I like Scheiber but it took him half this diavlogue to really hit his stride- the whole first half he kind of stammers and repeats "you know" over and over. I liked McArdle's performance and she's pretty much won me over to pessimism about the future of medical innovation. It's really tough to care about giving future generations better treatment, though, especially compared to giving us present generations a reasonable minimum level of treatment, so I don't think that actually effects my overall position on healthcare much. I'm also curious what happened to McArdle's eye, and hoping against hope that it involves some sort of horrible policy wonk battle royale. You might think that libertarians would be at a disadvantage in such a situation, what with the lack of numbers and unreliable teamwork, but based on McArdle and Welch I'm guessing libertarians are all 8' titans

No, seriously, does Megan have a black eye?

Quoting Stapler Malone: No, seriously, does Megan have a black eye?

You should see the other guy.

I think Megan just forgot to wash off last night's mascara. Anyway, this was really interesting, and I'd love to hear from a "real" doctor with a private practice (not an instructor at a medical school) who could give the doctors view of national health care. And yes, Noam just seems to know enough about financial markets to keep up with Megan, but not enough to offer any strong opinions or analysis. OH, one last thing: as to why people people pull equity out of their house to pay off bills...remember, you can deduct the interest on a line of credit, unlike the interest on your credit cards.

Was there any point to watching this diavog? It's pretty obvious the bailouts, stimulus, and expanding financial regulations will ultimately do more harm than good. It's sad we have to repeatedly explain to people the problems with socialized systems: A) There are zero incentives for reducing cost
B) There are zero incentives for innovation

Quoting NateS: It's sad we have to repeatedly explain to people the problems with socialized systems:

A) There are zero incentives for reducing cost
B) There are zero incentives for innovation

No incentives? No incentives at all? Oh, my indoctrinated little friend!

I heard one financial analyst say he thought that TARP was a ruse to save CITI and eventually put it on life support. Sounds plausible. Another said all the large bailouts occurred with corporations who are major campaign contributors. What else is new? Noam: work on not saying "you know" so many times. I have the same problem. John

Health insurance is not expensive. Check here for quotes:
http://www.ehealthinsurance.com/ A 50 year old female in NJ can get a very good plan for $313 a month. It would be even lower priced if the NJ government would allow HSA plans in the state. A person in NJ and NY will pay 3x as much for their rent as they do for health insurance. Why do the ruling democrats focus on the cost of health care and not housing? To address the needs of those who cant afford insurance, setup government funded health clinics where people pay what they can afford. Problem solved.

Quoting DenvilleSteve: Health insurance is not expensive. Check here for quotes:
http://www.ehealthinsurance.com/

I came back North of 900$ a month. Thanks for the tip, Steve.

Everyone agrees!

Quoting DenvilleSteve: To address the needs of those who cant afford insurance, setup government funded health clinics where people pay what they can afford. Problem solved.

Originally Posted by MichaelSteele
So if it’s a cost problem, it’s easy: Get the people in a room who have the most and the most direct impact on cost, and do the deal. Do the deal. It’s not that complicated.

If it’s an access question, people don’t have access to health care, then figure out who they are, and give them access! Hello?! Am I missing something here? If my friend Trevor has access to health care, and I don’t, why do I need to overhaul the entire system so I can get access he already has? why don’t you just focus on me and get me access?

Quoting bjkeefe: Everyone agrees!

George Bush leading the way on health care clinics for the low income:
http://www.nytimes.com/2008/12/26/he...26clinics.html So it is proven that health insurance is affordable and subsidized clinics can provide good care to the poor without causing budget deficits. Democrat health care reform is yet another devastating policy imposed on the minority republican people. Please allow these good folks to exit from the federal system.

Quoting DoctorMoney: I came back North of 900$ a month.

Thanks for the tip, Steve.

what parameters did you use? A 61 yo female pays $381.99 per month.

Quoting DenvilleSteve: Democrat health care reform is yet another devastating policy imposed on the minority republican people. Please allow these good folks to exit from the federal system.

You know, when you went quiet for a couple of weeks there, I entertained the faint hope that you had, in fact, opted out of the federal system by getting your whiny sore-loser ass on a plane and moving to some Galtian paradise. It's a pity actual self-reliance is in such short supply among you people.

The problem with rewarding outcomes is the same in health care as in education. In both the "provider" has a minority say in the outcome. They are both dependent on the qualities of the people you are working with. It works fine if you have a student or patient who will be compliant and follow the necessary instructions. It doesn't work when the patient or student wants a magic pill to solve all problems.
Thus, it's easier to get good outcomes in both fields in the suburbs than the intercity.
In both it's a classic leading a horse to water problem, if they won't drink there's not much you can do. (And the current proposal makes this worse by making it illegal to charge higher rates to smokers and drug abusers.

