Coyote Blog

The California labor board has ruled, in its infinite wisdom, that my company is responsible* for the unemployment insurance payments to an employee who got hurt when he wrecked his motorcycle on his own time and was physically unable to work.  So an employee gets hurt in his off time and leaves us in the lurch when he can't work during our busiest season, and we owe him money for staying home?  Other issues I have with California unemployment here.  The original post about the ruling I was trying to appeal is here.

* Being responsible means that these payments go into the calculation for our unemployment insurance premiums.  Effectively the premiums we pay this year are calculated to match the payouts to our employees (or ex-employees) last year.

The AP does a great job in this story reporting absolutely everything but the most important fact:

The Supreme Court has refused to offer help to Hurricane Katrina
victims who want their insurance companies to pay for flood damage to
their homes and businesses.

Wow, those insurance companies suck, and they have the Supreme Court in their pocket.  The only teeny-tiny fact missing is that the people suing had policies that very explicitly did not cover flood damage.    They sortof acknowledge this but say the insurance companies should pay anyway, because the flood was caused by a broken levee and that somehow is not really the same kind of flood, sort of.  Or whatever. 

Well, I can't blame this bit of command and control on Mitt Romney, but it is still a great example of politicians doing exactly the opposite of what is needed to making US health care even more convenient and affordable.

In-store health care services offer cheap primary care, ease the
burden on emergency rooms, and help people who can't afford health
insurance"“or who have insurance but can't find a decent primary care
physician. They also boast stratospheric customer satisfaction ratings. 

So why is idiot Boston Mayor Thoma Menino against them?  Because they're driven by profit!

The decision by the state Public Health Council,
"jeopardizes patient safety," Menino said in a written statement.
"Limited service medical clinics run by merchants in for-profit
corporations will seriously compromise quality of care and hygiene.
Allowing retailers to make money off of sick people is wrong."

This is as opposed to doctors in hospitals, who everyone one knows don't make any money off of sick people.  Seriously, who in their right mind could possibly oppose a free market solution to cleaning out these non-life-threatening type cases from hospital emergency rooms?

I just don't understand the enthusiastic support for Mitt Romney and his description as an heir to the Reagan legacy.  In particular, he claims to single-handedly have implemented HillaryCare in Massachusetts, the program that was arguably responsible for sweeping the Republicans into Congress in 1994.  My sense is that Hillary in the intervening years has moved on to an even more socialist plan, but everything I see in the Romney plan looks very much like Hillary's original proposal. 

The plan is command and control at every turn -- for example, I am a huge believer in high deductible health insurance.  My family has saved a ton with it, and it shifts health insurance to be more like, you know, insurance -- meaning it covers catstrophic, bankrupting problems but not day to day expenses.  Well, this sort of very reasonable plan, which has the added benefit of bringing some price competition to medicine because people like me now care about prices, was made illegal in Massachusetts by Romney and Company.  Romney strikes me as just another 1970's-style big government Nixonian Republican, like nearly every other Republican in the race this time around.

Previous posts on Romney's plan here and here and here.

Frequent readers will know that I don't think much of our County Sheriff Joe Arpaio.  Sheriff Joe gains a ton of PR for himself as the "toughest sheriff in America" and relishes in making jail conditions as miserable as possible.  Recognize that this is the jail that holds many people after arrest but before conviction. 

Now on to the figure mentioned in the Dickerson piece of 2,150
"prison condition" lawsuits since 2004. Anyone with two licks of sense
can go online at pacer.psc.uscourts.gov, or dockets.justia.com,
enter "Arpaio" into the federal court docket, then count the lawsuits
that name "prison conditions" as the cause. Count back to 2004, and as
of mid-December, that number was more than 2,150.

The same search for
the top jail custodians in L.A., New York, Chicago, and Houston nets a
total of only 43 "prison condition" lawsuits.

Remember, those 2,150
lawsuits against Arpaio are only in federal court. There are hundreds
more listed online with the Maricopa County Superior Court, at superiorcourt.maricopa.gov/docket/civilcourtcases/.....

                                       

"For the period January 1, 1993, to [November 29, 2007], the county
has paid $30,039,928.75 on Sheriff Department General Liability
claims," state the docs. "This figure includes all payments, attorney
fees, other litigation expenses, settlements, payments on verdicts,
etc."

Additionally, New Times
asked Crowley how much the lawsuit insurance policy that also covers
the sheriff has cost taxpayers. Crowley croaked, "The county has paid
for General Liability coverage for the period 3-1-95 to 3-1-08 total
premiums of $11,345,609.50."

Keep in mind that this
liability coverage figure is high, in part, because of all those
lawsuit payoffs to relatives of dead inmates.

From 1995 to 1998, the county paid $328,894 a year for an insurance policy with a $1 million deductible.                                       

Today,
Maricopa County pays a yearly premium of $1.2 million for outside
insurance with a $5 million deductible. For any lawsuit that costs $5
million or less, the county foots the entire bill. It's the best policy
the county can buy because of Arpaio's terrible track record.

My company, as I have written before, gets hosed on unemployment insurance in states like California where the government does nothing to police cheating.  Many of my seasonal employees take vacations during the winter, but draw unemployment from California because the state has absolutely no interest in really checking to see if they are looking for work (which is a legal requirement of drawing unemployment).

