Public/Private/Home … School, Healthcare, and Beyond

Recently the Paul interview sparked a conversation about the limits of government to take our choices putatively for the public weal. This is, for the nonce, the status quo regarding education. How that impacts us in society is of some relevance as the progressive/liberals in our midst have the notion that this would be a good thing if moved to other spheres, like healthcare. What they fail to do is point out the downside for the ordinary person.

Taken at quite a distance education industry in the US might be described as a system that it is divided into public, private, and home venues. From a financial standpoint private and home schooling requires either substantial private wealth (for private school) or substantial time commitment (home school). Private schools can be, and often are, cheaper per-student to run that the corresponding public schools while at the same time both private and home can yield a far better educational outcome for the student (at a lower cost). [note: this is true, and yes, there are explanations, but that isn’t the point.] What makes the private/home options more difficult is that while this expense is undertaken the payments to public schooling, which is not used, must still be made. There are some who can shoulder this burden, but many cannot.

A second thing occurs when school “went” public, that is their overall/average quality decreased. When I began blogging the question of education came up, and I took it on myself to experiment a bit. I purchased two 6th grade text books from the turn of the last century prior to wide public school acceptance. My estimation is that the difficulty of those 6th grade books are quite a bit harder than 6th graders receive today. I think a 6th grader would have difficulty answering “How many tons of copper telephone cable be would be required to connect Milwaukee and Chicago?” This was a question in a circa 1905 6th grade math text. The point isn’t again to argue why for explanations or circumstances which have led to lower educational standards over the last 100 years. The takeaway point is that it has. If you wish to repeat that experiment, old books like that are available on eBay (where I purchased them).

As a concrete example of cost burdens, when my children were younger I enrolled them in a Montessori school. At that time I was paying a little more than 2k per year to that school (which was about 4-5 times less than the per-student budget of the village school if I recall). Property taxes go largely to fund schools, which ran another 2k or so. The reason that a village/town can afford that higher price for its public schools is that 1 in 4 to 1 in 5 households at any given time actually have kids enrolled in school. At some point the double payment became too hign for the differential in outcome and I moved the kids to public school (Montessori methods work a lot better in my view in the pre-K -> 1st or 2nd grade than in the higher grades).

So, as schools went more public two things happened. Better education was available only to those with the resources (or time in the case of homeschooling) to shoulder a double burden, to pay for separate education while at the same time pay for the public schooling which they aren’t using. The second thing that happened is that for those without the ability to shoulder that higher cost, the standards of education were negatively impacted. It is those in the lower through upper middle classes in the main which must suffer, for they are impacted directly by the lower quality but cannot pay the now-higher price for better.

Healthcare is more costly. This make the public-izing of healthcare a more troubling prospect. Unlike the schooling situation there are fewer households with which to spread the cost burden. Currently the average working middle class stiff is getting about 8-12k from his employer in healthcare as a untaxed benefit. The move to public healthcare by rough analogy will lower the standard of healthcare products that he receives (longer lines, less equipment, less time with the doctors) and it will be difficult, if not impossible for the average person to “double pay” and take the analogy to the private option. That is, to obtain service from separate private healthcare while at the same time continuing to ante up the 8-12k for public healthcare at the same time.   Yet because healthcare is more costly that cost to get better care will not just a little more.

If the Democrats selling their healthcare dreams and Obamacare were actually honest, they’d be touting that their plans will yield somewhat better healthcare for 10-20% of us (if they were honest, they’d also be noting) that the price that 60-70% of us in the middle would pay would be in the form of  having substantially worse healthcare product availability.

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40 comments

  1. Boonton says:

    The problem with the ‘education standards have declined’ meme is that it fails the data test. Yes a 6th grade text bok from 1890 has harder questions than a 2010 one. Part of that is due to a shifting cannon of knowledge. But the core of it is due to the expansion of education.

    If you look at literacy rates, you’ll notice that the portion of the population that could not read was much higher in the past. Since reading is pretty basic to education how is this possible with those old time, ‘hard’ 6th grade text books? Because in 1890 6th grade was for the elite while in 2010 its almost impossible to find someone who hasn’t gone through 6th grade. The comparision then should not be between the average 6th grader of today versus 1890 but the top 6th graders of today versus 1890, 1910, 1940 or whatnot.

    If the Democrats selling their healthcare dreams and Obamacare were actually honest, they’d be touting that their plans will yield somewhat better healthcare for 10-20% of us (if they were honest, they’d also be noting) that the price that 60-70% of us in the middle would pay would be in the form of having substantially worse healthcare product availability.

    Since the health care plan essentially pushes people to buy private plans you should be estatic. If you want to make an analogy to education, its as if the health plan rejected public schools entirely and opted for a voucher system where you couldn’t even have a public school competiting with the private schools.

  2. Boonton says:

    As a concrete example of cost burdens, when my children were younger I enrolled them in a Montessori school. At that time I was paying a little more than 2k per year to that school (which was about 4-5 times less than the per-student budget of the village school if I recall).