Why did economist Charles Wheelan have to do it? Today, in his column for Yahoo he brought up the topic of the massive national debt, how it's financed, the repercussions of spending money you don't have and all the rest of it. As the radio talk show hosts like to say: "unbelieveable." What is he trying to do throw a damper on the massive budgets being thrown out by the Obama Administration: stimulus, healthcare, TARP, and too big to fail bailouts? It's OK since Reagen and G W Bush spent like drunken sailors (actually, being a former soldier not sailor we never were that profligate). Keep in mind we all know R.R. was a genius when it came to "the bottom line." Make no mistake about that. Come on now Charles a trillion here and a trillion there isn't a lot of money (forget about what Senator Everett Dirksen said). Where have you been lately? Get with the program it's not a big deal is it? John

Quoting bkjazfan: Why did economist Charles Wheelan have to do it? Today, in his column for Yahoo he brought up the topic of the massive national debt, how it's financed, the repercussions of spending money you don't have and all the rest of it. As the radio talk show hosts like to say: "unbelieveable." What is he trying to do throw a damper on the massive budgets being thrown out by the Obama Administration: stimulus, healthcare, TARP, and too big to fail bailouts? It's OK since Reagen and G W Bush spent like drunken sailors (actually, being a former soldier not sailor we never were that profligate). Keep in mind we all know R.R. was a genius when it came to "the bottom line." Make no mistake about that. Come on now Charles a trillion here and a trillion there isn't a lot of money (forget about what Senator Everett Dirksen said). Where have you been lately? Get with the program it's not a big deal is it?

John

you dont get it. The political system in the US does not work. The changes needed to end the deficit spending and payoff the Obama debt cannot be accomplished. The majority

I'm fairly sure markets and specialization of labor are the antithesis of "self reliance."

Who is excusing George Bush and Ronald Regan debts? They screwed up, and Obama is screwing up 5 times worse, and trying to blame it on his predacessors. He runs the ship. He owns whatever happens now. Imagine George Bush using Kosovo as justification for the utter failure in Iraq?

She did mention on her blog that her boyfriend has been out of work for a while. Unemployed deadbeat boyfriend definitely correlates to domestic violence.

Those lowball quote sites do not bear any resemblance to what the average person would actually end up paying. Any slight blemish on your health record, even something as seemingly insignificant as seasonal allergies, occasional hypertension, or a single back injury, can instantly double or triple your rates, if not outright disqualify you. Many individuals will find they have no choice but to resort to an expensive state-mandated guaranteed issue program (should they be so lucky as to live in a state that even has one.) Your 50 year old woman in NJ, if she has any health issues, would probably end up paying over $1,000 a month, and that's assuming she takes on a $1,000+ deductible. Of course she's better off than the same woman in, say, Oklahoma, who would likely have no access to insurance at any price.

Quoting NateS: Who is excusing George Bush and Ronald Regan debts? They screwed up, and Obama is screwing up 5 times worse, and trying to blame it on his predacessors. He runs the ship. He owns whatever happens now.

Imagine George Bush using Kosovo as justification for the utter failure in Iraq?

Heh, typical. In office five months and everything is his fault. You gotta love blind partisans.

Is this an argument against rewarding outcomes? Rewarding doctors' and teachers' use their skills with groups of people who have demonstrated some kind of higher ability to productively exploit their expertise seems like a reasonable plan for any society with limited resources. I'm not sure why we expect this group of people to be geographically organized in suburbs, but if that is the case that's okay with me.

Quoting Gravy: groups of people who have demonstrated some kind of higher ability to productively exploit their expertise

Who the fuck are they?

The upper 20% of the income bracket? {Not counting people with large Inheritances of course, which I wish was taxed much heavier}

Quoting pampl: I like Scheiber but it took him half this diavlogue to really hit his stride- the whole first half he kind of stammers and repeats "you know" over and over.

I thought it was quite hilarious how halfway through the diavlog, Scheiber picked up Mcardle's incredibly annoying habit of appending "right?" to every sentence. I was pleased, however, that he did not pick up her other incredibly annoying habit of spewing rightwing boilerplate. Go Noam!

Quoting Starwatcher162536: The upper 20% of the income bracket? {Not counting people with large Inheritances of course, which I wish was taxed much heavier}

1) Inherited money isn't income. 2) What does one's wealth have to do with his productivity? 3) Or expertise?

Quoting Ray: 1) Inherited money isn't income.