This week I received the  most amazing ruling from California on unemployment.  If you don't understand how it works, the state taxes me a percentage of my payroll in the state as unemployment insurance premiums.  The rate is set so that the premiums I pay are about equal to the payments my ex-employees receive.  This means that the rate can adjust up and down, and also means that any incremental payouts are eventually paid by my company.  The rules are that the employee must have been terminated, not voluntary quit, and can't have been terminated for cause (i.e. theft) though in the latter case states like California give employees a huge benefit of the doubt (so huge, that I have never been able to prove "cause" to their satisfaction, and end up paying the unemployment for people who stole from me).

So I got this notice this week:

The claimant quit your employment on his/her doctor's advice.   A leave of absence was not available or would not have resolved the problem.  Available information shows that the claimant had good cause for leaving work [the claimant admits in a second document to having had a motorcycle accident on his own time]

Great.  The state has agreed to exactly the facts as we submitted them.  Victory at last!  Or not:

Your reserve account will be subject to charges.

An employee of mine has a motorcycle accident on his own time, and my company has to pay his wages while he is hurt?  Why?  Because we were the nearest people at hand to grab the money from?  Who elected me this guy's parent?

I don't know if this has made the blog rounds yet (I have been out of touch and have not gotten through me feed reader today) but this is perhaps one of the most ridiculous things I have ever heard.  It's a 40 second interview with a woman named Geri Punteney in Iowa about Barack Obama on the left of this page  (ironically, NPR makes you listen to a brief commercial before you hear the clip).

You really, really need to take the time to listen.  I will include an excerpt below, but you won't get the full effect of the woman absolutely in tears through the statement, crying because she had gotten to touch someone she had seen on TV.

A few weeks ago, at the home in Oelwein, Iowa, she shares with her mother, Punteney said she'd been inspired to see Obama when he came to the area.                        

"I'd seen the commercials," she said. "And he just seemed sincere, like he's for people like my mom, my brother and me."                        

Many people feel politicians may not be the first place to turn when in dire need of help. But Punteney said she was confident Obama could do something to make her feel better.                     
"I never had anyone pay attention to me and my needs "” and he held my hand," she said.

He can do something to make me feel better?  Barf.  Can it really be that my future freedom and prosperity depend on how this woman votes?  Have we really given this woman so much power over the rest of us?  Have we really throttled back the most productive in society so this woman can feel like she is keeping up?  Have I really become the sacrificial lamb to this woman's need to feel better?

And, oh by the way, in case I have not gone off on this rant in the last five minutes or so, Obama can care because he can promise you whatever you desire, and then he can force me to pay for it.  Unlike people in private life who really do care, politicians don't actually pay for their promises because they can force other people to do it for them.  Worse, politicians like Obama reap the praises of women like this for being caring, while vilifying people like me who are productive and make his caring possible.  It just makes me sick.

Oh, and how much did Obama really care?  Not much, it seems:

I brought a tape recorder to Punteney's house and played her moment
with Obama back for her "” and his suggestion that he'd write her
brother a note. He never did.                        

"He
didn't have time, I guess," she said. "I understand. You know, he was
bombarded by so many people. But just knowing he knows "” that's more
important than a note."

So here it is:  Cares enough to spend Coyote's money:  Yes.  Cares enough to actually expend some effort himself:  No way.

Indeed, Punteney seemed to get just what she wanted from Obama. She got noticed.

How about a trade, Ms. Punteney?  If I promise to get you to an Oprah show, will you promise not to ever vote?

Update: Yeah, I know, her brother has leukemia, which is sad.  The lack of portability of his health insurance is also pain, a result of WWII wage control policy and subsequent tax policy that encouraged the practice.    Sorry, but this need to be touched and noticed by a second or third term Congressman is pathetic. 

Via Hit and Run, this is an incredible site for stat-geeks to fool around.  Top 101 city lists.

#1 Average Sunshine!  I have also lived in the 4th least sunny city.  Sunnier is better.   Seattle is not among the rainiest in terms of total inches, because it never rains very hard.  If you could measure rainy as "number of hours per month that rain is falling", Seattle would be right up there.  In places like Houston, you get a lot more volume of rain, but you get a whole years worth in just a couple of hours.

Other interesting ones:

• Size of government:  Largest local government salary and wages per resident.  Every man, woman, and child in Cambridge MA spends $3,532 a year towards the salary of a City of Cambridge government employee.
• Property taxes per resident (look at the map, all but 8 of 101 in the northeast)
• Living your whole life in the same spot
• The average woman in St. Louis weighs over 165 pounds?
• Counties with a net exodus are still dominated by the upper midwest, but look at people moving out of coastal California!
• I have often argued that the numbers of people without health insurance are skewed by new and illegal immigrants.  Check out this map of places with the most uninsured - they all seem to border Mexico
• Chicago was named the windy city because of its politics, not because of actual wind

I just wish they had a better explanation of the metric and the data source for each

A few weeks ago, my wife's car was totaled when a guy in a large van fell asleep and slammed into her car when she was sitting at a red light.  Since he admitted culpability, his insurance company quickly came up with a settlement amount for the totaled car based on blue book values and such. 

