Gail Wilensky, medicare bureacrat who moved to an NGO: Tax more expensive health insurance more and give the secretary of Health and Human Services lots more power over everything.
Yep, Congress is too busy to make the important, hard decisions that the policy elite want to happen, so it's best to outsource it all to the "experts" in the executive. Better deniability for lousy decisions all around.
Joseph Antos, think tank academic: Fix the employer tax break, competition in state markets, give pricing information to patients, make Medicare compete with Medicare Advantage.
And here's our first set of proposals that would actually lower costs while improving things. The solutions are of the "tweak the existing system" mentality, but at least they are steps in the right direction.
Daniel Callahan, think tank guy: Medicare rationing and price controls on health insurance.
At least he comes right out in favor of legally limiting how much health care people get! I'm not sure that's going to be too popular. It's definitely not necessary for bureacrats to tell people how much they need. And of course, price controls always result in shortages anyway.
Leslie Greenwald, think tank academic: Setup rationing by the elite based on "evidence".
Some how I don't think she gets who should be making the decisions about how much health care people should consume...
Arnold Kling, economist: Use vouchers to move from third-party payers to patients as consumers.
Our second idea that would actually accomplish something positive. Not sure it's totally workable, but it's for sure a big improvement on the current system!
My answer to the same question is totally unrealistic in the current political environment, but just for the record:
Increase supply of medical care by removing legal obstacles. That means removing licensing restrictions (especially for Health care professionals trained in other countries) and removing AMA (Doctor's union) restrictions on the number of new health care workers trained every year. It also means severely limiting the FDA's ability to stop drugs from being produced. At most, they should evaluate and report on, rather then control the legality of drugs. That way Doctors and their patients could choose what risks to take based on their best information available.
Add more competition to the system by overriding state insurance regulators with a federal mandate that allows interstate commerce in insurance policies. Either end tax breaks for employer-provided plans or make sure that they are matched exactly by breaks for non-employer-provided plans. Prevent any regulators anywhere from regulating what is offered at what price in health insurance plans. Innovation in insurance service doesn't start in state health insurance regulation committees!
Allow prices to reflect demand as much as possible by providing methods for price transparency in service as well as allowing insurance as insurance instead of pay-for-service plans. Most of that would be taken care of by removing regulatory obstacles as above.
Health care is a solvable problem, but it's unlikely to be solved when most of the proposals to do so just provide more of the same ideas that created the problems in the first place.
When people in this country consume more books than people in another country, we don't lament that U.S. "book costs" are much higher than average and that "something must be done!" Some of this issue results from government distortions of the market for health care at State and Federal levels, but a lot of this issue is also a misunderstang of what's going on.
I'm currently reading Tyler Cowen's 1998 book "In Praise of Commercial Culture". Cowen is better known as an economist writing over at Marginal Revolution. I'm also re-reading his 2007 book "Discover Your Inner Economist" at the same time. Maybe it's just the different target audiences, but I suspect Tyler would be the first to admit that his book writing style has gotten a lot better in the intervening 9 years.
In the process of explaining the influence of capitalism and wealth on art, he mentions a lot of artists in passing. Most I knew about, but many I hadn't. In 1998 Cowen couldn't have anticipated the process I've been going through while reading these books. I've actually been able to look up and sample the work of artists, from painters to rock bands, on the internet and get a taste of their work immediately and for free. That process, aided by things like wikipedia, Amazon's mp3 store (with it's music previews), plus tons of full-length videos with audio on youtube, is an amazing example of what in the book is a cultural optimism that allows for modern and historical art catering to all sorts of niche markets to be so much more accessible now than it ever has been in the past.
One of the facts referenced in the book is that Charles Perrault wrote "Mother Goose" in a deliberate attempt to match Aesop's Fables. I anticipate that my wife, currently teaching classic fables to the kids, will find that interesting. There's tons of similar tidbits in it.
