What You May Not Know About Your Health Insurance
A guest post by Icepick
Recently I heard President Obama once again claim that his health care/health insurance reform is needed to stop the growing costs of health insurance. He has repeatedly implied that health insurance costs are rising mostly because health insurance companies are raising rates to increase their profits. This is ill-informed at best. Health insurance costs are rising because health CARE costs are rising.
I know this because of personal experience. I used to have the fancy title of Senior Benefits Planning Analyst at a Fortune 100 company. I did the financial modeling of that company’s employee benefits costs for ~54,000 full-time employees, including the medical costs. Our department did a lot of research into the costs of health care, in part so that we could make decent forecasts, and also so we could give corporate leadership recommendations on how much we should charge for medical coverage. That’s right, the company set insurance rates (sometimes after collective bargaining, sometimes not), not some evil insurance company. That’s because the company was self-insured.
Something that the President never mentions is that most large companies self-insure their medical plans – they pay most or all of the medical expenses of their covered employees and families themselves. Let me explain it another way. If a company purchases insurance for an employee, the company only pays for the insurance which is typically a fixed cost. If that employee’s medical expenses are less than the insurance, the company loses money on that employee’s insurance. In a self-insured plan, the company pays those medical costs itself. Once a certain threshold in size is passed a company often finds it less expensive to self-insure.
Most people working for a self-insured company won’t know that the company has self-insured. Usually a company will hire an insurance company to handle the actual claims. Companies do this for several reasons. First, privacy concerns and HIPAA law mean that a company does not want direct access to its employees medical information. Second, most companies do not have the expertise to handle insurance claims. Third, insurance companies typically have more power to negotiate favorable rates with local providers. So a self-insured company will pay an insurance company to handle the administrative side of things, while the company pays for the actual medical expenses.
When I worked for such a company, we analyzed our medical and insurance costs in excruciating detail. And you know what? Our medical costs were increasing at roughly 9% a year for at least a decade. And the insurance company costs had little to do with it. Our costs were going up at that huge rate because medical expenses were going up that fast.
So all the talk of insurance companies fleecing the public is at best a side issue – insurance costs have increased in recent decades because medical expenses have increased. The current bill, which will no doubt be passed this weekend, does nothing to truly address that issue.
Ambiance 
Icepick said,
March 20, 2010 at 7:51 pm
A brief discussion of the difference between companies self-insuring and purchasing actual insurance pops up in the comments here. Incentives, law and expected outcomes all make a difference.
incidentally, in the almost five years I was professionally involved in this topic I never heard any concensus as to what the fix to America’s health care issues should be.
Icepick said,
March 20, 2010 at 10:22 pm
And a bill that truly addressed the issue of rising medical costs would receive what kind of reaction?
This implies that we should commit to any stupid act proposed. After all, we have to do SOMETHING (think of the children!), and someone will complain no matter what is proposed.
The country is poorly governed. I don’t see where calling for more poor governance improves the situation.
Peter Hoh said,
March 20, 2010 at 10:04 pm
And a bill that truly addressed the issue of rising medical costs would receive what kind of reaction?
Were one party to propose such a bill, members of the other party would attempt to use it to their advantage, demonizing the proposal as rationing, at the very least.
amba12 said,
March 20, 2010 at 10:13 pm
Since I read that New Yorker article you linked to, restraining costs doesn’t seem so impossible, and doesn’t seem to require rationing. It seems to require intelligent rather than stupid use of existing resources; collaboration and thinking. The only thing that would be rationed according to the prescription implied by that article would be the amount of profit doctor-entrepreneurs could make by referring patients to imaging centers and testing labs THEY owned. I suppose that would be read as anticapitalist.
Michael Reynolds said,
March 20, 2010 at 10:16 pm
Insurance companies have little motivation to push back against health costs. Whatever the cost they pass it along to policyholders plus a certain amount for profit.
They increase their profit not by pushing doctors or hospitals or drug companies to pay less, but by cherry-picking healthy people and cutting off sick people. That last part is an essentially criminal act. Fraud. They take money for a service they have no intention of providing.
Insurance reform denies them those two options. So they’ll look for profits either by raising premiums or by pushing back against health providers. With more government involvement it becomes harder for them to simply raise premiums indefinitely. Government regulation offers at least a minimal sort of brake — particularly since the government will be subsidizing many policies.
Which leaves insurers pushing back against hospitals and doctors.
(All the above with the following caveat: I gave up trying to follow the details of the legislation around version 800. So god only knows what’s in this bill, or whether what’s in it tomorrow will still be in it a week from now.)
Will any of that work? Who the hell knows. I would have supported single payer. But we got a camel — a horse designed by a committee.
On the optimistic side it’s always good to remember that we’ve generally had stupid, botched, half-assed, inexplicable legislation and here we are still, after better than two centuries.
amba12 said,
March 20, 2010 at 10:31 pm
Michael expresses that sort of weary disgust that everyone on all sides feels about the process that produced this product.
Icepick said,
March 20, 2010 at 10:47 pm
They increase their profit not by pushing doctors or hospitals or drug companies to pay less, but by cherry-picking healthy people and cutting off sick people.
They don’t want want the doctors and hospitals to pay less? Who are they paying, the patients? Or do you mean pressuring them to CHARGE less.
If you mean what you wrote you are making no sense. If you mean the second thing, then you don’t know what you are talking about. One reason for a self-insured company to use an insurance company is precisely because such insurance companies use their heft to force local hospital systems to charge less than they would have otherwise. The insurance companies basically say to them, “If you don’t play ball and lower your prices, we won’t send our patients to your hospitals.” That is EXACTLY what happens. It’s also what Medicare does. (Medicaid as well, if I understand correctly. Medicaid really pushes low prices, though, which is why so many medical service providers simply won’t take Medicaid patients. Need I point out that the government wants to expand Medicaid coverage without improving the benefit? The result is predictable.)
As for cherry-picking customers – how do drug companies make a profit by only dealing with healthy people who don’t need medication?