    Stephan Gould was diagnosed with a rare cancer which ‘on average’ gave him something like 6 months to live. He said, however, that he was not worried since he understood what was behind that number and the essential core truth that “no one is the average”. He lived something like another ten years or so, so what goes wrong with averages here?

    I think a few things:

    1. I suspect your comparision was between private elementary school and your villages school budget. This ignores the fact that educating high school kids is much more expensive than educating 1st graders. Your comparison is like comparing a hospital that mostly caters to plastic surgery and minor procedures to one that does the same but also has a full fledged oncology ward, cardio ward, and transplant ward and noting the ‘average cost per patient’ in the first hospital is much less therefore the 2nd must be highly inefficient.

    2. You’re neglecting the satallite nature of the private school. The public system takes on nearly all the students, the private takes on a tiny portion. The result is undoubtably that the private schools in the area depend upon the public ones to take the ‘hard cases’ thereby freeing them up to work with the less difficult ones. This is roughly analgous to the numerous small private practices offering same day surgerical procedures that crop up around a major hospital. Overall such system works because the hospital is acting as a backup for when things go wrong or the more serious cases.

    To really understand this you have to not only figure out your metrics but then get behind your metrics. Why is your computed average for the public system so much higher? What exactly is being spent that is making it so? For example, how much is being spent on maintaining sports infrastructure at the local high school? To what degree is the private school cheaper because the school budget is really a combination school and recreation budget? To what degree are there more or less teachers in the different schools and what is their pay differential?

    I suspect what happens is that pre-high school is lower than the total average cost but not HS and beyond. Note that public and private college is very expensive. Note also that private high schools are likewise very expensive. I suspect that the ‘on average’ differential gets much less dramatic once you account for things like cost shifting.

  3. Boonton says:

    http://www.capenet.org/facts.html has some interesting facts.

    Note the average private school tuition table, esp. the vast different between non-sectarian private schools and religious ones. Tuition does not necessarily equal cost as a religious school system may subsidiy tuition with private donations as part of its religious mission. Then compare to http://wiki.answers.com/Q/National_average_cost_per_student_in_public_school which cites the national average public school cost is just shy of $10K. The differential seems to be less than you like to think it is.

  4. Mark says:

    Boonton,
    You don’t think the education in private schools is better? You don’t think that they are “double paying”, i.e., putting out $2k for public school on top of their expenditures for private … a sum which is more difficult for the middle class.

    I’m not sure you’re addressing the main thesis point, that making X mainstream both has a overall negative quality impact and puts alternatives further out of reach for the middle class.

  5. Mark says:

    Boonton,
    I think a large part of the higher cost of public schools is the large baggage train. In the 16th-17th centuries European armed forces got more and more extravagant with a higher and higher percentage of the force and cost going to men and women not carrying the sharp pointy sticks (i.e., going to non-combatants). When I was at the H.S meet/greet three weeks ago, a flyer with staff listings was handed out. Two pages (of 8 or so) were devoted to individuals who didn’t teach children. And its likely that list didn’t even touch or include people who were doing purely administrative duties in ancillary supporting roles. At the Montessori school noted above, everybody employed by the schools taught.

    A number of years ago, in a dinner with a client after work, he was griping about his kids schools. One of his complaints was that the best teacher in his kids school stopped teaching. Why? Because he had three kids of his own and needed the higher pay associated with an administrative position within the school district. That such a position even exists is the crux of the problem with costs in schools.

    Another friend of mine, was elected and worked for a time in a local school in a suburb of Chicago. He was shocked at the causal corruption endemic in the system. Publishers regularly posted board members on cruises and junkets in return for purchase of new books. Do you think that pushed the cost of the school district up more than just a little?

  6. I have several large disagreements.

    1) Just so we’re clear, Obama’s health care plan does not provide public health care, so the analogy is worthless as far as private/public comparisons go. The analogy is worthwhile if you want to talk about fully socialized medicine.

    2) Boonton addressed this, but you can’t compare the average a hundred years ago to the average today without correcting for stupendous demographic differences. Today’s counterparts to the ones who were in school in the 1890s are still in private schools! You have to compare like to like.

    3) Your whole double-paying argument makes no sense w/r/t Obamacare. As mentioned in #1, you’ll still be going to your private health care providers.

    4) Note that under a single-payer system, which is what actual liberals want (at least those who don’t want socialized medicine) progressive taxation would mean that the very rich would end up paying more, while the lower and lower-middle classes would be paying much less. So your comments about them struggling to “double-pay” would be doubly irrelevant.

  7. Regarding school administrators, my wife has worked as several schools over the last few years. The quality of the principal and vice principal had HUGE HUGE HUGE impacts on the quality of learning. They not only get the best teachers and enable them to do good work (e.g. my wife and several of her colleagues left a school after the first year of a bad principal’s reign) but they set the tone and motivation for the school as well.

    As far as I can tell, this is your thought process on the subject. I, Mark, don’t understand what administrators do. Therefore they must be useless. I also heard this one anecdote about this one school district therefore that anecdote is not only true but perfectly representative of all school districts everywhere. Finally, my experience at a Montessori school is typical of what all private schools would be like if not for that pesky public education system.