Cowen talks about how because it was a big budget movie and thus had to appeal to a larger audience, the studio forced a happy ending on Blade Runner, but that when the movie was reissued in a Director's cut the original ending could be restored. I know that now it sounds amazing, but in 1998 DVDs weren't in commercial use. Laser Disc was supposed to be the next big thing. Ten years later, we'd fully expect that if the Director preferred a different cut to his movie, we'd get both versions plus a couple of voice-over explanations all on the same DVD and they'd throw in the deleted scenes and alternate endings!
I'm also picking up music tips from the "Possess All the Great Art Ever Made" chapter of his more recent book. He talks about how music tastes changes as individual identities change from different time periods and geographical regions and suggests trying out the best artists of all sorts of different types.
Tonight I've found lots to like. I also just figured out that youtube has tons of music in the form of videos... I know, slow to catch on, that's me.
Sometimes the familiar can be new again when seen through a different style of music. Also search for gamelan on youtube for some cool south-east asian hits.
Those guys are entertainers! Of course, it stands to reason that with literally billions of people to choose from, there are going to be a lot of great musicians (and other professions) available in the area.
A little closer to home, sometimes you just need to shake your head and tap your toes.
How could anyone not like that, whoever they are, unless they'd never heard it?
Jim Towey, founder of Aging with Dignity, brings up an interesting point in the Wall Street Journal. Health care reform advocates like to point to the VA as an example of an existing system similar to the proposed public option, but the VA has their own version of the "Death Panels" idea, a planning document called "Your Life, Your Choices".
Apparently the VA has found it necessary to do a little subtle cost controlling by influencing veterans towards a "life is not worth living" and "don't be a burden" mentality.
A large portion of the document consists of describing various horrible health situations in detail, then asking the veteran if in that situation, would life be difficult, just barely worth living, or not worth living. After that cheery thought, they list possible treatments and are asked to check a box if they'd rather die naturally or receive each treatment. The only treatment that is pre-checked for all the questions is "Comfort care', meaning painkillers and cleanings.
That isn't the only way to present this information and get people thinking about their options and wishes. Compare "Five Wishes". It's shorter, more focused, and much more positive.
So why has the VA chosen to use one over the other? After all, under the Bush administration the VA stopped using "Your Life, Your Choices" because of some of these very issues. The Obama administration started using it again.
It would be interesting to hear the discussion that led to that decision. Did it include a discussion of steering veterans away from expensive life-preserving treatments in favor of a "natural death" and how much money the VA could save as a result?
We don't need government health care providers trying to convince veterans that life may not be worth living.
We certainly don't need new government health care providers.
What we need is more freedom for individuals to contract for their own care and options. The progressives need to stop using regulations to stop people who want to do something different than the "experts" have decided is best for them. That's one of the problems with political solutions to economic problems. One size must fit all.
Most email users are familiar with the 419 scams they get with their morning spam, typically variations on the advance fee fraud.
There is an unusual charitable organization dedicated to fighting these scammers by wasting their time. The tactic is called scambaiting.
It's not an organization in the sense of being an IRS non-profit, but it has evolved into a society that provides assistance and advice to it's members, has rules about recognition, awards, and a code of conduct.
The membership has used an incredible range of creative tactics to focus the attention of the scammers on themselves instead of on the gullible. Go read their forums for an hour or two and laugh at the delays that poor english and desperate scammers can lead to. Everything from responding to scams as a dead person who just needs the scammer to contact their estate lawyer in order to get their payment processed, to pretending to be a rival scamming gang that is impressed with their work, has stolen the scammer's customers, and wants to hire them to work full-time for a percentage of the take. Many times the scam baiters will convince the scammers to send photographs, or even film a Monty Python sketch!
You might think that the amount of time that scammers waste dealing with this group is trivial. In contrast, you may notice that there are awards for how far you can get a scammer to travel while trying to close a deal. Bonus points depending on how many national borders they cross in the process.