The comment about insurance doing the same thing completely misses the point about what I wrote. Self-insured employers pay the bulk of medical expenses for their employees (contributions, deductibles co-apys and the like pay the rest) and other covered heads. Denial of service to those people generally isn’t done. The time to do that would be at the hiring stage, and you will note that just doesn’t happen much. It especially doesn’t happen for denial of spouses and children – the legal risks are too great. (You can make an HR person’s asshole pucker up good and tight by saying the words “HIPAA violation.”)
Your comment about indefinite raising of premiums also ignores what I wrote. Insurance costs are going up because medical costs are going up. You also fail to mention that the government has at least some conception that the insurance companies can’t insure every sick person without getting more cash – that’s the whole point of mandating that even the healthy people take out coverage.
When the insurance companies get stuck with only sick people, of course the rates have to go up. That’s part of what’s happening now – as times are tight more people are dropping their insurance coverage if they think they can. Those keeping the coverage are those who are sick and know they really need it. Thus bad times are pushing premiums even higher.
More service demands more money. That’s simple enough that even Congressmen and the President understand it, even though they rarely and only grudgingly admit it in their rhetoric. I have no idea why you can’t grasp that if the retards in elected office get it.
Icepick said,
March 20, 2010 at 10:54 pm
But we got a camel — a horse designed by a committee.
Camels are wonderfully well-adapted creatures. I would call the “horse by committee” comment trite is I suffered from an excess of politeness. I don’t have that particular character flaw. My conversational character flaw is bluntness, so I will call it what it is -stupidity. If made by an educated person, it should be called willful stupidity.
amba12 said,
March 20, 2010 at 10:56 pm
Accepting someone’s premiums and then denying them coverage WHEN they get sick IS, however, fraud.
Icepick said,
March 20, 2010 at 11:03 pm
On the optimistic side it’s always good to remember that we’ve generally had stupid, botched, half-assed, inexplicable legislation and here we are still, after better than two centuries.
This is the most wrong-headed idea in your whole comment, Michael. It was easy to survive stupid federal laws and policies when the federal government was small and ineffective, as it was designed to be. Even at that the whole thing almost ended in disaster on a few occasions, most notably the Civil War.
Now the government itself comprises a huge part of the economy directly, and has heavy direct influence on the rest of it.
To speak in terms of analogy, just because we survived putting a small calibre weapon to our temple and pulling the trigger in the past doesn’t mean we can survive having a howitzer set off in the same vicinity now.
Peter Hoh said,
March 20, 2010 at 11:06 pm
Icepick, I am not pivoting from my point to make the case that the current proposal should be passed. I am simply pointing out that in our current political system, a decent proposal that would address rising costs will be demonized as rationing by opportunistic members of the other party and the chattering class. Or, as Amba suggests out, it will be demonized as being anti-capitalist.
In other words, we’re screwed. Our political system is incapable of doing that which everyone knows needs to be done. (I.e. something to rein in costs — again, I’m not using that observation to press for any specific policy.)
Johnny Isakson had a reasonable proposal in an earlier version of the Senate bill. But his proposal for reimbursing doctors for their participation in voluntary, patient-directed end-of-life planning. This is something that, when done at a hospital system in Wisconsin, resulted in significant cost reductions. Not by killing off granny, but by letting granny spell out what sort of procedures she did or did not want performed as her health declined. Gingrich spoke highly of this Wisconsin plan and suggested that it should be a national model for Medicare. But when Palin unleashed the “death panels” rhetoric, Gingrich joined the chorus of those who were critical of the very thing he had previously championed.
amba12 said,
March 20, 2010 at 11:12 pm
I’ve gotten on an e-mail list for spouse-caregivers of people with Lewy body dementia (what J has). One of the shockers is that when one of these really terminally demented people goes into the hospital for any reason the doctors will perform things like PSA tests.
Peter Hoh said,
March 20, 2010 at 11:15 pm
Oops. Frankenstein sentence in that last paragraph above. I started the sentence going in one direction, but as I wrote, I felt I needed to give more background.
And then I didn’t re-read.
Icepick said,
March 20, 2010 at 11:27 pm
Accepting someone’s premiums and then denying them coverage WHEN they get sick IS, however, fraud.
Agreed. AS does damn near everyone else, which is why the President made a point of emphasising that today. It’s roughly equivalent of being in favor of Mom and apple pie.
The flip side is that it’s fraudulent for a healthy person to not buy insurance until after they require serious medical attention. Again, even the government recognizes this, thus they mandate that people buy coverage or else pay a penalty. However the penalty is so small compared to the cost of the coverage that it’s completely useless as a deterent.
The result is predictable – people will have no reason to buy insurance until they incure massive amounts of medical expenses. At that point they will buy insurance, which the insurance companies cannot refuse them. If this passes one will have to be either stupid or sick to keep buying insurance. It’s government encouraging people to behave dishonestly.
That will mean that either the insurance companies will be forced to lose money or the government will have to provide additional support for medical insurance.
That can be done several ways at that point. (1) They can let the companies charge higher rates to compensate, in which case we’ll have a system with even higher insurance rates which will only be paid by the sick. (2) They can charge higher penalites for people that refuse to buy insurance, truly punative penalities, to insure that healthy people buy insurance. (3) The govermnment could also just subsidize the insurance companies. (The term bailout will be out of fashion by then, surely, so I have no idea what they’ll call it.) (4) Or they can let the insurance companies leave the business, either by companies just getting out of the medical insurance game or by going broke. This last would then force the government to give up on the whole enterprise or double down by getting even more involved in the insurance racket than they otherwise would be at that time. (Sorry, I losing track of my future conditionals.)
Lots of people fear that last possibility is what the Democrats really want, but I imagine that the lure of campaign contributions will lead to some form of government aid to the insurance companies via some combination of methods (1), (2) and (3). (No doubt the worst possible combination. The worst possible solutions are what we’re doing for the housing and finanical systems currently.) Democratic pols are just like Republican pols ultimately, they all want to play the game. Rigging the system for a select few (see the TBTF financial institutions) ends up in more power for the elected elite.