  8. Boonton says:

    A number of years ago, in a dinner with a client after work, he was griping about his kids schools. One of his complaints was that the best teacher in his kids school stopped teaching. Why? Because he had three kids of his own and needed the higher pay associated with an administrative position within the school district. That such a position even exists is the crux of the problem with costs in schools.

    If he’s such a great teacher, why doesn’t he get the higher pay he needs from the private school industry? Ohhh wait, even in private schools you get paid more being an administer of the school than a teacher.

    Another friend of mine, was elected and worked for a time in a local school in a suburb of Chicago. He was shocked at the causal corruption endemic in the system. Publishers regularly posted board members on cruises and junkets in return for purchase of new books. Do you think that pushed the cost of the school district up more than just a little?

    Of course it did. But you were not talking about your local school or the Chicago school system in the 21st Century, you were talking about public schools in general and even more sweeping than that you weren’t even talking about public schools in general in the present day but instead public schools for all of history! The facts don’t back you up. There is no great cost differential and educational quality in the general population is higher since the introduction of public schools than it was before.

    I think the fundamental problem with ancedotes is that they are too much about seeing the trees while missing the forest. We all know there’s a lot of stupid people and policies where we work. From that we might conclude we are working or studying at or living in the most absolutely dysfunctional place in the world. This, quite often, though is not reality but a bias of perception.

  9. Boonton says:

    JA

    1) Just so we’re clear, Obama’s health care plan does not provide public health care, so the analogy is worthless as far as private/public comparisons go. The analogy is worthwhile if you want to talk about fully socialized medicine.

    The anlaogy is actually quite fruitful, but for reasons Mark may not expect. Its fruitful because it illustrates the problem with the right wing’s criticism of Obama’s plan, its basically “we hate it because its Obama’s”.

    If you wanted to model a public education bill on the health plan what would its primary features be?

    * Parents would be required to secure an education for their kids.

    * There would be a basic definition of a required education that all would have to meet. Beyond that you could add as much or as little as you cared too.

    * Parents would whatever education plan they want from a list of approved providers and plans. They would get subsidies based on income and THESE SUBSIDIES WOULD COME FROM SLOWING THE GROWTH OF THE PUBLIC SYSTEM!

    * Only the very poor could qualify for free public education. Everyone else must buy their education from the market and there would be no public school system that would compete in the market with or without subsidy!

  10. Yeah, it’s seriously exactly what a Republican plan would have looked like (and is pretty close to what Romney actually implemented) if they had been motivated enough to do it.

    One of my biggest frustrations with the Democratic Party and Obama is the way it/he has compromised preemptively and massively and STILL let Republicans paint him/them as liberals. If you’re going to be painted as a liberal anyway, why not at least advocate HARD for the liberal version before compromising if necessary?

    “Medicare for all” would have been a great way to swing the whole frame leftwards and might have even helped with older voters.

    Obama needs to be commended for getting something done in the right direction while so many have failed before, but his (lack of) use of the bully pulpit to shift the national conversation really sucks.

  11. The fact that people like Mark still think he’s a liberal who refuses to compromise is of course ridiculous and is one of many reasons that has me trying to comprehend their belief system.

  12. Mark says:

    JA,

    The fact that people like Mark still think he’s a liberal who refuses to compromise is of course ridiculous and is one of many reasons that has me trying to comprehend their belief system.

    Well, if you see Obamacare as a poison pill to kill the private insurance and drive everyone to the saving grace of the abomination which is single payer, then it becomes more clear. And speaking of “comprehend their belief system” I still fail to fathom your semi-infinite trust in government that allows to you grant an unchecked right to tax to the feds. Or, for that matter, how a guy with a 90+ liberal voting record in Congress is seen by y’all as “not a real liberal.”

    “Medicare for all” would have been a great way to swing the whole frame leftwards and might have even helped with older vote.Or get anyone with a eye to the budget to run away screaming.

    Boonton,
    The problem with your analogy is that you might be right in requiring education for kids, but there is no reason to require healthcare (insurance) for adults. As noted, two of my relatives opted out of care. Why do you insist they pay for something for which they don’t plan to participate.

    There would be a basic definition of a required education that all would have to meet. Beyond that you could add as much or as little as you cared too.

    If Obamacare’s “minimum coverage” is based on the $600/year penalty for non-participation, how much healthcare does $50 per month buy you? If that level is higher then the penalty by making cheating a more attractive option gives lie to the poison pill noted above. Why do you want a poison pill? How many decades will it take to untangle that? At what cost? Talk about stupidity.

    You still haven’t address why a mandate makes sense if I don’t want to participate. There’s a poster today on the left crowing about how great it is that “millions” of 20 somethings have signed up for insurance. He ignores the question of whether this money they spend actually has bought them anything they will use. Taxing 20 y/olds just ’cause doesn’t seem to me the liberal notion of progressive taxation, i.e., taxing the not-rich doesn’t seem something worth cheering about.

    On education, you’re wrong.

    The facts don’t back you up. There is no great cost differential and educational quality in the general population is higher since the introduction of public schools than it was before.