Why do they do it?
"It has been estimated that there are well over 250,000 scammers involved in 419 scams worldwide and that they reap in over US$1.5 billion annually. The average victim pays out US$20,000."
The members spend some time helping victims of the scammers directly, but they are also into prevention. The time and resources a scammer spends with an experienced baiter is time the scammer can't spend on creating a real victim. They also turn bank account and other scammer details over to the proper authorities in order to get them closed down.
Scambaiting is charitable activity to benefit some of the least able to protect themselves on the internet, the gullible and soft-hearted. It's not just financial scams. Some victims are lured in by the idea that they are going to be adopting needy children, or a million other excuses.
It's a fun game for the baiters that they can play in their spare time on the internet. Setup a free email account, publish your new email address so that you get plenty of spam, then adopt the persona of a someone who wants to know more. The rest falls into place quickly.
It's also a modern economic war of attrition, waged across the internet. Regular police agencies like the FBI or Interpol don't spend the time and resources that would be necessary to investigate all the reports of 419 scammers that come flooding in. When the scammers are sending millions of emails a day to try and lure in a victim, the police are unable to investigate them all.
Just like if a burgler shoots you in your home, by the time the police investigate, it's too late for the victims. In scammer cases it's even worse. All they can do is take a report and maybe see if a scammer ever visits the victim's country to be arrested.
That means the scammers have a key advantage over the police. They have the numbers and the inexpensive labor (as well as labor-saving computers) to overwhelm the current police response. There are more of them then there are of the police.
Hence the need for volunteer help. The volunteers aren't vigilantes. They don't go out and arrest scammers, and there is a strong ethic against doing anything illegal while baiting them.
What they do is become unpaid police informants in the one job that really can be done anonymously over the internet. They spend their free time and leverage it against the scammers in the same way the scammers are able to leverage their time against the police. That turns the economics of the situation back around, slowly making the cost of being a scammer higher and higher.
Something not addressed is that unemployment insurance has a superior substitute good.
To understand what a substitute good is, you might consider that attendance at plays goes up when movie prices go up, or sales of margarine go up when butter is less expensive, or cheaper cell phones lead to a drop in people purchasing plain old telephone service.
A substitute good for unemployment insurance is "safe" investments. It would be difficult to pay someone else enough to support you AND monitor that you lost your job and can't get another one through no desire of your own (the inherent moral hazard) and have them be able to pay you more in benefits than if you took your unemployment insurance premiums and simply invested them safely.
Essentially, you are self-insuring. You are the most efficient at that, because no moral hazard exists when you have perfect information on your own motivations and desires.
The next best option is a mutual assistance society that is run by people who know the members and can decided on benefits. That means there isn't a faceless bureaucrat deciding if someone deserves benefits, but rather someone in a much better position to determine exactly what is really needed and exactly how much work the someone is able to do in return for their benefits.
There are still some mutual assistance societies, but many of them vanished when the government "took over" their market and drove them out by using mandatory taxes and deficit spending to under price them. The ones that remain tend to have another primary function.
For example, the LDS church (among many other things) functions as a private welfare society. In their example, they reduce the inherent moral hazard in the situation by having those seeking welfare interviewed by the volunteer leader of their local congregation to determine exactly what help they need, but more importantly what they REALLY need (not money to eat out, or to live in a mansion), and what they themselves can contribute. It's not unusual for an LDS member on welfare to clean up the church grounds or work at a welfare farm if they are able to while seeking new employment, while someone sick may not be asked to do anything at all.
That sort of differentiation and local personalization is what a federal government program is unable to match.
Apparently the VA has found it necessary to do a little subtle cost controlling by influencing veterans towards a "life is not worth living" and "don't be a burden" mentality.
To understand what a substitute good is, you might consider that attendance at plays goes up when movie prices go up, or sales of margarine go up when butter is less expensive, or cheaper cell phones lead to a drop in people purchasing plain old telephone service.