Here is the interesting part -- since the insurance company is technically buying the wrecked hulk from us, Arizona treats the payoff as a taxable transaction, and charges its full automotive sales tax rate on the settlement.  It's incredible to me that having my car wrecked is considered by the state of Arizona to be a taxable event, and that the tax is owed in this case by the victim.  I am glad my house didn't burn down, the state might have bankrupted me!

This all seems odd to me, since if I had sued the driver to make us whole, rather than accepted the insurance settlement, any amount I won in court would not be taxable.  My guess (and hope) is that they are only taxing me on the scrap value of the hulk, not the entire transaction, but I have to do more checking.

Note before commenting that laws and rules on this are highly variable by state.

I propose a survey.  We will ask 500 CEO's of large company's and 500 small business owners just one question

1.  Do you agree/disagree with the following statement:  In order to make my business more competitive in international markets, the federal government needs to raise taxes and expand its scope

How many out of the 1000 would answer "Agree?"  Well, at least the number won't be zero, as long as you ask the NY Times:

"¦the taxes collected last year by federal, state and local governments in the
United States amounted to 28.2 percent of gross domestic product. That
rate was one of the lowest among wealthy countries - about five
percentage points of GDP lower than Canada's, and more than eight
points lower than New Zealand's. "¦the meager tax take leaves the United
States ill prepared to compete. From universal health insurance to
decent unemployment insurance, other rich nations provide their
citizens benefits that the U.S. government simply cannot afford.
"¦revenue will prove too low to face the challenges ahead.

I love the part about unemployment insurance particularly -- other countries are more competitive than we are because they pay their citizens more not to work.  Huh?  Daniel Mitchel responds:

The editorial conveniently forgets to explain, though, how America is
less competitive because of supposedly inadequate taxation. Is it that
our per capita GDP is lower than our higher-taxed neighbors in Europe?
No, America's per capita GDP is considerably higher. Is it that our disposable income is lower? It turns out that Americans enjoy a huge advantage in this measure. Is our economy not keeping pace? Interesting thought, but America's been out-performing Europe for a long time. Could higher rates of unemployment be a sign of American weakness? Nice theory, but the data show better job numbers in the United States.

I also would point out the general direction of net immigration, which has always been towards the US from nearly every country in the world rather than the other direction.

The favorite argument du jour for more taxes is that the US has more income inequality than other countries.  Well, that is sort of true.  Our rich are richer than theirs.  But are our poor poorer?  In fact, as I posted here, the data (from a liberal think tank) shows that they are not.   The poor in European countries have a higher percentage of a lower median wage.  When you normalize European income distribution numbers to percentages of the US median wage, you can see our poor do at least as well as those in Europe, while our middle class and rich do better.

The US poor still trail countries like Switzerland, but that is because of very different immigration realities.  The US numbers for the bottom quartile are weighed down by tens of millions of recent immigrants (both legal and not) whereas those of Switzerland and Norway are not.  If you left out recent immigrants, my guess is that the US poor would be the richest in the world.

Via Arnold Kling, Maggie Mahar writes:

Some citizens of the Commonwealth don't even want to pay for their own
health care insurance. Under the plan, everyone in Massachusetts is
required to buy insurance (or pay a penalty), with the state providing
a 100% subsidy for those who earn less than 150% of the poverty level.
Those receiving the full subsidy are enthusiastic. The state had hoped
to sign up 57,000 uninsured and they've over-shot their target: 76,200
of Massachusetts' poorest citizens have enrolled.

At the other end of the spectrum, the program isn't doing as well.
Uninsured citizens earning more than 300% of the poverty level are
expected to buy their own insurance. Here, the state hoped that 228,000
of its uninsured citizens would sign up. So far, just 15,000 have
enrolled.  Apparently, they've done the math and decided that it would
be cheaper to pay the penalty.  But their premiums are needed to keep
the program going.  If more in this group don't sign up, it is not at
all clear how the state will be  able to continue subsidizing the poor.

All of this adds up to "people without health insurance are so because it is not worth the price."  If they get it free, fine, they will use it like crazy, but they won't pay for it.  So I should for them?

The NY Times outdid itself last week with a truly awful article on dentistry.  They started with just one fact:

Previously unreleased figures from the Centers for Disease Control and Prevention
show that in 2003 and 2004, the most recent years with data available,
27 percent of children and 29 percent of adults had cavities going
untreated. The level of untreated decay was the highest since the late
1980s and significantly higher than that found in a survey from 1999 to
2002.

They then apply the patented NY Times class-based story-generation model to assume a cause for this rise that is not supported by the study itself:

But many poor and lower-middle-class families do not receive adequate
care, in part because most dentists want customers who can pay cash or
have private insurance, and they do not accept Medicaid
patients. As a result, publicly supported dental clinics have
months-long waiting lists even for people who need major surgery for
decayed teeth. At the pediatric clinic managed by the state-supported University of Florida dental school, for example, low-income children must wait six months for surgery.