2) What does one's wealth have to do with his productivity?

3) Or expertise?

I was kinda under the impression that there being some form of relationship between productivity and wealth was one of the core concepts of capitalism.

Anybody else reading Atul Gawande? He's amazing: The Bell Curve: What happens when patients find out how good their doctors really are? (real innovation in action):

Matthews had started a cystic-fibrosis treatment program as a young pulmonary specialist at Babies and Children’s Hospital, in Cleveland, in 1957, and within a few years was claiming to have an annual mortality rate that was less than two per cent. To anyone treating CF at the time, it was a preposterous assertion. National mortality rates for the disease were estimated to be higher than twenty per cent a year, and the average patient died by the age of three. ...
In 1964, the Cystic Fibrosis Foundation gave a University of Minnesota pediatrician named Warren Warwick a budget of ten thousand dollars to collect reports on every patient treated at the thirty-one CF centers in the United States that year—data that would test Matthews’s claim. Several months later, he had the results: the median estimated age at death for patients in Matthews’s center was twenty-one years, seven times the age of patients treated elsewhere. He had not had a single death among patients younger than six

Quoting Starwatcher162536: I was kinda under the impression that there being some form of relationship between productivity and wealth was one of the core concepts of capitalism.

You'd think so, but theories of capitalism have very, very little to say about income/wealth distribution. Supply and demand, yes. Distribution, only a little. The first datasets on income distribution were only put together in the last few years (by Thomas Piketty and Emmanuel Saez).

Quoting NateS: I'm fairly sure markets and specialization of labor are the antithesis of "self reliance."

I dont see why. Collectively, all the specialists form a self reliant whole. A self sustaining community, where everyone works. Utopia.

Quoting bjkeefe: You know, when you went quiet for a couple of weeks there, I entertained the faint hope that you had, in fact, opted out of the federal system by getting your whiny sore-loser ass on a plane and moving to some Galtian paradise.

It's a pity actual self-reliance is in such short supply among you people.

BJ, I think you're mistaken. Steve isn't actually "people." He's the ghost of Lyndon La Rouche! Listen to what he says and I think you'll draw the inevitable conclusion. After weighing this incontrovertible proof, can you honestly look me in the eye (figuratively speaking, of course) and say there's no such thing as a supernatural world? [DERISIVE SNORT]

Quoting Starwatcher162536: I was kinda under the impression that there being some form of relationship between productivity and wealth was one of the core concepts of capitalism.

You're kinda under a false impression. Or you're mistaking increases in total productivity leading to an increase in general wealth for increases in individual productivity leading to an increase in respective, individual wealth. In other words, capitalism leads to increases in capital. It doesn't allocate the new capital to the people who actually generated it. Capitalism is complicated and difficult to understand, and this fact about capitalism--that it generates wealth without justly rewarding the people who generated it--may be the most incomprehensible aspect of the system. For people like Megan, confronting this fact becomes like theodicy. Justifying why capitalism is unfair is like explaining why Jesus had a criminal murder their child. It's a desperate attempt to maintain an inconsistent worldview.

Sweet! Did he lose his health insurance??

Do you actually read Megan McArdle? She's anything but boilerplate.

Ezra Klein is on it:

Insurers often complain that their critics don't understand their business practices. It would be hard to say that about Wendell Potter. Potter, whose name sounds like that of a character in a Frank Capra movie, worked in the health insurance industry for more than 20 years. He rose to be a senior executive at Cigna. He was on their calls, at their board meetings, in their books. And today, at a hearing before Sen. Jay Rockefeller's Commerce Committee, he testified against them.

What drove Potter from the health insurance business was, well, the health insurance business. The industry, Potter says, is driven by "two key figures: earnings per share and the medical-loss ratio, or medical-benefit ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits."

Think about that term for a moment: The industry literally has a term for how much money it "loses" paying for health care.

The best way to drive down "medical-loss," explains Potter, is to stop insuring unhealthy people. You won't, after all, have to spend very much of

Quoting claymisher: Ezra Klein is on it:

http://voices.washingtonpost.com/ezr...insurance.html

Thanks for that. I remain deeply pessimistic about the chances of getting a decent health care bill passed, but every little bit helps. On a related note, did you see Chris Matthews give Joe Scarborough the what for? Say what you will about Tweety and his long list of flaws, sometimes he gets it right with a vengeance.