    No. That grammar school text wasn’t for the “rich elite” and the middle class was getting educated. There were sectors of the populous that were not getting adequate education, I’m not arguing that point. The point is that this is mostly a hit absorbed by the middle class. The “cheering” above backs that up in the healthcare region. It’s the middle class that is getting hit.

    Re corruption: The corruption noted wasn’t in the Chicago schools system and board which is clearly more corrupt. It was a vanilla school system in a far outlying suburb. If there is corruption rampant there, my suspicion is that his the norm not the exception. Your suggestion:

    We all know there’s a lot of stupid people and policies where we work. From that we might conclude we are working or studying at or living in the most absolutely dysfunctional place in the world.

    is not the conclusion I’m drawing. I’m saying we shouldn’t conclude where we are is the most dysfunctional, but that it is ordinary … and dysfunction is the norm.

    If he’s such a great teacher, why doesn’t he get the higher pay he needs from the private school industry?

    Because perhaps he didn’t want to move? The accessibility to large variety of educational opportunities from the jobs perspective might not be as wide open in rural Nevada (an hour south of Reno) than in North Jersey.

  13. Well, if you see Obamacare as a poison pill to kill the private insurance and drive everyone to the saving grace of the abomination which is single payer, then it becomes more clear.

    Oh, so if you believe some wild conspiracy theory for absolutely no reason, then it becomes more clear. Gotcha.

    And speaking of “comprehend their belief system” I still fail to fathom your semi-infinite trust in government that allows to you grant an unchecked right to tax to the feds.

    Who said anything about semi-infinite trust in government? I don’t trust them in a lot of ways. I just said they’re allowed to tax us under the constitution.

    Or, for that matter, how a guy with a 90+ liberal voting record in Congress is seen by y’all as “not a real liberal.”

    I’m talking about his presidency.

    Or get anyone with a eye to the budget to run away screaming.

    Anyone who would have screamed at that is already screaming hysterically about Obamacare.

  14. You can’t pretend you care about the middle class when your party has been making the tax code more regressive for 50 years!

  15. Mark says:

    JA,

    You can’t pretend you care about the middle class when your party has been making the tax code more regressive for 50 years!

    That’s not the point, you claim to care about regressive/progressive taxation.

    Anyhow,

    Why would you oppose a law that fixed the problem even if it only affects 1000 millionaires (who, if they’re anything like Buffett, would still represent a significant chunk of money?

    Because as is being pointed out over and over, it doesn’t come to a very big chunk of money (and for that matter a lot of those “millionaires” dodging taxes are getting dividend payments from tax free municipal bonds … are you against that “loophole?”)

    I’m talking about his presidency.

    Heh. You’re cute. Lesee … this “so-called” conservative vetoed how many bills put forth by a liberal held Senate and House? Hmm?

    If you’re going to be painted as a liberal anyway, why not at least advocate HARD for the liberal version before compromising if necessary?

    That’s because you nominated without very much introspection a guy who has never led in his life, who was supremely inexperienced to boot. Why not? ’cause he’s not a leader. Never has been. He’s a follower. He recently was admitting to being a wonk. Hell, wonk’s are a dime a dozen in Washington. You need a leader in the Presidency not a hipster wonk.

    Oh, so if you believe some wild conspiracy theory for absolutely no reason, then it becomes more clear.

    If you took the trouble to read … I said why it was a poison pill. The “mandate” has been touted as necessary because you need full enrollment to keep the insurance companies solvent. Yet, if the penalty is set so low that it encourages people (and corporations) to un-enroll then you’re going to be in a situation where you’ve mandated coverage no matter the pre-existing condition and at the same time tacitly encouraged mass free ridership? What do you call it besides a poison pill? National suicide? Or to borrow from the Moderate Voice dude I linked today, is it treason?

  16. Mark says:

    JA,
    Just to remind you, if you tax those 1k guys making 1million at 100% it only comes to 1 billion. That’s what, a half a day of deficit coverage? You’ve a 3 trillion dollar gap to close. It’s pissing in th wind if you think its going to help.

  17. He recently was admitting to being a wonk. Hell, wonk’s are a dime a dozen in Washington. You need a leader in the Presidency not a hipster wonk.

    That is a problem Democrats seem to have, I admit. I couldn’t believe it when we nominated Kerry right after nominating Gore. At least Obama can give a speech.

    If you took the trouble to read … I said why it was a poison pill. The “mandate” has been touted as necessary because you need full enrollment to keep the insurance companies solvent. Yet, if the penalty is set so low that it encourages people (and corporations) to un-enroll then you’re going to be in a situation where you’ve mandated coverage no matter the pre-existing condition and at the same time tacitly encouraged mass free ridership? What do you call it besides a poison pill? National suicide?

    I assume you have math to back this up?

    Or to borrow from the Moderate Voice dude I linked today, is it treason?

    WTF is wrong with you??

    Just to remind you, if you tax those 1k guys making 1million at 100% it only comes to 1 billion. That’s what, a half a day of deficit coverage? You’ve a 3 trillion dollar gap to close. It’s pissing in th wind if you think its going to help.

