Actuarial papers on Adverse Selection in Health Reform

[Pandora]

Two new papers for you guys to read. Both are brief (4 pages each), and very focused on the impact of adverse selection, and some of the dangers we need to watch out for.

Adverse Selection and the Individual Mandate (http://www.milliman.com/perspective/healthreform/pdfs/adverse-selection-individual-mandate.pdf)
If the mandate to maintain insurance coverage is not strong and effective and cannot prevent adverse selection, and if additional provisions or restrictions accompany a weak mandate, premium rate levels are likely to escalate significantly in the markets involved. This could create a selection spiral that potentially results in an increase in the total number of uninsureds.

Adverse Selection and the CLASS Act (http://www.milliman.com/perspective/healthreform/pdfs/adverse-selection-class-act.pdf)
While the eventual effects of complex financial programs are difficult to forecast, the CLASS Act as currently structured is conspicuous because it introduces guaranteed-issue LTC benefits without installing the kinds of protections necessary to minimize adverse selection risk.


***Aside... I posted the Oliver Wyman report at FRDB, and instead of rational discussion, I got semantic arguments that because the article was written by only one actuary, and the other guy was not an actuary, it was ignorable... because I claimed it was written by "actuaries". I also got tons of argument that because the Blue Cross Blue Shield Association paid for the study to be done by an independent agent, it was dismissible because it was biased.... because insurers paying someone to do the study was indistinguishable from the insurers themselves doing the study. I got maybe 3 posts actually discussing the report itself.

So I just want to say a very hearty THANK YOU!!!! :hug: to everyone here for being so much more freethinking and rational ;).

[Celsus]

Pointing out the biased origin is relevant because it's ridiculously simple to tweak factors in actuarial studies to get the results you want, especially for a subject as complex as healthcare. The simple fact is that universal coverage can and has been done in every developed economy except the US, which finds spending billions of dollars a day in two wars unimportant compared to at worst a few million dollars a day their healthcare system might expand with a universal system.

It's not about the potential effects. It's about the hypocrisy of being so adamantly in favour of one project and so vehemently in opposition to another, one of which actually will affect every single American alive, the other which is a goal for some future unpredictable 'good' (with heavy negative consequences in the present).

[laughing dog]

Pointing out the biased origin is relevant because it's ridiculously simple to tweak factors in actuarial studies to get the results you want, especially for a subject as complex as healthcare. This is especially the case when only health care actuaries have the knowledge and expertise to begin with. Anyone else who even considers studying this must, by definition, do an inferior and slipshod job.

[Pandora]

Pointing out the biased origin is relevant because it's ridiculously simple to tweak factors in actuarial studies to get the results you want, especially for a subject as complex as healthcare. The simple fact is that universal coverage can and has been done in every developed economy except the US, which finds spending billions of dollars a day in two wars unimportant compared to at worst a few million dollars a day their healthcare system might expand with a universal system.

It's not about the potential effects. It's about the hypocrisy of being so adamantly in favour of one project and so vehemently in opposition to another, one of which actually will affect every single American alive, the other which is a goal for some future unpredictable 'good' (with heavy negative consequences in the present).

Did you even read the reports? They have nothing at all to do with universal care, nor are they championing any particular approach. Both are identifying serious risks and concerns with what congress has put on the table - in very high level ways.

Please... before you go off on the "oh it's biased" bit, at least read them. :bang:

[Pandora]

Pointing out the biased origin is relevant because it's ridiculously simple to tweak factors in actuarial studies to get the results you want, especially for a subject as complex as healthcare. This is especially the case when only health care actuaries have the knowledge and expertise to begin with. Anyone else who even considers studying this must, by definition, do an inferior and slipshod job.

Blah blah blah. Same holds true for any other report by any other specialization: climatologist studies, for instance. Yet I don't see you complaining about how the climate studies are biased and how someone who is not a climatologist ought to be doing the studies :rolleyes:. Could it possibly be a case where you like the conclusion of the report, therefore it is "unbiased"... but if you don't like what the report says, it's biased and untrustworthy?

[laughing dog]

Pointing out the biased origin is relevant because it's ridiculously simple to tweak factors in actuarial studies to get the results you want, especially for a subject as complex as healthcare. This is especially the case when only health care actuaries have the knowledge and expertise to begin with. Anyone else who even considers studying this must, by definition, do an inferior and slipshod job.