So is the rise in untreated dental problems concentrated in the poor?  Well, they don't say, and there is not data for that in the study, but that does not prevent the NY Times from just assuming it to be so.  In fact, the article itself contradicts this premise, by noting that the problem is not limited to the poor:

The lack of dental care is not restricted to the poor and their
children, the data shows. Experts on oral health say about 100 million
Americans "” including many adults who work and have incomes well above
the poverty line "” are without access to care.

By the way, how did they figure a 100 million don't have "access"?  I don't know, but the figure is suspiciously close to this one:

With dentists' fees rising far faster than inflation and more than 100 million people lacking dental insurance...

Anyone want to bet that the NY Times just made its usual logical fallacy of equating lack of insurance with lack of access?  And by the way, dental insurance is a HORRIBLE investment.  I have priced it many times myself and for a normal family, it is much cheaper to just pay the dental bills, particularly since there are not that many things in your mouth that can go wrong that will be bankrupting.  Trying to push everyone to dental insurance is a terrible idea.  Every time there is a dental procedure in our family, it turns out there are several options for fixing it at different prices.  We actually have the incentive to ask for these alternatives and make trade offs.  What do you think would happen if we had insurnace?

In fact, I can think of a LOT of reasons why people don't go to the dentist as often as they should.  One reason is that no one like the dentist.  Another is people's busy schedules.  And certainly rising costs are a factor -- As I mentioned before, our family makes very different decisions about treatment options than we used to with a fat corporate dental plan.  Which is as it should be. 

By the way, note the screaming socialism here:

The dental profession's critics "” who include public health experts,
some physicians and even some dental school professors "” say that too
many dentists are focused more on money than medicine.

"Most
dentists consider themselves to be in the business of dentistry rather
than the practice of dentistry," said Dr. David A. Nash, a professor of
pediatric dentistry at the University of Kentucky. "I'm a cynic about my profession, but the data are there. It's embarrassing."

I wonder.  Does Dr. Nash accept a salary for being a professor?  Then I guess he is focused more on the business of education than the practice of educating.

Oh, and by the way, how is socialism in dentistry working out?

In a survey of 5,000 people in the UK, six percent claimed that
they had done DIY dentistry, including yanking their own teeth and
fixing cracked crowns with glue. Apparently they resorted to such self
treatment because they couldn't get in to see a National Health Service
dentist "¦

One respondent in Lancashire, northern England, claimed to
have extracted 14 of their own teeth with a pair of pliers. In
Liverpool, one of those collecting data for the survey interviewed
three people who had pulled out their own teeth in one morning.

"I took most of my teeth out in the shed with pliers. I have one to go," another respondent wrote.

The long drain begins:

When Kathleen Casey-Kirschling signs up for
Social Security benefits Monday, it will represent one small step for
her, one giant leap for her baby boom generation "” and a symbolic jump
toward the retirement system's looming bankruptcy.

Casey-Kirschling "” generally recognized as the
nation's first boomer (born in Philadelphia on Jan. 1, 1946, at
12:00:01 a.m.) "” won't bankrupt the Social Security system by taking
early retirement at 62. But after her, the deluge: 80 million Americans
born from 1946 to 1964 who could qualify for Social Security and
Medicare during the next 22 years.

The first wave of 3.2 million baby boomers turns
62 next year "” 365 an hour. About 49% of the men and 53% of the women
are projected to choose early retirement and begin drawing monthly
Social Security checks representing 75% of the benefit they'd be
entitled to receive if they waited four more years to retire.

If Social Security were a well-managed private insurance program, this would be a non-event.  The returns on investments over the last 40 years have been tremendous, such that a private fund could easily start paying out benefits based on boomers' premiums.

Unfortunately, as a government program, the funds in the program are subject to the whims of politicians.  And it turns out that boomers have elected politicians who have spent all the money that has been contributed to Social Security (despite USA Today in their graphics trying to continue the myth that a meaningful "trust fund" actually exists as anything but a bunch of government IOU's to itself.)  So, because Congress has spent all the past contributions, an action that would have had any private manager jailed decades ago, Social Security must now run itself as a Ponzi scheme, where current contributions pay off retiree benefits.  This game runs out somewhere in the 2020's.  And this all despite the fact that Social Security pays out a negative rate of return.

For years I had some kind of corporate health plan.  When I started my own business, I bought a Blue Cross plan that roughly mirrored the corporate health plan I used to have -- very low deductible, lots of coverage.  And it had very high premiums. 

So I finally got serious and went out and did something 99% of Americans never do or never have to do:  I went out and really researched my health care options.  And what I found was that to raise our family's deductible from $500 a year to $2000 a year would save me over $3000 a year in premiums.  In fact, if I switched plans, I would get just as high of a maximum payout and I would get a better gaurantee on future pricing and a commitment never to drop my coverage from a large, well-rated insurance company.

There's an old joke about an economist and another fellow walking down the street.  There was a $10 bill laying on the ground, but the economist just walked right past it.  The other fellow said "what are you doing, you just passed up $10."  And the economist replied "It can't be a real $10 bill, because in an efficient market someone would have already picked it up."

That was my reaction to my health care options.  I asked my broker, "you mean that if I increase my deductible $1500 I can save $3000 a year?  Even in a worst case year I am better off, and in a healthy year I am MUCH better off."  He replied "Yep."  I asked, "But why doesn't everyone do this?"  He just shrugged.  As my Harvard investment management professor used to say, as he wrote up a market situation on the chalkboard to begin each class, either this is an opportunity, of there is something we don't understand.  As I have gained more experience with my new health plan, I have become convinced it is the former.