    I don’t think it’s going to help as in fix it, but it’s a small step in the right direction.

  18. Boonton says:

    Well, if you see Obamacare as a poison pill to kill the private insurance and drive everyone to the saving grace of the abomination which is single payer, then it becomes more clear.

    Or perhaps its a plot to boost the sales of alumnin fiol because people will need to make tin foil hats to keep out the Obama-mind-control waves.

    More seriously, the problem with the poisen pill idea of yours is that it would have too many risks. For example, a lot of data seems to indicate that people don’t like to play games with their health coverage (i.e. waiting until something goes wrong to get coverage). They try to secure coverage whenever they can. If a lot of people aren’t going to try to game the system, then insurance companies aren’t going to go bankrupt. If they aren’t going to go bankrupt, then where’s the push going to come from for single payer? Hmmm? Other countries like France have gone with a system where people buy their own coverage from private insurnace with state subsidy or help when necessary for decades with no evidence yet of either a massive bankrupting of the insurance companies or a swing in favor of single payer.

    Or insurance companies could simply lobby to get subsidies or increase the penalties for not being covered or to be allowed to limit pre-existing coverage for a year or two so. Problem solved but if your ‘secret agenda’ was single payer you’re now stuck with a system that’s working well enough to make it hard to convince anyone single payer is needed.

    Your little plot idea isn’t even that original. It’s a variation on the movie The Hudsucker Proxy. In that moview Paul Newman is a high level manager of a company whose beloved CEO has just committed suicide. He and his allies want to take over the company but its stock price is too high. They hatch a plot to select a total idiot as the next CEO which will drive down the price so much that they can buy up a controlling stake. The plan is foiled because the idiot they select is actually a minor genius (his big idea is a circle that he draws on a blank piece of paper for anyone who wants to listen, he says “you know…for kids”….turns out he is talking ’bout the hola hoop and it makes the company millions). Very funny and entertaining movie…..much more funny than your idea.

  19. Boonton says:

    The problem with your analogy is that you might be right in requiring education for kids, but there is no reason to require healthcare (insurance) for adults. As noted, two of my relatives opted out of care. Why do you insist they pay for something for which they don’t plan to participate.

    So for their entire lives these two relatives have never used the health system?

    I suppose if I don’t care about getting mugged I have a right to opt out of police protection and have my proated portion of taxes refunded to me as well than? Hmmm?

    If Obamacare’s “minimum coverage” is based on the $600/year penalty for non-participation, how much healthcare does $50 per month buy you? If that level is higher then the penalty by making cheating a more attractive option gives lie to the poison pill noted above.

    To work as a poisen pill, one would have to not get coverage until right before one had a sign that something was wrong (felling a lump in their breast, noticing a tightness around their heart) and then get signed up right before going to the doctor about it. For most people, this would be a rather risky game to play. It’s also a game you could play today. If you feel a lump in your breast, it’s not a pre-existing condition till a doctor actually sees you and makes a record of it.

    I wouldn’t be surprised if there’s other provisions to protect insurance company in the bill (such as a right to exclude pre-existing conditions from coverage for a time period, like 6 months).

    Perhaps you should consider the stock market reaction to passage of the bill. Care to pull some stock price charts for big insurance companies and point out evidence to us that the market thinks a bill was just passed that would bankrupt them in less than 3 years?

    You still haven’t address why a mandate makes sense if I don’t want to participate. There’s a poster today on the left crowing about how great it is that “millions” of 20 somethings have signed up for insurance. He ignores the question of whether this money they spend actually has bought them anything they will use.

    No one has ever broken into my house. I have never had to use 911. Is the police system therefore a failure? The chances that a ‘don’t want to participate’ person will need and want serious amounts of health care in their life is much, much higher than the chances of them needing a cop to stop a robbery ever. Last time I checked diabetes is getting about 1/5 of us at some point in life, cancer another 1/5, chronic heart disease etc. Unlike the past chronic health problems will be the norm for most of us in the latter part of our lives, not the exception.

    Education
    No. That grammar school text wasn’t for the “rich elite” and the middle class was getting educated. There were sectors of the populous that were not getting adequate education, I’m not arguing that point. The point is that this is mostly a hit absorbed by the middle class. The “cheering” above backs that up in the healthcare region. It’s the middle class that is getting hit.

    The middle class was a lot smaller then too. I’m not saying your text was only for elites, I’m saying its difficulty level is a lot less impressive when you adjust for:

    1. Subjects that are no longer taught as a standard part of the cannon.
    2. The fact that a serious portion of the population was not educated and even among those that were, a serious amount were allowed to drop out. The average of then and the average of now is seriously two different bases.

    Ever see the Clinton Eastwood movie Unforgiven? In it there’s a character called W. W. Beauchamp whose a writer of cheap tabloid gunslinger novels. Invariably whenever he is introduced to someone as a writer, their first question is “writer of letters and such?”. At the time you could make a living writing or reading letters for people who were illiterate. Try to do that now in this age where education has supposedly gone down.

    is not the conclusion I’m drawing. I’m saying we shouldn’t conclude where we are is the most dysfunctional, but that it is ordinary … and dysfunction is the norm.