Icepick said,
March 20, 2010 at 11:28 pm
In other words, we’re screwed.
Apologies, then, and mea culpa. I misunderstood your point.
amba12 said,
March 20, 2010 at 11:38 pm
The flip side is that it’s fraudulent for a healthy person to not buy insurance until after they require serious medical attention
That too is true. Yet the mandate is one of the things conservatives object to — more government telling us what we have to do. (We’ve gotten used to having to buy auto insurance, though. I suppose that’s on the state books, but it is also universal.)
A healthy young person can choose to save money by not buying health insurance — and then can get lymphoma or be in a devastating car accident.
Icepick said,
March 20, 2010 at 11:39 pm
Peter, the end of life planning bit reminds me of so many idea that I have read about that worked in trial programs. Almost none of them seemed to work when tried on a larger scale. (I’m thinking of various wellness programs as well as ideas like companies just hiring their own medical staff and building their own clinics.) The problem was often one of self-selection. Some small to medium sized company would make a “commitment to wellness” and then would get fabulous results.
After a while it became easy to see that these companies usually possessed the right kind of workforce to get good results. Most often this would mean a heavy proportion of well-educated people*, a workforce that was typically well-motivated in eveery aspect, and usually a good “team” atmosphere where pear pressure would help achieve desired outcomes. My test for these kinds of programs became WalMart – if WalMart could implement these programs with its larger, less uniform, less well-educated (on average) and less motivated (on average) workforce, I would believe that it could work everywhere. But a lot of these programs just would not and did not work outside of the example companies. I’d be willing to bet that hospital system in Wisconsin will not get such good results if it goes to a more diverse location, such as LA or NYC or Atlanta or Orlando. I bet it won’t work.
Peter Hoh said,
March 20, 2010 at 11:52 pm
You may be right about scale, Icepick, but that doesn’t change the fact that Gingrich behaved like a pandering, opportunistic bastard when he decried the very thing that he had previously promoted. Here’s his WAPO op-ed lavishing praise on the Gundersen system.
I expect that any number of Democrats would be doing the same opportunistic demonizing were there a credible health care proposal coming from the GOP.
Icepick said,
March 20, 2010 at 11:58 pm
I’ve gotten on an e-mail list for spouse-caregivers of people with Lewy body dementia (what J has). One of the shockers is that when one of these really terminally demented people goes into the hospital for any reason the doctors will perform things like PSA tests.
Some of the things that go on with our elderly are absurd. Last year during a sonogram exam to check a blockage in Mom’s carotid artery the technician thought she saw a growth on Mom’s thyroid. (Turns out the technician was correct. It also turned out to be nothing serious, thankfully.) We were referred to a specialist – the wrong kind of specialist. Mom’s primary sent her to a hematologist/oncologist instead of a endocrinologist. Fortunately he sent Mom to the correct specialist, but not before he got a chance to see some bloodwork. He saw low iron levels, a slight case of anemia.
The hematologist wanted Mom to come back in six months to have it checked again. Apparently there is a type of anemia that can get progressively worse in the elderly. (What doesn’t?) It could have been a particular kind of condition or a precursor to cancer or some damned thing. What I knew, though, was that Mom has always been borderline anemic. When the six month follow-up came up I cancelled because I was too sick to be around Mom, and I am the person that keeps track of all her medical stuff. I kept putting off rescheduling, though, because it just didn’t seem worth it. First, if it was some rare condition it would be hard to treat. Mom’s already dealing with a few issues, throwing one more type of treatment on top of everything else would likely cause adverse side-effects with some of the other conditions and treatments. Second, it just didn’t seem that likely.
So when we saw her primary last week, I asked if they check her iron levels. I already knew the answer, and I already knew the results from the past. I explained to the primary what the henatologist had mentioned, and he agreed with me that it didn’t seem to be a useful test. If I hadn’t had that cold in early January, I might have gone through with the appointment reflexively. Instead I thought about it, saved Mom and myself some extra trips to doctors offices and hospitals, skipped at least one unpleasant blood draw (Mom bruises very easily these days) and probably saved several hundred dollars in Medicare and insurance costs. As it was the mistaken referal had already cost the tax payers s few hundred (specialists are expensive) and led to added aggravation on our part.
(Mom has excellent retiree medical coverage. That absolute most she could spend out-of-pocket in one year would be less than $1,550. Note that that is an encouragement for her to do anything the doctors recommend. She doesn’t, because she’s stubborn. And in 2007, 2008 and 2009 she hit that maximum for serious issues. But financially her medical care is essentially free, so she could get as much as she wanted. That is NOT necessarily a good thing. In fact it’s the opposite.)
Peter Hoh said,
March 21, 2010 at 12:07 am
What I know is that even though commercial construction has pretty much ground to a halt in the Twin Cities, the big hospitals continue to expand. There’s money in health care.
I’m not sure if a market-driven system would produce some of the incredible life-saving treatments/medications that we have now.
In aviation, the market produces some very good commercial jets, but there would be no incentive to push the envelope with VTOL or stealth technology without the government shoveling huge piles of money towards those projects.
Of course, we don’t expect to be flown around in fifth-generation fighter jets while paying JetBlue fares. But that’s what happens with health care. Herceptin is an amazing drug, but it comes at a very steep price. A market-driven health care system probably wouldn’t support it. But a company developed it, and people who need it want it, but very few of them could afford it if they were paying the bill themselves.
Of course, then the company would have to lower the price, but at some point, that price drops below their cost to develop such drugs.
Icepick said,
March 21, 2010 at 12:14 am
You may be right about scale, Icepick, but that doesn’t change the fact that Gingrich behaved like a pandering, opportunistic bastard when he decried the very thing that he had previously promoted.
I haven’t been on the Gingrich bandwagon for a long time. He has a reputation for having big ideas, but most of them are trivial or procedural. I’m all in favor of good procedure, but such ideas don’t make one an “idea guy”.
