who drive and are under 18 Y% of them will be in an accident - even though we can't say if your kid will hit or be hit while driving. Clear as mud? Maybe.
Health insurance used to be that way. Smokers, as a group, tend to have higher health problems than non-smokers and as such had to pay more for their insurance due to the increased statistical risk. Where we went wrong was in saying that just because, say, regular testicle, prostate, or breast exams could lower the cost (while NOT affecting the actual risk!) when the cancer did show up then insurance should somehow pay for them. That is the primary fatal flaw, and until we rectify this we can't "fix" it. The medical system in this country isn't broken. How we pay for it (and by whom!) is.
Insurance is about risk assessment. Annual check-ups are not about risk assessment. Annual checkups are a semi-fixed cost. They aren't unexpected and insurance is about covering the unexpected.
The second way this battle has been lost is in accepting the notion that insurance companies are "profiting from illness". This could not be more bass-ackwards. Insurance companies profit from the healthy people! You don't profit when you have to pay out more money than you took in in from premiums. You need the healthy people to paying the system or you go broke. Something we are beginning to see, and something we will continue to see more of. In a sense, the healthy people are the health of medical insurance in the sense that producers are the health of the economy.
I would bet if you returned health insurance to it's true and proper purpose the cost of health insurance would plummet to the point that more people can afford it than can "afford" Obamacare.
The third leg of this disaster was accepting third-party payment for medical services. Every industry where the services are not paid for by the one receiving them sees inflation. Look, for example, at the cost of college. The rise of tuition takes an abrupt northerly turn when it became socialized through student loans. OPM is a sure-fire way to increase the price of any good or service. For this you can look at things which "insurance", prior to the latest national debacle act, did not cover. In particular look at laser eye surgery. Insurance refused to cover the cost and contrary to the prevailing winds it tacked downward in price - faster than other medical services rose even.
That isn't an accident, nor is it isolated. Elective reconstructive surgery has seen a similar decline, as has every other non-covered service I have looked at and found data for.
Instead we have the trifecta of problems forming the disaster we have today.
1. Insurance covering maintenance
2. The notion that people are profiting from the sick instead of the healthy
3. The ponzi scheme of OPM
And they happened in that order. Perhaps we can reverse it the same way. I dunno. But you have to start somewhere. I think there may be a window of converting the first item. If we could get a division in order to "lower the costs" that might start reversing the flow. You'd have to differentiate between "health care" and disaster coverage.
For item two (and part of three) I think we'd have to get it across as a point of basic responsibility[1], maybe even civic or patriotic. Make it a point of pride, if you have to, to ensure you get (your own) regular checkups, avoid smoking (except smoking meat of course; let's not get hasty), and so forth. I'd rather Facebook be full of "smug I-take-care-of-myself" posts than my wallet full of looter hands.
To relate this to Rand, I don't think she had a problem with "classic insurance", but would certainly have a problem with the "faux insurance" we have today in the medical field. You can see some of the principles in AS just on a private level. They evaluated risks, covered for them, and took the risks. I am quite open, however, to others' thoughts on her opinions on what I call "classic insurance" as I've o;y read, so far, AS and Anthem (for school no less!) as my intro to Rand.
Anyway, that covers my overall thoughts.
1: Cue "what personal responsibility?" calls. I know, I know. But I see that stating to take hold in the young people of today. Maybe, just maybe we could get somewhere by encouraging this.
In the linked article Ben Carson is quoted as saying:
"So, basically, I’m looking at practical solutions as opposed to political solutions. And I say in the book, “If the Golden Gate Bridge fell down, who would you get to rebuild it, structural engineers, or people who like to talk about building bridges?” Basically, that’s what we’ve done with medicine – just a bunch of people who like to talk about it but know nothing about it – and that’s why we’ve got what we’ve got now."
The underlying premise, that non-experts shouldn't be "fixing" things outside their bailiwick, is correct. Here is the rub. Healthcare isn't about medicine. Doctors can't fix it because the problem is not lack of preventative care or something doctors are doing or not doing. The problem is we turned health insurance into socialized medicine. Now, hear me out first.