    Aye ok, but the next question that often doesn’t get asked is how relevenat is the dysfunction in the big scheme of things? For example, the ‘great teacher’ who your friend was sad to see leaving….how ‘great’ is he really in the big scheme of things? For example, do you think in 20 yeas you would feel confident you could detect a statistical difference in the kids that went thru his class versus those that didn’t?

    Taxes

    Just to remind you, if you tax those 1k guys making 1million at 100% it only comes to 1 billion. That’s what, a half a day of deficit coverage? You’ve a 3 trillion dollar gap to close. It’s pissing in th wind if you think its going to help…

    Speaking of crappy education, what is it with basic math that tosses people with higher math knowledge for such a loop? You are correct, a special 100% tax on 1,000 people who make exactly $1M each will raise $1B.

    This, though, is totally irrelevant. Care to guess why?

  20. Mark says:

    Boonton,

    To work as a poisen pill, one would have to not get coverage until right before one had a sign that something was wrong (felling a lump in their breast, noticing a tightness around their heart) and then get signed up right before going to the doctor about it. For most people, this would be a rather risky game to play. It’s also a game you could play today. If you feel a lump in your breast, it’s not a pre-existing condition till a doctor actually sees you and makes a record of it.

    No. To work as a poison pill, one could get short term coverage and leave getting the long term coverage until you are using it.

    If you feel a lump in your breast, it’s not a pre-existing condition till a doctor actually sees you and makes a record of it.

    But after the law goes into effect (strangely in 2014 after the election cycle? Coincidence? I think not). You’ll be able to purchase that coverage without penalty after< ?em> its been identified by a test or doctor.

    I suppose if I don’t care about getting mugged I have a right to opt out of police protection and have my proated portion of taxes refunded to me as well than? Hmmm?

    Well, it might be interesting if you didn’t have to pay for police protection but could jump in during the mugging. If that was the case, why would you pay ahead of time? That’s the question.

    The chances that a ‘don’t want to participate’ person will need and want serious amounts of health care in their life is much, much higher than the chances of them needing a cop to stop a robbery ever.

    Yes, but if I’m 75 and decide ahead of time that if I get cancer (or other long term illness) I’m not treating it, then why do you insist I pay to cover that which I don’t want. Why can’t I leave that money to my children? That’s the problem with the top-down one-size-fits all approach.

  21. Mark says:

    Boonton,
    Or am I forgetting y’all Dems thing passing wealth to children is a bad thing and shouldn’t’ be allowed anyhow.

  22. Boonton says:

    Well, it might be interesting if you didn’t have to pay for police protection but could jump in during the mugging. If that was the case, why would you pay ahead of time? That’s the question.

    That’s less interesting than you think. That would only mean that police departments could not be self-financing from ‘subscription fees’. In effect today police departments are the non-optional ‘base coverage’ while private police options are optional. The first is taxpayer funded, the second isn’t.

    I think your poisen pill concept doesn’t match the facts. There is a moral hazzard danger that too many healthy people will decide $600 is cheaper than buying coverage leaving only sick, pre-existing condition people in the insurance pool. This seems to be offset, though, by employer coverage and the other various incentives in the bill. If not the insurance companies would be screaming over a virtual death sentence being imposed on ’em in less than 5 years and the market would have judged insurance stocks accordingly.

    Yes, but if I’m 75 and decide ahead of time that if I get cancer (or other long term illness) I’m not treating it, then why do you insist I pay to cover that which I don’t want.

    You’re almost certainly on Medicare which is, in fact, optional. You’re free to drop your coverage in exchange for saving $60 a month or so on your social security check.

  23. Boonton says:

    Notice how we’ve moved rhetorically from ‘death panels’ telling Grandma she must be killed to save money for covering young people to Mark worrying about ‘life panels’ that might cost Grandpa $60 a month to get coverage when he may want his cancer to just kill him.

  24. Boonton says:

    I will be happy to fund the construction of a big tower in Washington DC for such victims of the health reform. Any senior who thinks he is being forced to live against his will may go there, climb to the top and toss himself off. There will, of course, be handicap ramps and rails!

  25. Mark says:

    Boonton,

    There is a moral hazzard danger that too many healthy people will decide $600 is cheaper than buying coverage leaving only sick, pre-existing condition people in the insurance pool. This seems to be offset, though, by employer coverage and the other various incentives in the bill.

    Which is the problem. Corporations are going to defect (and have been).

    You’re almost certainly on Medicare which is, in fact, optional. You’re free to drop your coverage in exchange for saving $60 a month or so on your social security check.

    So is $60 an accurate accounting of the cost?

  26. Boonton says:

    Accounting of what cost? If you’re not getting coverage because you don’t want to be treated then you’re not costing anyone anything, including yourself.

    As for whether the $60 is an accurate accounting for Medicare cost of covering a $60 yr old with cancer…..depends. How many years has he been on Medicare? How much did he pay in? How much did he pay out etc. Regardless Medicare was introduced not in the Obama health care bill but under LBJ in the late 60’s so I’m not sure why you think that’s a very important aspect of this debate.