Blah blah blah. Same holds true for any other report by any other specialization: climatologist studies, for instance. Yet I don't see you complaining about how the climate studies are biased and how someone who is not a climatologist ought to be doing the studies :rolleyes:. Could it possibly be a case where you like the conclusion of the report, therefore it is "unbiased"... but if you don't like what the report says, it's biased and untrustworthy? Projection is the sincerest form of narcissism. It's a
case of an arrogant (and ignorant) appeal to authority.

[Pandora]

Pointing out the biased origin is relevant because it's ridiculously simple to tweak factors in actuarial studies to get the results you want, especially for a subject as complex as healthcare. This is especially the case when only health care actuaries have the knowledge and expertise to begin with. Anyone else who even considers studying this must, by definition, do an inferior and slipshod job.

Blah blah blah. Same holds true for any other report by any other specialization: climatologist studies, for instance. Yet I don't see you complaining about how the climate studies are biased and how someone who is not a climatologist ought to be doing the studies :rolleyes:. Could it possibly be a case where you like the conclusion of the report, therefore it is "unbiased"... but if you don't like what the report says, it's biased and untrustworthy? Projection is the sincerest form of narcissism. It's a
case of an arrogant (and ignorant) appeal to authority.

You seem to really not understand "Appeal to Authority".

I've done no such thing. I have, however, appropriately and properly acknowledged that the experts in a certain field have a more credible understanding of the material than non-experts.

I've got to say - I just LOVE how you imply that the experts in a field are ignorant of their field... while you seem quite certain that you, with no knowledge of the topic, should be considered credible. Talk about narcissism.

[The Barefoot Bum]

First, that the source or funding of some report is known to be biased is not evidence or proof that it's definitely wrong. A known bias, however, completely undermines any otherwise justifiable appeal to expertise. Unless the reader herself has the expertise to understand an actuarial report, then, the information is completely worthless.

Consider too that what you choose to quote in the OP is more or less obvious to anyone who understands even the basics of health care reform: Guaranteed benefits without either an individual mandate or a basis in taxation is counter-productive. That's a point made by all reasonably expert analysts of the health care plan, and one reason liberal and progressive experts such as Krugman have been quelle surprise pushing for a strong individual mandate.

What we are really interested in is whether the bill that actually passes does or does not guarantee benefits without mandating a source of funding as a matter of actual practical reality and political will, a question I don't know how an actuary would even address, or why an actuary would have any relevant expertise.

(Also, as a matter of manners and etiquette, I find it vaguely insulting to be thanked for my open-mindedness before I have opened my mouth, as if I might not be open-minded without the suggestion. It suggests too that any criticism or opposition will be labeled as closed-mindedness; the suggestion has been proven by subsequent commentary.)

[laughing dog]

You seem to really not understand "Appeal to Authority".

I've done no such thing. I have, however, appropriately and properly acknowledged that the experts in a certain field have a more credible understanding of the material than non-experts. I understand appeal to authority. You claim that these studies are better because they are done by health actuaries. There are plenty of experts in health care, and not all of them are health actuaries. The accuracy or reliability of study does not depend on the authors but on the precision of the reasoning, the accuracy of the data, and the reasonability of the underlying assumptions. Tose may be influenced by the expertise of the authors but the study should stand on its on merits not on the alleged merits of the authors. When you claim that a particular study is better because it is don by a particular type of expert, you are making an appeal to authority.

I've got to say - I just LOVE how you imply that the experts in a field are ignorant of their field... while you seem quite certain that you, with no knowledge of the topic, should be considered credible. You are confusing implication with inference. Your straw man is a figment of your arrogance.

Talk about narcissism. No need to, your post is a prime example of it.

[Pandora]

First, that the source or funding of some report is known to be biased is not evidence or proof that it's definitely wrong. A known bias, however, completely undermines any otherwise justifiable appeal to expertise. Unless the reader herself has the expertise to understand an actuarial report, then, the information is completely worthless.
Hmm. So tell me, where is the funding for these reports coming from that makes it so biased? 'Cause I'm pretty sure you're off base on this.