McQ over at Q&O has a great post on insurance vs. insulation.  I won't quote it all, but it is well worth your read.  Towards the end, he quotes John Stoessel on my particular conundrum:

But people are so conditioned to expect others to pay their medical
bills that they hate high deductibles: They feel ripped off if they
must pay a thousand dollars before the insurance company starts paying.

But high deductibles may be the key to lowering costs and putting you in charge of your health care.

I am absolutely convinced that the best possible step for US health care is to expose more users to the market and price-value trade offs, while providing high-deductible insurance that shelters people from bankrupting unusual events.  More here, here, and here.

For a while, I have been trying to highlight that the real problem with health care is that consumers who receive the service do not have any incentive to shop for the best price or to make trade offs on marginal procedures based on price.  The only people who have any incentive to shop are 1) people without insurance and 2) people with high deductibles (like me).  Politicians are trying to eliminate the former group, even if they don't want insurance, and programs like Romney's in Massachusetts actually ban high deductible insurance.

Now, Obama is worried about anti-trust:

The consequences of lax enforcement for consumers are clear. Take
health care, for example. There have been over 400 health care mergers
in the last 10 years. The American Medical Association reports that 95%
of insurance markets in the United States are now highly concentrated
and the number of insurers has fallen by just under 20% since 2000.
These changes were supposed to make the industry more efficient, but
instead premiums have skyrocketed, increasing over 87 percent over the
past six years. As president, I will direct my administration to
reinvigorate antitrust enforcement. It will step up review of merger
activity and take effective action to stop or restructure those mergers
that are likely to harm consumer welfare, while quickly clearing those
that do not.

How can these mergers harm consumers when consumers don't shop for the service and don't care about price in the first place?  Candidates like Obama and Clinton are threatening to create single payer systems that use monopsony power combined presumably with the coercive power of government to hammer suppliers.  Is it any wonder that they are joining together to try to gain some sort of bargaining position for themselves?  In the context of what Obama wants to do with health care buying, this can be thought of more as unionizing than merging.

By the way, does anyone else note the irony of Obama, who wants to create a single supplier for health care (the US Government) lamenting concentration in the health care field?

I hire retired couples for the summer to run campgrounds and other recreation facilities.  Since these campgrounds are closed in the winter (most are under 8 feet of snow) I lay most of these folks off in October. 

The vast majority of my employees do not work the winter.  They have other retirement savings that they supplement working for me in the summer and then they take the winter off.   And that would be all of the story, except in  California.  For some reason in California, but not in most other states, all these folks run straight to the unemployment office and file for unemployment over the winter.  For those of you who don't know how unemployment insurance premiums work, the premium I pay as a percentage of wages is based on past claims experience.  In California, I am an "F", the worst category, and have to pay over 6%(!) of wages to unemployment insurance. 

Now in most states, what these employees are doing is illegal.   It is typical of unemployment offices that you have to call in each week and certify that you are looking for work.  If you are not actively looking for work, then you are not eligible, and most states outside CA seem fairly diligent about enforcing the rules.  Last year, not one but two of the people who were claiming unemployment in CA over the winter were in Mexico on the beach the whole time!  I know, because they called me from there to see if they were going to be rehired in the spring.

It was then that I found out why this happens more in CA than in other states.  I called the California state unemployment office and asked them how I could have cases of unemployment fraud (ie claiming unemployment when one is not actually looking for work) investigated.  The person from the state office got very hostile with me.  She said that I was making a very serious charge, and that if I made such a charge, and fraud was not proven, then I could be liable for civil and even criminal penalties for asking for the investigation.  I said forget it, raised prices to customers to cover the extra winter vacation wages I was forced to pay, and moved on.   

I have written on a number of occasions that the real problem in American health care is the insulation between the person who receives the services and the true cost of the services.  Other than a few folks like me with high deductible policies, there is no incentive to shop around and no incentive to eschew certain avoidable and high cost procedures.

Marc Cooper complained that he went to the hospital for a day and it ended up costing the insurance company over $100,000.  His take-away form this is that the government needs to step in.  My take-away was different:

Did he ask for a price estimate in advance? Did he ask, as most of
us do with all of our large purchases, for a written estimate or
quotation? Did he get such estimates from two or three competitors? Did
he shop around?

Of course not! Because in a system where someone else is paying the
bills, we have no incentive to shop around. So providers have no
incentive to compete on price or to worry about productivity and cost
control.

Sure, this looks like a rip-off.  But if you went in to buy a car,
concerned only with the quality of the
car, and never asked the price and then got a bill for $100,000 a few
weeks later, would you be surprised?  Would anyone give you sympathy if
you complained you paid $100,000 for the car but admitted you never
asked what the price was?

So I was very pleased to see this from John Stossel:

America's health-care problem is not that some people lack insurance, it is that 250 million Americans do have it.