    Which is the problem. Corporations are going to defect (and have been).

    Ancedotes trying to pretend to be trends. I take it you have no market evidence of a mass insurance company bankruptcy pending.

  27. Mark says:

    Boonton,
    I have no clue what this (tower construction) has to do with anything we’re talking about.

  28. Mark says:

    Boonton,

    Notice how we’ve moved rhetorically from ‘death panels’ telling Grandma she must be killed to save money for covering young people to Mark worrying about ‘life panels’ that might cost Grandpa $60 a month to get coverage when he may want his cancer to just kill him.

    So, you’re beginning to cotton on to the notion that “one-size-fits-all” is what is being rejected? Hmm. I suppose that’s progress. Some people should be able to spend more, some less. Choice is what your taking away.

  29. Mark says:

    Boonton,

    There is a moral hazzard danger that too many healthy people will decide $600 is cheaper than buying coverage leaving only sick, pre-existing condition people in the insurance pool.

    So, what happens when that “person” taking the moral hazard step for economic gain employs 100k people (who has a department and means to (a) cover the short term, (b) smooth the purchase of long term, and (c) cover the IRS penalty within the scope of their savings).

  30. Boonton says:

    So, you’re beginning to cotton on to the notion that “one-size-fits-all” is what is being rejected? Hmm. I suppose that’s progress. Some people should be able to spend more, some less. Choice is what your taking away.

    Except:

    1. Granpa has the right to not be covered should he want to.

    2. Whether or not he’s covered, he has more or less perfect freedom to choose his medical treatments including ‘let me die’.

    I have no clue what this (tower construction) has to do with anything we’re talking about.

    You seem to be concerned with Obamacare forcing coverage on unwilling 75 yr olds who don’t want medical care. This odd concern seems to neglect the fact(s) that:

    1. For the most part, the health bill did not impact Medicare coverage.

    2. The 65+ set is already covered by Medicare, “I want to die but Medicare won’t let me” has yet to really be much of a problem. If you really think it is let’s build the suicide tower for those seniors being forced to live so long under Medicare. Likewise I’d really like the GOP to pick this up and run an honest campaign….”hey seniors, tired of your long lifespan pushed on you by big gov’t! Elect us and we’ll help you take back your right to a shorter lifespan!”

    I find it ironic that you put so much care into the most minor of issues. How many 74 yr old men who want to let their cancer kill them are really troubled by the prospect that maybe they might pay $50 a month or so for universal coverage they may not want to use? For this population we must really deny coverage to hundreds of thousands of people? This is what I’m supposed to get worked up over rather than the unemployed single mom who feels a lump in her breast one morning?

    So, what happens when that “person” taking the moral hazard step for economic gain employs 100k people (who has a department and means to (a) cover the short term, (b) smooth the purchase of long term, and (c) cover the IRS penalty within the scope of their savings).

    Firms that employ 100K people already solve their moral hazard issue. They require the insurance company to cover all their employees regardless of condition. In exchange, they usually limit ‘open enrollment’ to only once a year making it difficult for an employee to shift in and out of insurance for only the times when they need it. I’m not really sure what else you’re asking here….I’m not even sure you’re sure what else you’re asking…

  31. Mark says:

    Boonton,

    Firms that employ 100K people already solve their moral hazard issue. They require the insurance company to cover all their employees regardless of condition. In exchange, they usually limit ‘open enrollment’ to only once a year making it difficult for an employee to shift in and out of insurance for only the times when they need it.

    Yes. That’s what they do now. However given a law that requires insurers to pick up pre-existing conditions they can save an awful lot of money free-riding.

    I think an essential problem here is that you think that insurance costs are 10s of dollars a month, not nearer a thousand. Grandpa doesn’t “have the right” to be not covered under Obamacare, that’s what the mandate is about. And if the mandate doesn’t cover the cost of free-riding its a poison pill, as noted elsewhere.

    He has the freedom to choose? But if that’s the case, why are you and JA handwringing about the 40 y/old making a bet he’s “perfectly allowed to do?”

  32. Boonton says:

    Yes. That’s what they do now. However given a law that requires insurers to pick up pre-existing conditions they can save an awful lot of money free-riding.

    Care to explain exactly how they would do this? Basically a firm with 100K employees basically says that they will pay for their health expenses whatever they are. The insurance company is just earning administrative fees for managing the logistics of doing that as well as any savings they can achieve by using their negotiating clout to secure discounts from health care providers.

    For your poison pill idea, the insuance industry seems to think that the additional people who will be getting coverage outweighs the potential risk of savy people who wait until they get sick to get coverage. Otherwise they would be screaming very loud and the market would be crashing their stocks as well. Perhaps you know their business better than they do, but nothing you’ve written to date indicates that.

    I think an essential problem here is that you think that insurance costs are 10s of dollars a month, not nearer a thousand. Grandpa doesn’t “have the right” to be not covered under Obamacare, that’s what the mandate is about.

    Please cite the provision of the bill that denies Grandpa the right to pull out of Medicare.