First we have to realize what insurance is. Think of a car. When you buy insurance what does it cover? Essentially accidents and theft. The risks are an aggregate function of the theft-appeal of the car, where you live, your driving record, and to a lesser extent the cost of repairs and replacement. But what is specifically not something we expect or demand to be covered by insurance? Preventative maintenance.
Your car insurance does not cover oil changes. It does not cover changing your wiper blades, or replacing the fuse or relay which powers your horn. Nor does it cover cleaning your windows. Why? Those are not what insurance is designed for. What/How is insurance properly designed?
Simple. Sort of. We can not calculate your specific risk of getting into an accident. Don't listen to anybody who tells you otherwise. Insurance companies look at what aggregate groups you fall into and basically make a judgement call (mostly algorithmically) on your risk given where you fall on aggregate risks. Because we can make risk assessments in the aggregate. We can say that out of X people who drive and are under 18 Y% of them will be in an accident - even though we can't say if your kid will hit or be hit while driving. Clear as mud? Maybe.
Health insurance used to be that way. Smokers, as a group, tend to have higher health problems than non-smokers and as such had to pay more for their insurance due to the increased statistical risk. Where we went wrong was in saying that just because, say, regular testicle, prostate, or breast exams could lower the cost (while NOT affecting the actual risk!) when the cancer did show up then insurance should somehow pay for them. That is the primary fatal flaw, and until we rectify this we can't "fix" it. The medical system in this country isn't broken. How we pay for it (and by whom!) is.
Insurance is about risk assessment. Annual check-ups are not about risk assessment. Annual checkups are a semi-fixed cost. They aren't unexpected and insurance is about covering the unexpected.
The second way this battle has been lost is in accepting the notion that insurance companies are "profiting from illness". This could not be more bass-ackwards. Insurance companies profit from the healthy people! You don't profit when you have to pay out more money than you took in in from premiums. You need the healthy people to paying the system or you go broke. Something we are beginning to see, and something we will continue to see more of. In a sense, the healthy people are the health of medical insurance in the sense that producers are the health of the economy.
I would bet if you returned health insurance to it's true and proper purpose the cost of health insurance would plummet to the point that more people can afford it than can "afford" Obamacare.
The third leg of this disaster was accepting third-party payment for medical services. Every industry where the services are not paid for by the one receiving them sees inflation. Look, for example, at the cost of college. The rise of tuition takes an abrupt northerly turn when it became socialized through student loans. OPM is a sure-fire way to increase the price of any good or service. For this you can look at things which "insurance", prior to the latest national debacle act, did not cover. In particular look at laser eye surgery. Insurance refused to cover the cost and contrary to the prevailing winds it tacked downward in price - faster than other medical services rose even.
That isn't an accident, nor is it isolated. Elective reconstructive surgery has seen a similar decline, as has every other non-covered service I have looked at and found data for.
Instead we have the trifecta of problems forming the disaster we have today.
1. Insurance covering maintenance
2. The notion that people are profiting from the sick instead of the healthy
3. The ponzi scheme of OPM
And they happened in that order. Perhaps we can reverse it the same way. I dunno. But you have to start somewhere. I think there may be a window of converting the first item. If we could get a division in order to "lower the costs" that might start reversing the flow. You'd have to differentiate between "health care" and disaster coverage.
For item two (and part of three) I think we'd have to get it across as a point of basic responsibility[1], maybe even civic or patriotic. Make it a point of pride, if you have to, to ensure you get (your own) regular checkups, avoid smoking (except smoking meat of course; let's not get hasty), and so forth. I'd rather Facebook be full of "smug I-take-care-of-myself" posts than my wallet full of looter hands.
To relate this to Rand, I don't think she had a problem with "classic insurance", but would certainly have a problem with the "faux insurance" we have today in the medical field. You can see some of the principles in AS just on a private level. They evaluated risks, covered for them, and took the risks. I am quite open, however, to others' thoughts on her opinions on what I call "classic insurance" as I've o;y read, so far, AS and Anthem (for school no less!) as my intro to Rand.
Anyway, that covers my overall thoughts.
1: Cue "what personal responsibility?" calls. I know, I know. But I see that stating to take hold in the young people of today. Maybe, just maybe we could get somewhere by encouraging this.