You have to understand something right from the start. We Americans
got hooked on health insurance because the government did the insurance
companies a favor during World War II. Wartime wage controls prohibited
cash raises, so employers started giving noncash benefits like health
insurance to attract workers. The tax code helped this along by
treating employer-based health insurance more favorably than coverage
you buy yourself. And state governments have made things worse by
mandating coverage many people would never buy for themselves.

Competition also pushed companies to offer ever-more attractive
policies, such as first-dollar coverage for routine ailments like ear
infections and colds, and coverage for things that are not even
illnesses, like pregnancy. We came to expect insurance to cover
everything.

He concludes:

Imagine if your car
insurance covered oil changes and gasoline. You wouldn't care how much
gas you used, and you wouldn't care what it cost. Mechanics would sell
you $100 oil changes. Prices would skyrocket.

That's how it works in health care. Patients don't ask how much a
test or treatment will cost. They ask if their insurance covers it.
They don't compare prices from different doctors and hospitals. (Prices
do vary.) Why should they? They're not paying. (Although they do in
hidden, indirect ways.)

From Kevin Drum:

Marc Cooper spends 20 hours in the hospital and tells his story here.  Price of stay without insurance: $116, 749.  Price with insurance: $4,730.  Only in America, folks.

He's not very clear if this was an emergency situation -- like, did he have a heart attack and get rushed to the hospital in an ambulance -- or an important but non-emergency situation.  I will assume the latter by the tone of Marc Cooper's detailed post.

If so, then my first comment is, indeed only in America would he have gotten this procedure without waiting twelve weeks or without traveling to, say, America to get it done more expeditiously,

Second, I wonder:  Did he ask for a price estimate in advance? Did he ask, as most of
us do with all of our large purchases, for a written estimate or
quotation? Did he get such estimates from two or three competitors? Did
he shop around?

Of course not! Because in a system where someone else is paying the
bills, we have no incentive to shop around. So providers have no
incentive to compete on price or to worry about productivity and cost
control.

Sure, this looks like a rip-off.  But if you went in to buy a car, concerned only with the quality of the
car, and never asked the price and then got a bill for $100,000 a few
weeks later, would you be surprised?  Would anyone give you sympathy if you complained you paid $100,000 for the car but admitted you never asked what the price was?

So this is a dead-obvious outcome from the health care system we
have, where no one has the incentive to shop. By the way, I have a high-deductible policy which causes me to
shop around, because costs come out of my own pocket. I ask questions
like, is that extra CT scan really necessary?

It's incredible to me that given this situation, the solution for
this blog's author and most of his readers is not "we should find a way
to have individuals experience both the cost and benefits of care,
because only they can make these tradeoffs for themselves and shop
around for better options" but is instead "lets just turn it over to
the government, since they do such a good job with Iraq and the mail
and our schools."

Finally, I would point out that the author is making some wild assumptions about an insurance statement he probably does not understand (I say that with confidence since no one understands health insurance statements).  His assumption that the walk-in poor would have had to pay $100,000 for the procedure or would have been left to die are demonstrably untrue, since there is just not that much evidence that either outcome is occuring with any regularity.  That is why health care socialization supporters always talk about the number of people uninsured, which is almost irrelevant, instead of the number of people who don't get care, which is a much much smaller, almost vanishingly small number.

Reader Robert Hammond, who always sends me good stuff, pointed out this article from the Evening Standard about proposed new health care rules in England.  Frequent readers will know that I have long argued that nationalized or single-payer health care is a Trojan Horse for fascism (and much more here) in the form of micro-management of individual decisions.  If your personal choices that in the past only put yourself at risk now cost other taxpayers money, then those other taxpayers are going to try to redirect your choices.

Failing to follow a healthy lifestyle could lead to free NHS treatment being denied under the Tory plans. 

Patients would be handed "NHS Health Miles Cards" allowing them to earn
reward points for losing weight, giving up smoking, receiving
immunisations or attending regular health screenings.

Like a
supermarket loyalty card, the points could be redeemed as discounts on
gym membership and fresh fruit and vegetables, or even give priority
for other public services - such as jumping the queue for council
housing.

But heavy smokers, the obese and binge drinkers who
were a drain on the NHS could be denied some routine treatments such as
hip replacements until they cleaned up their act.

Those who
abused the system - by calling an ambulance when a trip to the GP would
be sufficient, or telephoning out of hours with needless queries -
could also be penalised.

The report calls for a greater
emphasis on the "citizen's responsibility" to be healthy and says no
one should expect taxpayers to fund their unhealthy lifestyles.

Here is the real problem:  This is absolutely logical.  There is nothing at all incorrect about the last statement for example.  This is not an abuse or an excess.  This is a completely predictable result of single-payer health care.  Any single-payer is going to have these incentives, but when the single-payer is the government, they not only have the incentives but the full coercive power to do something about it.  I am exhausted with the statist defense against such outcomes that "well, its just the particular individuals in charge -- if we could get the right guys in there, it would work great."  No.  The right guys are never in there, despite technocrats' big dreams, in part because the incentives in place turn even the right guys into the wrong guys. 