Ezra Klein interviews Atul Gawande:

You brought up medical cultures. And those are hard to change. It's hard to legislate norms. But how do they develop it? How does one city end up with a culture with totally different incentives than another?
In the early 90s, McAllen was the same cost as El Paso. Three years later, they jumped into the top 10 or 20 and never really left. The first thing to really leap in price was home health care and it happened, it seems, because a few home health agencies came on the scene and began offering doctors something serious for their involvement: extra salaries as medical directors who don't really do much. McAllen is also on the leading edge of for-profit innovations. They were early with a specialty hearts center, for instance, and cardiovascular operation rates began climbing. Then you had physician-owned imaging centers and physician-owned surgery centers and everything began going up a lot.

What I've observed -- and we really need some real data behind in it -- but in those places with organized systems of care, with lower cost and higher quality, they've had to find some way to

Wow, who knew Matthews could sound so reasonable?

Excellent stuff. Thanks for posting that. I'm often amazed that there are so many "lawyer" and "used car salesman" jokes out there and no "insurance company" ones. The insurance business model is: 1) sell as many policies as possible, 2.) tack on as many extra coverage options as you can convince the person is needed, and then 3.) deny as many claims as possible (including those of the ones you just convinced to buy coverage they didn't really need.) Repeat perpetually. Collect large bonus.

Quoting uncle ebeneezer: Excellent stuff. Thanks for posting that. I'm often amazed that there are so many "lawyer" and "used car salesman" jokes out there and no "insurance company" ones. The insurance business model is: 1) sell as many policies as possible, 2.) tack on as many extra coverage options as you can convince the person is needed, and then 3.) deny as many claims as possible (including those of the ones you just convinced to buy coverage they didn't really need.) Repeat perpetually. Collect large bonus.

Glad you liked the links! Here's some insurance humor. http://www.youtube.com/watch?v=bVpX5fUvPlg

Quoting bjkeefe: Thanks for that. I remain deeply pessimistic about the chances of getting a decent health care bill passed, but every little bit helps.

On a related note, did you see Chris Matthews give Joe Scarborough the what for? Say what you will about Tweety and his long list of flaws, sometimes he gets it right with a vengeance.

Oh boy, 14 minutes of the Scar. Too much. I'll check to see if ThinkProgress has the highlight ...

Quoting uncle ebeneezer: Wow, who knew Matthews could sound so reasonable?

I never got why people on the left are hostile to Matthews; the guy has been a straight up progressive for years now. He was against the Iraq invasion from the get go, as well!

Quoting Lyle: Do you actually read Megan McArdle? She's anything but boilerplate.

I read her column in the Atlantic, and yes, it is occasionally quite interesting. As for her appearance in this diavlog? Yes, boilerplate's the word. But now that you've given me an opportunity to gratutiously insult Andrew Sullivan (thanks!), I will say that the only people on the Atlantic website that are worth reading are Fallows, Coates, & Goldberg. McArdle and especially Sullivan just don't deserve the hits.

Quoting claymisher: Oh boy, 14 minutes of the Scar. Too much. I'll check to see if ThinkProgress has the highlight ...

I can certainly appreciate that sentiment, but in this case, it was worth it.

McArdle is not boiler plate because she's a socially liberal libertarian conservative or some such kind of conservative. There is nothing, absolutely nothing main stream conservative/Republican about her. You need to read her every day. Do it while you're in China, learn to appreciate her. I am with you on Sullivan, although he's a must read irregardless of his foolishness.

Quoting bjkeefe: I can certainly appreciate that sentiment, but in this case, it was worth it.

Here's a better clip of JScar:
http://www.thedailyshow.com/video/in...oe-scarborough

Quoting claymisher: Here's a better clip of JScar:
http://www.thedailyshow.com/video/in...oe-scarborough

Yes, the general rule for him is a good one: the shorter, the better.

Quoting DenvilleSteve: what parameters did you use? A 61 yo female pays $381.99 per month.

I applied there 4 months ago. I was hospitalized as a 9 year old for something unusual and chronic, though I haven't been on meds for it for more than 15 years now. Checking my excel sheet that I made during my last round of applications, I can see that they came back with a monthly cost of 963$ a month for me. It's their form of a Dear John letter.

Actually I've always enjoyed Matthews. Hardball was really the first show I watched when I started to become more actively engaged in political affairs. I got a little tired of him when he would get all misty-eyed at our brave Prez every time Bush did his cowboy, protect-the-nation thing, and he often falls for the same obsessive angles that the MSM can't let go, but otherwise I don't think he's any worse than anyone else, and he does know how to hold somebody's feet to the fire on occasion. I see him more as a shmaltzy romantic, rather than a blustering idiot.

Quoting uncle ebeneezer: I see him more as a shmaltzy romantic, rather than a blustering idiot.

There's rarely a difference.