An example of his small ideas was one that isn’t online anymore, unfortunately. A few years ago he was trying to create a large majority coalition. He was promoting several propositions, with the idea that 90% or so of the public favored all of these ideas. One of the ideas he was touting was a defense of keeping the words “under God” in the Pledge of Allegiance. Unfortunately the site that had these ideas has been scrubbed clean of these more idiotic ideas, but I remember being appaled that not only was he pushing that as an issue, but that it was his lead-off issue. This was around 2006. Think back to 2006 – in retrospect was the wording of the Pledge of Allegiance one of the more important issues of the day?
Gingrich got lucky* once, and he’s been touted as a genius ever since. His record doesn’t support that view, even ignoring his unsavory personal life. So it doesn’t surprise me to see him blowing in the wind on this one point.
* If luck is preparation meeting opportunity, that is. Gingrich had prepared and worked to bring a Republican majority to the House, and in 1994 he was presented with the golden opportunity. But he didn’t accomplish much once there, and he never built a solid Republican majority. Ever since we’ve been split damned near 50-50 in percent terms, and that has just exacerbated partisanship on issues great and small, to the point that most can’t recognize which issues are great and small anymore. Example (1), the Dems can’t seem to recognize that ramming through healthcare in this partisan fashion is destructive as hell for the body politic. Example (2), the Republicans can’t seem to recognize that fighting over every single issue is just as destructive as example (1). (See Jim Bunning’s pissing contest over extending unemployment benefits froma couple weeks ago. His larger point was corrrect – that Dems had touted PAYGO only to turn around and immediately ignore it on eveery bill large and small. Holding up UE compensation was bad form, making the whole thing look petty, mean-spirited and pointless. As my wife asked, why do these sudden outbreaks of principle only happen when the “little guy” gets the shaft. The dumbness of the politics meant that few even understood what his actual point was, while just turning up the heat on eveerything else.
Icepick said,
March 21, 2010 at 12:25 am
A healthy young person can choose to save money by not buying health insurance — and then can get lymphoma or be in a devastating car accident.
I lived that last part, 22 years ago. I didn’t have insurance and couldn’t afford any. (Yeah, that sounds quaint given the relative costs.) Then a great big car wreck left me a mess. So a good deal of my medical costs got written off. The hospital bill was $25,000. That included six hours of OR time, a day or so in ICU, around the same amount of time in PCU, and 14 days in the hospital altogether. All for just $25,000! It’s stuff like that why I don’t get too worked up about people “not having healthcare” – no one really lacks healthcare for emergencies like that.
The other things, though, are where insurance would matter – chronic conditions (e.g. diabetes) and major diseases (e.g., cancer).
Oh by way of comparison, here’s how much medical expenses have increased in 22 years. Mom had a relatively uninvolved outpatient operation on her bladder last year. The hosptial bill for about six hours came to over $42,000. That’s before the Medicare markdown, of course. After that it only came to about $9,000. Something is wrong with the pricing in the system, ’cause either that first price is way too much, or that other one is way too little.
I’ll state my own position again: The system is broken, but I don’t know what the fix is. I do know enough to know that very little of what I hear out of Washington DC (from any side) seems to even begin to address the real issues, and most of what gets proposed will only compound current problems.
Also, this is ultimately just a symptom of the real problem.
amba12 said,
March 21, 2010 at 12:29 am
The Pledge of Allegiance thing is actually another example of Gingrich pandering, to the religious right. He wrote a whole book about how this was a Christian nation. That never seemed to be a major preoccupation of his before; he was a geek who loved to go to zoos (which I actually find his most appealing characteristic). It’s possible that he genuinely got religion, but it smells of political convenience much more, to me.
Michael Reynolds said,
March 21, 2010 at 12:31 am
Ice:
Obviously is was a mis type of “pay” for “charge.”
And really, you want to diss my choice of metaphors? Me? As in New York Times bestselling author, starred reviews, publishers lined up six deep asking me to write for them, 22,000 pages published, translated into every major language in the world, 40 million books sold, me?
Well, there, cubicle monkey, I’m always open to literary criticism. You don’t think maybe I deliberately chose a trite metaphor so all the readers would get it? You think maybe I don’t bust a gut to entertain you with sparkling prose for free when I normally get paid about a grand for us many words as I put into that comment?
Let’s see. Stephen King says, “this is great fiction.” And yet some pencil pusher with the staggeringly original and not at all self-consciously tough guy pseudonym of “Icepick,” (was ‘rottweiler’ taken?) doesn’t like my writing. Hmmm. Who to believe?
Icepick said,
March 21, 2010 at 12:33 am
What I know is that even though commercial construction has pretty much ground to a halt in the Twin Cities, the big hospitals continue to expand. There’s money in health care.
That’s an interesting observation, and I’ve noticed the same thing in Orlando. Both of the two major systems (Florida Health and Orlando Health (formerly the ORMC system)) are continuing to add large new buildings along with large new parking garages. Not only that, but on the SE side of town we are adding a new VA hospital, a new children’s hosptial, the first new medical school in the state in a long time and providing space for a major medical research firm to open up a large new facility. LOTS of construction. The only other piece of major building construction that I see is (of course) the new arena for the NBA team. (That project was approved before the bottom fell out of the economy.)
Four years ago I could easily count 15 construction cranes just downtown. Those are all gone now, but the hospitals continue to boom. (That wasn’t meant to be bad wordplay, but I see that it is.)
Icepick said,
March 21, 2010 at 12:37 am
In aviation, the market produces some very good commercial jets, but there would be no incentive to push the envelope with VTOL or stealth technology without the government shoveling huge piles of money towards those projects.
Of course, we don’t expect to be flown around in fifth-generation fighter jets while paying JetBlue fares. But that’s what happens with health care. Herceptin is an amazing drug, but it comes at a very steep price. A market-driven health care system probably wouldn’t support it. But a company developed it, and people who need it want it, but very few of them could afford it if they were paying the bill themselves.