One of the reasons we spend so much on health care today is because most of us can do so without any personal financial cost.  Few of us (I am an exception, with a very high deductible policy) actually have to make cost-benefit trade offs in each of our health care purchases like we do in contrast for ... absolutely everything else we buy except health care.   The results are predictable.  We get pissed off when our insurance company denies coverage on some procedure or cost, we is part of the base-level of discontent that health care "reformers" draw on.  But it is stunning to me that people who have discontent with their current insurer feel like things will be better with the government!

Hey, this sounds like a women's issue!

What this article really shows is that by going with a single-payer government system, each of us would be ceding the decisions about our health care, our bodies, and even lifestyle to the government.  So surely women's groups, who were at the forefront of fighting against government intrusion into our decisions about our bodies, is out there leading the fight against government health care.  WRONG!  Their privacy arguments stand out today as sham libertarian arguments that applied only narrowly to abortion.  It's clear that as long as they can get full access to abortion, women's groups are A-OK with government intrusion into people's decisions about their bodies.

So please, dedicated feminists are urged to comment.  How do I relate this T-shirt from the NOW web store:

With this button from the NOW home page:

And a bit of text from their site:

People need and deserve universal, continuous,
and accessible health coverage that is provided by a single payer and
does not require full-time employment and a beneficent employer.
Learn more with our action toolkit....

With the recent release of Michael Moore's new movie, "SiCKO", and the
introduction in Congress of a bill to provide health insurance to all
U.S. residents, the movement for universal single-payer health
insurance is gaining momentum. This toolkit is provided to help you
take action on this important issue....

Health care is a right, not a privilege.

Apparently, we taxpayers gaurantee $645 billion in flood insurance so wealthy folks can build second homes on the beech, and have them wash away every few years at taxpayer expense.  USAToday, breaking from general habit, actually criticized a government giveaway in this article.  But I think that the John Stossel article linked by Q&O is better  (Memo to ABC web guys -- your articles stay online for years so it might be nice to add a year to that date in the byline).  Stossel points out that the tab for flood insurance understates the beachfront subsidy:  Costs for FEMA, disaster relief, Corps of Engineers projects, beech erosion abatement, etc. all are also government subsidies for living in dangerous locations.

But the outrage is that federal flood insurance exists at all. There is
a quarter-million-dollar limit on each payment, and as long as I build
my house in accordance with zoning laws and ordinances, there is no
limit on how many times the government will pay if a house keeps
washing away

From the USA Today:

In working-class areas here, homes for sale
have begun to move briskly. But in the ritzy Uptown district and other
well-to-do neighborhoods, the picture is bleaker. "New Price" and
"Reduced" signs adjoin grand Victorian homes "” symbols of a struggling
upscale housing market.

They're the lingering effects of Hurricane
Katrina. In coastal Louisiana and Mississippi, a glut of higher-end
homes points to soaring property insurance costs that are pricing many
people out of the market. It also speaks to the legions of doctors and
other professionals who have left the area and have yet to return. The
price of their exodus could be severe: Economic development experts
warn that if these professionals stay away en masse, it could cripple
the region's recovery.

For anyone with a stake in the region's recovery, the loss of
higher-income residents "” and their job skills "” is alarming. The
problem is compounded by the shortage of upper-income buyers willing to
put down stakes to replace those who have left.

So what is the problem?  I thought this would make New Orleans a progressive paradise.  No rich to get richer and create envy in the working classes.  No issues with income distribution.  Just a worker's paradise with no capitalist oppressors.  Huge portions of the populations dependent on the government and refusing to rebuild until they get government handouts to do so.  This sounds like everything Progressives are working for.  But...

Doctors, bankers and other professionals are "the backbone of the
community," says William H. Frey, a demographer at the Brookings
Institution, a Washington think tank. "They're the people who will help
the tax base. If they leave, they are going to be very hard to replace."

Oh, I see.  We don't really want them around, but we need milch cows we can tax so we can have handouts for everyone else.  It must be a hard tightrope for progressives to walk -- they hate rich people but need them to pay for their schemes.

Michael Canon has proposed for principles of an anti-universal health care coverage club:

1. Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
2. To
   achieve "universal coverage" would require either having the government
   provide health insurance to everyone or forcing everyone to buy it.  Government provision is undesirable, because government does a poor job of improving quality or efficiency.  Forcing
   people to get insurance would lead to a worse health-care system for
   everyone, because it would necessitate so much more government
   intervention.
3. In a free country, people should have the right to refuse health insurance.
4. If governments must subsidize those who cannot afford medical care,
   they should be free to experiment with different types of subsidies
   (cash, vouchers, insurance, public clinics & hospitals,
   uncompensated care payments, etc.) and tax exemptions, rather than be
   forced by a policy of "universal coverage" to subsidize people via
   "insurance."

You know I'm in;  after all, I am the one that has said that "universal coverage is as if, in the Great Society public housing programs, everyone in the country, not just the poor, had been required to tear down their current houses and enter monolithic public housing structures."

However, I would have added a fifth principle:  Health care decision-making and tradeoffs amongst cost, quality, and
content of care should belong to the individual, except when an
individual delegates this decision in some way by his own choice (say
by joining a very structured HMO program).

I wrote about the joys of actually shopping for health care under a high-deductible policy here and here.  Michael Canon also has a new post on shopping and HSA's here.