(Also, as a matter of manners and etiquette, I find it vaguely insulting to be thanked for my open-mindedness before I have opened my mouth, as if I might not be open-minded without the suggestion. It suggests too that any criticism or opposition will be labeled as closed-mindedness; the suggestion has been proven by subsequent commentary.)
Reading Comprehension 101: I thanked people here for their openmindedness in regard to the PRIOR report that I posted. It was not preemptive.

[Pandora]

You seem to really not understand "Appeal to Authority".

I've done no such thing. I have, however, appropriately and properly acknowledged that the experts in a certain field have a more credible understanding of the material than non-experts. I understand appeal to authority. You claim that these studies are better because they are done by health actuaries. There are plenty of experts in health care, and not all of them are health actuaries. The accuracy or reliability of study does not depend on the authors but on the precision of the reasoning, the accuracy of the data, and the reasonability of the underlying assumptions. Tose may be influenced by the expertise of the authors but the study should stand on its on merits not on the alleged merits of the authors. When you claim that a particular study is better because it is don by a particular type of expert, you are making an appeal to authority.


Seriously... you REALLY don't get this, do you?

Yes, there are lots of "experts" in the health industry - but they are experts in particular fields. Medical experts, clinical experts, economy experts, etc. For THE TOPICS COVERED IN THESE REPORTS, the experts are called "actuaries".

For actuarial topics, the appropriate experts are actuaries. There is no reason for you to argue that a non-actuary is just as credible as an actuary when discussing specifically actuarial topics! Your insistence on ignoring this is simple contrarianism, and is irrational.

When I claim that a study that relies on "the precision of the reasoning, the accuracy of the data, and the reasonability of the underlying assumptions" is most appropriate coming from a source that has the necessary experience and knowledge, as opposed to that of someone without those criteria, it is NOT an appeal to authority.

ETA: Let's clairify: you're claiming that it is an appeal to authority, and implying that it is therefore fallacious. In truth, it is an acceptance of appropriate and credible authority, and is therefore NOT fallacious. Technically, it is still appealing the authority of the author, but it is NOT fallacious to do so in this case. The problem I have with you here is that you are implying that it is fallacious and thus shouldn't be believed. You have no reasonable basis for implying that it is fallacious.

Let's review:
An Appeal to Authority is a fallacy with the following form:

1. Person A is (claimed to be) an authority on subject S.
2. Person A makes claim C about subject S.
3. Therefore, C is true.

This fallacy is committed when the person in question is not a legitimate authority on the subject. More formally, if person A is not qualified to make reliable claims in subject S, then the argument will be fallacious.

Since this sort of reasoning is fallacious only when the person is not a legitimate authority in a particular context, it is necessary to provide some acceptable standards of assessment. The following standards are widely accepted:

1. The person has sufficient expertise in the subject matter in question.
2. The claim being made by the person is within her area(s) of expertise.
3. There is an adequate degree of agreement among the other experts in the subject in question.
4. The person in question is not significantly biased.
5. The area of expertise is a legitimate area or discipline.
6. The authority in question must be identified.

As suggested above, not all Appeals to Authority are fallacious. This is fortunate since people have to rely on experts. This is because no one person can be an expert on everything and people do not have the time or ability to investigate every single claim themselves.

[laughing dog]

For actuarial topics, the appropriate experts are actuaries. There is no reason for you to argue that a non-actuary is just as credible as an actuary when discussing specifically actuarial topics! Your insistence on ignoring this is simple contrarianism, and is irrational.

When I claim that a study that relies on "the precision of the reasoning, the accuracy of the data, and the reasonability of the underlying assumptions" is most appropriate coming from a source that has the necessary experience and knowledge, as opposed to that of someone without those criteria, it is NOT an appeal to authority. OF course it is. Even your own citation indicates that it is. Perhaps you should read them before you post them.

ETA: Let's clairify: you're claiming that it is an appeal to authority, and implying that it is therefore fallacious. Wrong. I'll repeat my position using slightly different words. I am saying that your claim that study X is more reasonable than study Y because the author(s) of study X are health actuaries is an appeal to authority because it is not based on the relative content of the studies.

[laughing dog]

Reading Comprehension 101: I thanked people here for their openmindedness in regard to the PRIOR report that I posted. It was not preemptive. Um, that is the definition of preemptive.