  33. Mark says:

    Boonton,

    Please cite the provision of the bill that denies Grandpa the right to pull out of Medicare.

    That would be the individual mandate. He is penalized if he doesn’t have insurance. Duh.

    Care to explain exactly how they would do this? Basically a firm with 100K employees basically says that they will pay for their health expenses whatever they are. The insurance company is just earning administrative fees for managing the logistics of doing that as well as any savings they can achieve by using their negotiating clout to secure discounts from health care providers.

    I just did. The company puchases no long term insurance for any individual without long term healtcare needs. Those who come down with long term needs, have insurance purchaesed for them after the problem is contracted. I thought I’d made that clear.

  34. Boonton says:

    Or taxed. How is that different from Grandpa being taxed to cover unemployment insurance? Or aid for the blind or disabled?

    Let’s just imagine a $600 tax to fund unemployment compensation, but with a $600 refund should any person purchase private unemployment insurance that covers their bills for at least 6 months. Or imagine a tax credit for companies that have large campuses and as a result fund their own small fire department?

    Insurance for 100K employees-

    I think you missed what I said. Companies with 100K employees basically are not buying insurance. They are basically saying “send us your medical bills and we will pay them”. The insurance company is simply being tapped because of their expertise in providing processing and administrative services. In effect, if in a year no one out of those 100K people had a single medical expense the company would have no insurance expense aside from what they’d be paying the HMO to print up all those cards and man the 800 lines. This is unlike your world where you actually *buy* insurance. If you have no car accident this year, you still pay for a auto policy.

    Also technically in order for a company to enjoy the tax benefits, they have to provide roughly equal coverage. They can’t health profile their employees and only provide coverage to the ones unlikely to get sick.

  35. Mark says:

    Boonton,

    I think you missed what I said. Companies with 100K employees basically are not buying insurance. They are basically saying “send us your medical bills and we will pay them”.

    Why would the do that any more if they can purchase long term care via purchasing insurance only for those who need long term care.

    Also technically in order for a company to enjoy the tax benefits, they have to provide roughly equal coverage. They can’t health profile their employees and only provide coverage to the ones unlikely to get sick.

    And does that tax benefit come out to be less or more expensive than the free rider option?

  36. Boonton says:

    Why would the do that any more if they can purchase long term care via purchasing insurance only for those who need long term care.

    The reason they don’t is because they don’t have and don’t want to acquire the expertise in processing transactions and policing the receipts to make sure doctors are not overbilling or billing for unreasonable services. They also don’t want to get in the business of negotiating with tens of thousands of doctors and other providers around the nation (any firm with 100K employees is almost certainly nationwide at the very least). For this type of megapool its more efficient to use an insurance company as a type of back office support….esp. because the insurance companies have already done the legwork of creating these networks for their smaller pools.

    And does that tax benefit come out to be less or more expensive than the free rider option?

    I’m still unclear what the ‘free rider option’ is here? Out of 100K people, say 1K will get cancer in any particular year. Is the company going to not provide any coverage for 99K only to switch 1K into a plan real fast if they get cancer? This seems like an exceptionally nimble company that has an exceptional amount of private health information about their employees.

    More importantly, most medical expense is not the car accident model where you have zero claims until whooops, big one. Most is in the form of relationship management where a pool of patients is managed to try to lower the dramatic health expense or delay it. To do that you need regular health coverage.

    No I think the only place where free riders might become an issue is the population that’s not poor enough for Medicaid, not old enough for Medicare, working but not at a company that offers coverage…not able under 26 or not with parents who have work based coverage……I think while its true the industrious contractor might pull off a free rider….it seems the market suspects that will get washed out with the added influx of people who will get coverage.

  37. Mark says:

    Boonton,

    The reason they don’t is because they don’t have and don’t want to acquire the expertise in processing transactions and policing the receipts to make sure doctors are not overbilling or billing for unreasonable services.

    So? Don’t. Buy cheaper short term/prescription-only coverage.

    Out of 100K people, say 1K will get cancer in any particular year. Is the company going to not provide any coverage for 99K only to switch 1K into a plan real fast if they get cancer?

    Seriously. You think 1 in 100 get cancer every yeaer?

    To do that you need regular health coverage.

    Only short term to cover only the ordinary not-as-expensive items.

  38. Boonton says:

    So? Don’t. Buy cheaper short term/prescription-only coverage.

    Most health insurance operates on a year to year model. So I’m not sure what you mean about ‘short term coverage’. Prescription only coverage neglects the fact that you need doctors to write scripts for you…plus exactly how does prescription only coverage handle a broken leg? Kidney failure? Even a history of heart attacks? It’s kind of like saying a solution to auto insurance is to buy an auto policy that covers you only for being hit by a tractor trailier. Yes such coverage will be cheaper no doubt but it would only meet a fraction of your auto insurance needs.

  39. Mark says:

    Boonton,

    So I’m not sure what you mean about ‘short term coverage’.

    Emergency room and doctor checkups = short term (for problems which require less than a multi-day hospital visit).

  40. Boonton says:

    And this will save money how again?