Michael Canon has proposed for principles of an anti-universal health care coverage club:

1. Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
2. To
   achieve "universal coverage" would require either having the government
   provide health insurance to everyone or forcing everyone to buy it.  Government provision is undesirable, because government does a poor job of improving quality or efficiency.  Forcing
   people to get insurance would lead to a worse health-care system for
   everyone, because it would necessitate so much more government
   intervention.
3. In a free country, people should have the right to refuse health insurance.
4. If governments must subsidize those who cannot afford medical care,
   they should be free to experiment with different types of subsidies
   (cash, vouchers, insurance, public clinics & hospitals,
   uncompensated care payments, etc.) and tax exemptions, rather than be
   forced by a policy of "universal coverage" to subsidize people via
   "insurance."

You know I'm in;  after all, I am the one that has said that "universal coverage is as if, in the Great Society public housing programs, everyone in the country, not just the poor, had been required to tear down their current houses and enter monolithic public housing structures."

However, I would have added a fifth principle:  Health care decision-making and tradeoffs amongst cost, quality, and
content of care should belong to the individual, except when an
individual delegates this decision in some way by his own choice (say
by joining a very structured HMO program).

I wrote about the joys of actually shopping for health care under a high-deductible policy here and here.  Michael Canon also has a new post on shopping and HSA's here.

The USAToday published a front-page story today arguing that a health care "crisis" looks a lot like Houston, Texas.  I would argue, from their descriptions, that a health care "crisis" looks exactly like state-run medicine.

Ijeoma Onye awoke one day last month short of
breath, her head pounding. Her daughter, Ebere Hawkins, drove her 45
minutes from Katy, Texas, to Ben Taub General Hospital, where people
without health insurance pay little or nothing for treatment.

Onye, 62, waited four hours to be seen. Still,
going to the emergency room was faster than getting an appointment. For
that, "you have to wait months," Hawkins says....

The huge number of uninsured residents here means that health officials
must make tough decisions every day about who gets treated and when.
"Does this mean rationing? You bet it does," says Kenneth Mattox, chief
of staff at Ben Taub, the Houston area's pre-eminent trauma care
facility.

The article goes on and on like this.  The problem is delays and queuing in facilities that provide free care.   And the difference between this and state-run health care is what exactly?  When a product or service is free, people will tend to over-consume the supply, with rationing taking place via queuing rather than price.  This is how every state-run supply system works, from food in the Soviet Union to health care in Canada.  And by the way, exactly how upset should I be about people receiving an extraordinarily valuable and costly service for free but having to wait a while to get it?

This article is actually a great rebuttal of the inherent message in
the health care debate that "uninsured" means "denied health care."  In
fact, it is clear that even in the spot USAToday picked out as the worst in
the country, the uninsured are in fact getting health care.  It is tedious with long waits, but there are no examples in the long article of people going without.  Yes some people consume less than they might if it was free and convenient, but that is just the rationing at work.  Anyone who says that rationing goes away in a state-run system is bald-faced lying to you.

Remember that national health care does not eliminate queuing and waits for the poor -- it just institutionalizes these waits for the rest of us.   Universal Health Care is equivalent to a Great Society housing program where everyone, rich and poor, have to give up their house and move into a crappy public apartment block.

Postscript: By the way, I am sympathetic to certain hospital administrators who have a "crisis" on their hands because the mass of uninsured show up in their emergency rooms.  That, however, is a problem manageable far short of government-run health care.  They want to blame diversions of critical patients away from over-crowded emergency rooms on the "uninsured" but it is really a function of their own faulty triage.

Update: Michael Moore will soon argue that its better in Cuba.  Hah! That is funny.  If people really want to believe this, then it is another reason is is way past time to open up our relations to Cuba, so people can see for themselves what a lying sack of poop this filmmaker is.

While it may have been unintentional, a quote in New York magazine helps make the point I have been trying to make about universal health care (HT: John Scalzi)

"With universal [health care], you'd get the same kind of
mediocre shittiness that you'd get in all other kinds of standardized
approaches. But for millions of people, that would be a big upgrade."

Americans are unbelievably charitable people, to the extent that they will put up with a lot of taxation and even losses of freedoms through government coercion to help people out.

However, in nearly every other case of government-coerced charity, the main effect is "just" an increase in taxes.  Lyndon Johnson wants to embark on a futile attempt to try to provide public housing to the poor?  Our taxes go up, a lot of really bad housing is built, but at least my housing did not get any worse.  Ditto food programs -- the poor might get some moldy cheese from a warehouse, but my food did not get worse.  Ditto welfare.  Ditto social security, unemployment insurance,and work programs. 

But health care is different.  The author above is probably correct that some crappy level of terribly run state health care will probably be an improvement for some of the poor.  But what is different about many of the health care proposals on the table is that everyone, not just the poor will get this same crappy level of treatment.  It would be like a public housing program where everyone's house is torn down and every single person must move into public housing.  That is universal state-run health care.  Ten percent of America gets pulled up, 90% of America gets pulled down, possibly way down. 

I don't think most Americans really know what they are signing up for.  Which is why it is so important for health care socialists to have people like Michael Moore running around trying to convince the middle class they will be getting better health care.  Because there is almost no possibility of this being true, and health care proposals will never pass if people realize it.

More here.