[Pandora]

Reading Comprehension 101: I thanked people here for their openmindedness in regard to the PRIOR report that I posted. It was not preemptive. Um, that is the definition of preemptive.

No.

I essentially said "Thank you for being so openminded last time". That's not preemptive. It would be preemptive if I said "Thanks in advance for your openmindedness this time".

Expressing appreciation after the fact isn't preemptive.

Like I said... reading comprehension 101.

[laughing dog]

Reading Comprehension 101: I thanked people here for their openmindedness in regard to the PRIOR report that I posted. It was not preemptive. Um, that is the definition of preemptive.

No.

I essentially said "Thank you for being so openminded last time". That's not preemptive. It would be preemptive if I said "Thanks in advance for your openmindedness this time".

Expressing appreciation after the fact isn't preemptive.

Like I said... reading comprehension 101. Since you said it before anyone had read the referenced studies and with a false and snide reference to your experience at another board, you clearly have no idea what reading comprehension 101 means.

[Pandora]

Reading Comprehension 101: I thanked people here for their openmindedness in regard to the PRIOR report that I posted. It was not preemptive. Um, that is the definition of preemptive.

No.

I essentially said "Thank you for being so openminded last time". That's not preemptive. It would be preemptive if I said "Thanks in advance for your openmindedness this time".

Expressing appreciation after the fact isn't preemptive.

Like I said... reading comprehension 101. Since you said it before anyone had read the referenced studies and with a false and snide reference to your experience at another board, you clearly have no idea what reading comprehension 101 means.

I grow tired of your constant harassment.

I posted the same article in both places. I commented on the sophomoric reception it got at FRDB, and expressed gratitude that people here hadn't acted the same way for the same article that I had previously posted here. I thanked them for being nicer here. About the Oliver Wyman report - NOT about these two reports. An Oliver Wyman report that I had posted in the past. And that they reacted to nicely in the past.

Where the hell do you get "preemptive" out of that?

[laughing dog]

I grow tired of your constant harassment. This is either hyperbole or proof that you don't know what constant harassment is. In fact, your snide responses filled with observably false statements could be considered a real form of harassment.

I posted the same article in both places. I commented on the sophomoric reception it got at FRDB, Since the responses there were similiar to the ones here, you must be referrring to your immature reaction to the responses.

and expressed gratitude that people here hadn't acted the same way for the same article that I had previously posted here. I thanked them for being nicer here. About the Oliver Wyman report - NOT about these two reports. An Oliver Wyman report that I had posted in the past. And that they reacted to nicely in the past.

Where the hell do you get "preemptive" out of that?
Well, the few posters in this thread did not read it that way. Perhaps you should consider that fact before you make any more accusations.

[/QUOTE]

[diana]

Um, muidiri?

I don't think we have a reading comprehension problem. You may have meant to thank us for our openmindedness regarding past reports, but what you posted does not say that.

***Aside... I posted the Oliver Wyman report at FRDB, and instead of rational discussion, I got semantic arguments that because the article was written by only one actuary, and the other guy was not an actuary, it was ignorable... because I claimed it was written by "actuaries". I also got tons of argument that because the Blue Cross Blue Shield Association paid for the study to be done by an independent agent, it was dismissible because it was biased.... because insurers paying someone to do the study was indistinguishable from the insurers themselves doing the study. I got maybe 3 posts actually discussing the report itself.

So I just want to say a very hearty THANK YOU!!!! to everyone here for being so much more freethinking and rational .You basically just said that you got a poor reception at FRDB for "the Oliver Wyman" piece--whatever that was. Then you said thanks to all of us for being "so much more freethinking and rational."

You perhaps meant that you were appreciative that we'd been more accepting of "the Oliver Wyman piece," whatever it is, but what you wrote doesn't say that. (A link to the thread where we were, in fact, so much more freethinking and rational regarding said piece would have made this clearer, I suspect.)

As it is, I took it the same way Barefoot Bum did (and I had the same reaction to it). After reading your exchange with laughing dog, I went back and read what you said, looking for the piece I clearly missed before, and I understood it the same way I had the first time.

Just to say: It isn't always the other person's fault that you are not understood--even if that person is a sworn enemy.

d

[munnki]

Easy now chaps...