Of course, then the company would have to lower the price, but at some point, that price drops below their cost to develop such drugs.
This is all true. Unfortunately, even the Soviets and Chinese Communist Party eventually had to bow to market forces – eventually someone will get stuck with the bill. My own take is that all this subsidizing of health care development has simply pulled future demand to the present. We’re going to have to pay for that, pretty much starting now. SO that will mean fewer benefits and/or greater payments very soon. The governemt is promising the exact opposite, though. The government is doomed to fail.
Icepick said,
March 21, 2010 at 12:42 am
And really, you want to diss my choice of metaphors? Me? As in New York Times bestselling author, starred reviews, publishers lined up six deep asking me to write for them, 22,000 pages published, translated into every major language in the world, 40 million books sold, me?
This just demonstrates (again) that the world is unjust. Who sold more, you or Bulgakov? Who got paid more? Which one of you is the better writer?
As for the toughguy name, its actually just the short version of the Stab Master Icepick. It’s actually an homage to two verey minor parts of popculture from recent decades – Chris Rock’s first film, CB4, and a minor character from Magnum PI. Admittedly, I don’t have the courage to use my onw name, unlike you, Reynolds. Or is it Grant? Or M Takhullus? Whatever.
amba12 said,
March 21, 2010 at 12:43 am
Michael: if I had put “by Icepick” in the tweet about this post, would you have stayed away?
You two have a history of insulting each other. I wondered if Icepick would’ve started in with “stupid” if that comment had had some other name on it. Probably, but probably not with as much zeal. It’s like you both just picked up where you left off last time.
Michael, we already know your financial dick is bigger than everyone else’s here put together and we all bow down to it, okay?
amba12 said,
March 21, 2010 at 12:46 am
The UNC hospital complex is also building and expanding like crazy. Now that is a university hospital, and maybe the university’s endowment is paying for it. I don’t know how these things are funded. But still.
Icepick said,
March 21, 2010 at 12:51 am
You don’t think maybe I deliberately chose a trite metaphor so all the readers would get it?
I think you’re just lazy. Would you wirte any better if we paid you? Perhaps you should write nothing for us until we pay up.
More importanly, I note that you have changed the subject to the trivial. The important point was that you didn’t know what you were talking about when it came to how insurance companies behave (especially with the corrected language), and what self-insurance means to the overall debate. You got those matters completely wrong.
Icepick said,
March 21, 2010 at 12:55 am
Michael: if I had put “by Icepick” in the tweet about this post, would you have stayed away?
I could only hope. My contempt for him grows with every encounter. I really didn’t think my opinion could get worse after he tried to take money off me last year with a dishonest bet. Big man, the millionaire writer trying to con an unemployed person out of money. He’s a self-important ass, a phony, and as contemptible as a politician. He should be in the Senate.
Peter Hoh said,
March 21, 2010 at 12:59 am
Icepick: The government is promising the exact opposite.
Yeah, one of the major consequences of the GOP’s recent grandstanding is that they have positioned themselves as being opposed to any cuts in Medicare. Hoo boy.
Icepick said,
March 21, 2010 at 12:59 am
I wondered if Icepick would’ve started in with “stupid” if that comment had had some other name on it. Probably, but probably not with as much zeal.
I would have definitely called it stupid, though I probably would have been gentler about it if it had been someone I had any respect for. That particular crack about the camel really rubs me the wrong way. Camels are ugly, ungraceful and reportedly very ill-tempered. They’re also wonderfully well-designed for arid climates.
The reason I call it stupid and not ignorant is because anyone with some intelligence ought to be able to think about it and realize that a camel only appears poorly designed if you wanted a horse in the first place. And educated person should have already had that thought after encountering that line a few times.
amba12 said,
March 21, 2010 at 1:01 am
*sigh*
I know Michael and have described him more than once as “a good man pretending to be a bad man.” But on the Internet, your pretense is your persona is you, for all anyone knows. I think Michael likes it that way.
Icepick said,
March 21, 2010 at 1:04 am
Yeah, one of the major consequences of the GOP’s recent grandstanding is that they have positioned themselves as being opposed to any cuts in Medicare. Hoo boy.
Absolutely attrocious. The idea of Mitch McConnell and John Boehner in charge is why I can’t bring myself to vote Republican this fall, even though my Congressman (Alan Grayson) is a perfect example of what’s wrong with both Washington and Florida.
The worst thing about the proposed Medicare cuts, though, is that we all know the Dems will back out of those cuts when the time comes.* We know this because they’re doing it right now. That’s one of the things Jim Bunning was holding up a few weeks ago. The Republicans are just as guilty, of course, and I can’t take any of the lot that voted for Medicare Part D seriously on any of these issues. We’ve really got no where to turn for decent goveernance now, and it’s all our fault.
*
Actually, I suspect they might not get the chance to back out. The current crisis is just the first of many. By the time those cuts would take place I doubt this legislation will have any relevance.
Peter Hoh said,
March 21, 2010 at 1:05 am
I would be willing to bet my house that UNC is not using its endowment to build the new hospital wing. Perhaps they are using endowment money to self-finance, but if so, they are counting on making that money back, and then some.
amba12 said,
March 21, 2010 at 1:11 am
Sleepy time for me …
Peter Hoh said,
March 21, 2010 at 1:13 am
As much as I’ve railed about Medicare, Part D, I’ve heard it suggested that it may actually end up saving some money. Not that it was intended that way, of course.
Icepick said,
March 21, 2010 at 1:17 am
But on the Internet, your pretense is your persona is you, for all anyone knows.
Unfortunately for me, my internet persona is closer to my real persona than the one I usually display in real life. (Or at least the one I used to display. Not working means I that I no longer have to pretend to not notice stupidity and bad ideas. That’s the one advantage of unemployment.)