I have respect for your point of view muidiri. But it is to a limited extent and I'll explain my reasoning. I think that the provision of health care (and the question 'to what extent' is a strong and valid one) should be a universal right irrespective of considerations of nation, religion, class... and etc... And because I believe that, I find that fundamental questions of whether health care should be provided to all or not difficult ones to listen to. I take as a starting position that it should and then think that serious consideration needs to be given to the questions of cost, nature of provision, etc... I think my point of view may be shared by some here but I can't speak for others.

However, the questions of cost are real ones but I think they are questions that should and can be addressed by using taxes whether in the form of vat, increased income tax, or etc... I believe this because I believe that states should be, to a certain extent, based on redistributive principles. I am not to an extreme in that position but it's certainly something I believe that needs to be part of the structure of a modern state that chooses a capitalist base. Why? Well because it's a fairly well established fact, notwithstanding the rants of the Chicago School economists and the neo-Hayekians, that capitalist states produce some fairly radically unfair outcomes. That's not a statement of judgement, in my opinion, it's a statement of fact backed up by examination of the gini co-efficient or indeed any formula you wish to choose that examines structurally the distribution of wealth in modern Capitalist states. This not a recommendation for a change of system nor is it a radicalist leftist position - it is a description of a fact of modern Capitalist states backed up by empirically testable evidence.

It's also my feeling that providing decent health care for all citizens could produce positive economic outcomes. Although this is a hypothesis, it seems a reasonable one. For example, not having to pay fees on each occasion a doctor is visited would encourage people to have the regular check-ups that might prevent more serious problems from emerging. And people with serious problems and no insurance still end up in hospitals - it's just that then there's nobody to pay for them - making them into criminals, at worst, or containing the possibility of rendering them bankrupt - and costing the hospitals untold monies in unpaid bills and administration - who does that benefit? It does also, I will grant, produce a huge number of people who miss appointments or who seek care with no real problems and, indeed, deeper problems alongside those - to me, that's an acceptable problem in a system which is based on what I think is a strong moral position.

For the record though, I think Obamacare is an awful solution, I think compelling people to all get insurance rather than the state actually taking on the problem structurally is a solution which, in the long run, will only benefit the racketeers who run the insurance industry anyway. It is a solution proposed by business, rendered into policy by business and produced in the interest of business with only the rhetoric applying to the people. In this sense, I agree with your criticisms. And while I don't think the insurance business is evil per se - that's a ridiculous extreme - I do think that it has, again, produced some pretty shady outcomes whether we're talking about dead peasant policies, pre-existing conditions, hiked premium costs or small-print exclusionary policies that require high levels of legal skill to understand.

National health care has been done, it can be done and, in my opinion, it should be done. Sure, it has its problems... but how have the alternatives been any better (and yes, by better, I mean better at providing for everyone)? And how have the alternatives come in any way as close as fulfilling what I think is a pretty damn good dream - that of making sure that every human being is given decent and basic provisions for their health regardless of their level of income which should never be and never really was the measure of the worth of a human being anyway.

Not providing it, to me, is pernicious and shameful. It would be understandable but awful in a poor country (although Cuba seems to manage just fine at providing it) but it is wicked to not provide it in rich countries. Being an atheist I believe that heaven and hell are merely useful metaphors for material conditions on earth and a system that tells people they have to die because they weren't lucky enough to have the money to pay for an operation sounds like a pretty apt occasion for use of the latter. Unless we equate the value of a human being to the amount they have in the bank and if we play that game, for real, we're already f£4ked.

[Pandora]

I follow your points, munnki, and for the most part agree with them. I think that if we had addressed the topic earlier in our history, a hybrid solution (private market with government subsidization) could have been found that would be functional... but I think we ignored it too long. I think it's still possible to find a hybrid solution, but it would involve a huge amount of revision and rebuilding of the current regulations... and if you're going to put in that much effort, why not just go ahead and do a single payer solution which is undoubtedly easier than the restructuring needed for a hybrid solution? My only stipulation is that I'd like to see a rational plan for implementing single payer that minimizes the downside effects on an already entrenched industry. I don't see that a sizable increase in unemployment is a good trade-off, especially when it should be possible to form a phased in approach that negates the majority of the problem.