Deep down I’m prickly, quick to take offense (sorry Peter), slow to forgive (sorry Peter), hate willful stupidity with a bloody passion, and hate condescension even more. I especially hate that last one when I catch myself doing it, which is more often than I’d like. (Ignorance is tolerable, so long as one is willing to correct it when it matters.) “Doesn’t play well with others.” That’s why I don’t want to have administrator privlieges here. Really, if it wasn’t for my wife, Cat and cats I’d just assume be a hermit. (Or I would if hermits had better plumbing.)
Icepick said,
March 21, 2010 at 1:26 am
As much as I’ve railed about Medicare, Part D, I’ve heard it suggested that it may actually end up saving some money. Not that it was intended that way, of course.
I just don’t believe it. And if it does save money it will be because of something the government didn’t foresee.
Michael, we already know your financial dick is bigger than everyone else’s here put together and we all bow down to it, okay?
The guys on Wall Street got paid even more, and all they did was ruin the world’s financial system and damned near destroyed the world economy in the bargain. One’s personal financial statement really has nothing to do with the actual worth of the person, either morally or (counter-intuitively) to society at large. It’s funny to see such a flaming liberal as Michael go immediately to that free market trope every time, though. As I said, phony.
Icepick said,
March 21, 2010 at 1:27 am
Sleepy time for me …
Wimp. Sleep, like mercy, is for the weak.
Icepick said,
March 21, 2010 at 1:29 am
Correction in bold: One’s personal financial statement really has nothing to do with the actual worth of the person, either morally or (counter-intuitively) to the economy.
I must be getting sleepy too.
Dammit.
Peter Hoh said,
March 21, 2010 at 1:41 am
On Wall Street, as in politics, the system rewarded short-term gains without regard to the long-term consequences.
Paco Wové said,
March 21, 2010 at 10:25 am
Being God’s gift to the English language apparently makes one extremely thin-skinned.
realpc said,
March 21, 2010 at 1:50 pm
I didn’t read the healthcare reform bill (did anyone?), but I had a feeling it is probably stupid. This post is interesting, and made me even more suspicious that the whole thing is stupid. The Democrats have just wasted a year on something that won’t solve any of the serious problems this country has. While neglecting the real problems, or doing insane things like pouring money into failing banks, just to make sure no one has to go without their usual million dollar bonus.
Various things are contributing to rising health costs (and rising education costs, by the way). One problem is the over-use of useless treatments, some of which have already been mentioned. It is very common, probably, to continue pouring toxic chemicals into a cancer patient even when the doctors know perfectly well there is no chance of a cure.
The AIDS industry is also way out of control. (No I am not an AIDS denier).
The Democrats believe health care is a right, not a privilege for the rich. Ok, but how do they define “health care” exactly? New and more expensive treatments are continually being developed. We don’t find out until many years later if they actually work. They get through the FDA somehow and are prescribed like mad.
A typical example is the drug Aricept, which was developed for Alzheimer’s disease. It might have a small benefit in delaying Alzheimer’s symptoms a little. But it is now prescribed for every elderly person with symptoms of dementia, even if there is no reason to suspect the dementia is related to Alzheimer’s disease.
Someone is making a big pile of money from Aricept. Patients ask their doctors for a pill and doctors try to give them something, often knowing there is little or no benefit.
Do you think that sort of problem is mentioned in those two thousand pages? I really doubt it.
And what about malpractice insurance? When doctors pay $200,000 a year for insurance, they naturally charge patients more. And one reason malpractice insurance is expensive is because jury awards can be out of control. But Democrats won’t dare to alienate malpractice lawyers.
wj said,
March 21, 2010 at 2:16 pm
One interesting aspect of the current health insurance situation doesn’t seem to have made it into the discussion.
Suppose that you do not have employer-paid health insurance. You can go out and get your own . . . unless you have a “pre-existing condition.” In which case you are essentially uninsurable.
But there is an out: if you set up a company (presumably for another purpose, although nobody seems to check that), you can buy group health insurance for the company. At which point, you are suddenly insurable. In my experience, the insurance companies don’t even ask about the health of the group members — just name, age, and gender. Even if, as in my case, the “group” is only 4 people. Two of whom have (different) pre-existing conditions, which had previously made us unable to buy insurance.
If there is any sanity to this, I am hard pressed to find it. (Perhaps a little Darwinian effort to select for those clever enough to game the system…?)
Peter Hoh said,
March 21, 2010 at 5:52 pm
A few paragraphs from David Frum:
Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.
Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.
We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.
There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible.
Icepick said,
March 21, 2010 at 6:04 pm
David Frum is delusional. Obama and the Dems wanted nothing to do with Republicans (“We won.”), and mostly excluded them from the start. As the push-back from voters grew more intense, the Dems backed up from their original ideas and adopted some more Republican ideas.
Most importantly, neither side has presented much in the way of analysis explaining how their ideas would actually reduce medical costs. The last year has been nothing but bad political theatre and bad politics leading to bad policy. More bad governance, yay!
Icepick said,
March 21, 2010 at 6:08 pm
Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible.
This is particularly ill-informed. FNC and talk radio guys have mostly been behind the curve on this (Glenn Beck excepted), and at times seem oddly out of step with the Tea Party types. (Limbaugh and Levin seem completely oblivious to the fact that the Tea Partiers have legitimate gripes about how the Republicans have governed in recent years.) But someone like Frum can’t fathom that the little people could possibly have ideas of their own, ideas not given to them by the David Frums of the world. Just another elitist tool. It’s enough to make one root for a true revolution – the Frums of the world would be first up against the wall.
amba12 said,
March 21, 2010 at 6:27 pm
I believe that Dems’ openness to “bipartisanship” at the beginning was mere lip service. Later on, they needed it more but the damage was done. Both parties have been playing for partisan advantage before anything else.
A house divided and sunk in debt cannot stay ahead of the Chinese.
Icepick said,
March 21, 2010 at 7:41 pm
A house divided and sunk in debt cannot stay ahead of the Chinese.
Oddly I’m not really concerned about the Chinese in the short term. Or even the medium term, They’ve got problems of their own, and appear to be building the biggest economic bubble yet. If that bubble bursts I don’t know who will be left to pull the world economy out of the doldrums. Japan has been stuck in a rut for 20+ years, with no sign of recovery. The strain is starting to show in Europe, and we’ve fucked ourselves over royally.
The worst of our current situation is that the only time people really care about the debt is when the proposed spending is for stuff they oppose. The Tea Parties started about 6 years too late.
amba12 said,
March 21, 2010 at 7:59 pm
One of the ironies of this whole situation is that Bill Clinton looks better all the time. Of course, he was lucky; his presidency hosted the tech and internet bubble. Was that all?
amba12 said,
March 21, 2010 at 8:00 pm
the only time people really care about the debt is when the proposed spending is for stuff they oppose.
That statement reminds me of how ready much of the right was to forgive Scott Brown’s pro-choiceness. One even said, “But he’s against partial-birth abortion.” A little inconsistent?
Icepick said,
March 21, 2010 at 8:40 pm
Of course, he was lucky; his presidency hosted the tech and internet bubble. Was that all?
No, that wasn’t all. He also had the benefit of his domestic agenda getting blown out of the water in 1994, and from 1995 to 1999 te government was so divided that neither side could impliment their bad ideas. After the impeachment trial, the two sides came to an agreement and sometimein late 2000 they began to increase spending. If their had been more comity between the parties, they would have reached that point sooner. Sometimes partisanship helps.
Icepick said,
March 21, 2010 at 8:41 pm
If THERE, if THERE…
amba12 said,
March 21, 2010 at 8:43 pm
So if we can’t have small government, the next best thing is gridlocked, paralyzed government . . .
Icepick said,
March 21, 2010 at 8:47 pm
A little inconsistent?
For the current crop of “conservative” politicians, yes. An anit-abortion federalist that truly cared about states’ rights would be okay with a federal senator that was pro-abortion, as abortion should truly be the jurisdiction of the states.
Icepick said,
March 21, 2010 at 8:49 pm
So if we can’t have small government, the next best thing is gridlocked, paralyzed government . . .
Yes, but that can’t hold for long. Eventually the two sides (in the American system) figure out that they can get more for themselves by uniting against their constituencies.
Icepick said,
March 21, 2010 at 10:27 pm
Speaking of our debts….
Obama Paying More Than Buffett as Bonds Show U.S. Losing AAA
That’s slightly unfair. Obama looks to be the biggest single abuser of debt in the history of the world, but he’s had many accomplices – about 200,000,000 of them.
Not that we’re about to stop this madness. The elites have no idea what to do other than keep pumping out debt. Not that it will do any good. (Warning, I haven’t checked the source data on this one, but it looks correct.)
In other words, the government has become our pusherman. They don’t know anything but debt. What the fuck are they gonna do but hustle? Meanwhile
I.M.F. Warns Wealthy Nations about Debt
CR points out that Lipsky of the IMF also expressed the need for the rebalancing of global trade, although he was too much of a wimp to call out the Chinese when he had their ear. That leads to
Report: China Losing Support of American Business Community
The possibility of a trade war seems more real every day, although still somewhat remote at this point. The Chinese are saying we have the most to lose. They might be right, but they’d be fools to bank on it. We’re fools to bank otherwise. Just because a trade war would most likely be foolish doesn’t mean it won’t happen. We’re a nation of Buellers.
That low sound you hear from the horizon? It might be the sound of distant thunder. But it’s probably the just the Piper playing a low note, and he’s a lot closer than you think.
Icepick said,
March 21, 2010 at 10:34 pm
All of this, and health care reform too! From people who don’t even understand the current system. But what did we expect? CNN reported on a small anti-war rally yesterday and a small pro-immigration (i.e. amnesty) rally today, but seemingly missed the large rally in front of the Capitol Building protesting against the health care bill on both days.
There really isn’t any hope at this point. The elites are running wild with no thought, no clue, and no scrupples of any kind. No nation can survive this much stupidity at the top.
Michael Reynolds said,
March 22, 2010 at 1:48 am
I didn’t see a tweet. I just happened by.
Ir’s not about my dick size, it’s about really not being in the mood to have my prose criticized gratuitously by an ignoramus. I get plenty of that and I just really wasn’t in the mood for more. It was an obnoxious cheap shot and I thought it was time to school Icepick on just how much meanness can really be packed into a very few words. It’s a bit like being a prize fighter where every time you walk into a bar some jerk-off decides he has to fight you. If you don’t want to get hit, don’t pick a fight. And if you decide to pick that fight anyway, don’t be surprised when the pro knows how to land a hard punch.
And this fight was definitely picked by Ice. Show me a single mean, hostile, disrespectful word in my initial comment. Icepick has always been a nasty, arrogant, abusive prick to anyone he doesn’t like. So he doesn’t like it when someone else hits back? Waaah.
As for a bet with Ice I honestly have no idea what he’s talking about. If he owes me something I absolve him. If I owe him something let me know what it is.
If I’m not mistaken Icepick has declared HCR dead repeatedly. As has everyone on the right and not a few on the left. And yet it just passed. We won.
We won because — as I’ve been saying from the start — Obama never loses focus on his objective. He’s ruthless. He’ll do whatever it takes — even when that means displaying endless patience with GOP obstructionism.
Obama just pulled off what no one has been able to do before. In the middle of a huge recession. With two wars raging. While digging out from under the Republican financial shit storm. With zero help from the allegedly loyal opposition. Without ever uttering a harsh word. Smiling all the while, he just established the right of Americans to health care.
Now here’s what you’ll see next: about a 5 point jump in Obama’s approval rating. I’ll guess a month from now Gallup is around 52%. That will rise as the economy recovers.
And you’ll see the Tea Party movement become smaller, ever more shrill, and ever more overtly racist. The Democrats will feel empowered. The Republicans will see their poll numbers begin to wane along with their hopes for congress. Obama’s already hit his bottom, and his bottom is about the same number he won the election with.
Annie your tired tropes about Obama not being ready, being immature, naive, too young, weak and so on? You must see how silly they are. Obama just did what Bill and Hillary were unable to do. What Ted Kennedy couldn’t do. What Harry Truman couldn’t do. Some weak.
I am genuinely sorry to hear that Icepick is unemployed. I would never wish financial difficulties on anyone. Been there, done that, didn’t enjoy. (Oh, no! A trite turn of phrase!) But of course his situation will be somewhat ameliorated by the Democratic invention of unemployment insurance, by Mr. Obama’s stimulus package which included tax cuts, funds for states and communities some of which goes to help the unemployed, by the Democrat’s repeated extension of unemployment benefits, by the Democrat’s invention of COBRA, so that, one hopes, he won’t lose his health insurance. And if he has a hard time getting a job going forward at least he won’t have to move into a cardboard box in order to get some help with health coverage. Thanks to Democrats.
amba12 said,
March 22, 2010 at 2:15 am
From my point of view, Icepick is a sweetheart, and so are you. The enemy of my friend is my friend. Go figure. I think I keep my ideology soft (if any) because friendships are far more important and real to me than opinions. I think none of us humans really know what works and that opinions are sorry things to get too attached to, colorful two-dimensional banners of guesswork and rattling bravado, like having kite fights.
Um, I think the ruthless ball-buster here was Pelosi. Without her nothing would have happened. However, I think you’re right that Obama’s approval rating will rise. Americans admire a winner, even one who wins ugly. His base will be relieved and even his enemies will have a grudging new respect, except for the out-there ones who want to kill him.
I don’t think this is quite the done deal you’re celebrating. Republicans’ constituents expect them to continue to do all they can to derail it. And the money won’t be there to pay for it, unless it comes out of your Medicare. America is not going to turn into some giant France-like crêche. There’s more big financial trouble ahead. (I would make you a bet on that, if I had anything to bet.)
amba12 said,
March 22, 2010 at 2:44 am
By the way, I didn’t say Obama was naïve or weak. (Who could survive in Chicago politics as either?) I said he was inexperienced as an executive. And provincial, class-wise. I grew up in Hyde Park-Kenwood and I know what a sheltered and provincial environment that is, ironically, since it is also very cosmopolitan. But it’s cloistered economically and politically. It’s kind of a hothouse. It’s like the Sixties activists and seekers who had been to India but never to a working-class neighborhood in their own town (which they disdained, with the exception of the Trotskyists). Who romanticized the minority poor and excused criminal behavior when they engaged in it, which is, you know, racist. I think the president somewhat represents everybody, so the broader his or her experience of modes of life, the better. G.W. Bush was also lacking in this regard.
amba12 said,
March 22, 2010 at 2:57 am
Here’s what I mean about big financial trouble ahead.
Icepick said,
March 22, 2010 at 8:52 am
Ir’s not about my dick size, it’s about really not being in the mood to have my prose criticized gratuitously by an ignoramus. I get plenty of that and I just really wasn’t in the mood for more. It was an obnoxious cheap shot and I thought it was time to school Icepick on just how much meanness can really be packed into a very few words.
Well, since it continues….
I criticized your prose because it was lazy and thoughtless. I criticized much else that you wrote becasue it was wrong. You get all huffy about your professional pride. But your arrogance doesn’t allow you to accept that anyone else knows what they’re talking about on any subject. Well, jackass, you;re wrong. I know more about this particular topic than you do, by a lot. Several of your comments about insurance were factually wrong.
But you refuse to listen. You always have. So you resort to bully-boy behavior. This isn’t the first time you have made reference to your wealth in an effort to show your superiority, and I doubt it will be the last. You just don’t have that many tricks up your rhetorical sleave, despite all the books you’ve sold.
Icepick said,
March 22, 2010 at 8:56 am
And Michael, if you’re trying to be mean, try harder. Also, try to stay on target. Let’s look at an example of how much meanness you managed to pack into a few words.
Well, there, cubicle monkey, I’m always open to literary criticism. You don’t think maybe I deliberately chose a trite metaphor so all the readers would get it?
Wow, you called me a cubicle monkey. That’s hardcore. But then you insulted everyone else who reads this blog by assuming that many of them can only understand trite metaphors. I suppose that’s more of your mighty writing skills.
Icepick said,
March 22, 2010 at 9:07 am
As for a bet with Ice I honestly have no idea what he’s talking about. If he owes me something I absolve him. If I owe him something let me know what it is.
It dates back to a year ago. :Here it is. Note that I didn’t accept the bet, given it’s dishonest terms.
You wanted to bet, among other things, that “a year from today we have a bottom in the stock market and in the housing market”. Really? Of course the markets would have had a bottom even if they fell every single day from March 7 2009 to March 7 2010. The bottom would have just been at the end. I didn’t bother to figure out how you meant to cheat on the other terms of the bet, but I’m sure you had something in mind. Or is it that you were careless and thoughtless about that bit of writing too? Nah, couldn’t be. You’re a professional writer after all….
Icepick said,
March 22, 2010 at 9:18 am
Reynolds, you claim that I started this pissing contest. I did, on this thread. But in the past you’ve compared me to Fascists and Nazis because I don’t believe in high marginal tax rates. I am not going to afford you any respect whatsoever after such behavior. You always accuse those who see the world differently than you do of being nasty people. (See your tea party comment above, for example.) You shouldn’t be so surprised that people take offense to that kind of behavior.
amba12 said,
March 22, 2010 at 9:33 am
Oh, Ice, you should’ve taken the bet! At least, it was a good bet. Here’s the rest of what Michael said on March 7, 2009:
Icepick said,
March 22, 2010 at 9:45 am
I’m sure he would have claimed he meant the U-2 numbers (seas adj) and probably would have cherry-picked the approval numbers as well. Really, he either doesn’t know how to phrase terms correctly or he was trying to cheat me. Either way why gamble with him?
amba12 said,
March 22, 2010 at 9:56 am
Note that he didn’t specify your side of the bet if he lost, and there might not have been one.