The problem here is that congress is doing their damndest to create a "solution" that solves nothing. The current version makes things worse all around. It allows coverage for everyone... but it increases costs for the vast majority of people who see no increased benefit (or the benefit increase is not proportional to the cost increase). The adverse selection risk with this bill is astronomical, and is very likely going to result in a shift in the uninsured from lower-income to middle-income... which has a reasonable chance of actually resulting in more people being uninsured. The penalties for failure to insure are small relatrive to the increase in costs that most middle-income families will see. It's going to produce even more of a squeeze on the checkbooks of most Americans, and it's going to have some seriously detrimental effects. It's very likely that a large number of insurers are going to exit the individual market in short order - they'll be unable to sustain a solvent business at an affordable premium rate. All in all it's simply a stupid proposal. The side effects are worse than the illness :(. I post these things in the interest of explaining the side effects, in hopes that people will yell loudly at their congressfolks and maybe halt this abysmal trainwreck before it ruins us.

I hear a lot of folks complaining about how this bill is just more pandering to big business, and essentially saying that it benefits the insurance companies, but nobody else. This isn't true though - it doesn't benefit the insurance companies either! It hurts nearly everyone.

Honestly, I just get downright tired of being told that I'm biased and therefore ignorable... simply because I'm offering up reports that explain exactly how bad this bill is... and trying to explain the reasons. Being opposed to a BAD idea is NOT the same as being opposed to any idea. Sometimes I run out of patience :dunno:.

[laughing dog]

The notion that the health insurance industry will be harmed by the current version in the bills is a curious one, since the health insurance industry via its lobbyists and Congressional servants (including Joe Lieberman and Max Baucas) have been active since day one. The heath insurance industry has been fighting single payer insurance for decades.

Some form of the current bills will be passed. Some people's lot will be improved and some will not. From what I've read from disinterested sources, the proposals will result in more people being covered. And, I think this is just a first step in a longer inevitable jounery towards a single payer system.

[Pandora]

Some form of the current bills will be passed. Some people's lot will be improved and some will not. From what I've read from disinterested sources, the proposals will result in more people being covered. And, I think this is just a first step in a longer inevitable jounery towards a single payer system.
At the outset, more people will be covered. But the impact is disproportionate, and it results in the average cost increasing for everyone - even before you consider the cost of taxes. If you would just read the various reports I've offered, you might see the problems that I've been trying to address.

BTW... there are no "disinterested" sources in this - else they wouldn't bother writing about it. I suspect you meant "unbiased", at least in your opinion. But you've sort of taken the stance that anyone involved with the health industry is biased... which is going to make it hard for you to get any credible information.

I'm curious what your "disinterested" sources are. Care to share any of them?

[munnki]

Muidiri, it's pretty safe to say that your comments are valued here, as are you, insofar as being valued in an online forum counts for anything. It's refreshing to see somebody taking up a position that they believe in, even, and especially, in an environment where it may be unpopular for them to do so.

I utterly agree with you when you talk about the solution that solves nothing. Given how Obamacare was created and who was consulted during its creation - I think my comments about by business, for business...etc... stand pretty well. Although I will concede it's not in their interest either... at least, not in the long term, in the short term though it will no doubt, be another record year for the investors...

Again, I agree with you that it should have been created earlier in history and that the moment for actual universal healthcare in a sense has passed in the United States, passed that is, in terms of congressional and senatorial will (and even, because I'm not buying him all that much, in the president's - what he has passed is a please-everybody please-nobody piece of foolishness)... This is, however, a sad truth rather than a democratic one - and it's a truth of how little the representatives take into account the desires of their electorate, and more widely their constituents... What surveys demonstrated prior to Obama's presidency was that the majority of US citizens did want access to universal health care - but then it became a political issue and what seemed like a simple moral issue became a far muggier and foggier one...

It really does come down to the base - you decide on what is moral and then figure out how it is to be implemented. And this is not an irrational position to take. These decisions have led to societies having prisons, hospitals, schools etc.. even though those institutions, in Hayekian terms, are profit-free... To repeat what I said at the beginning of my last post though, and with due respect, to me it really is a moral issue and it works by asking this question 'how can we ensure that all of our citizens have access to baseline free healthcare?' And by free meaning without them having to pay at point of service and with the costs being borne by all the members of that society.

The issue of entrenched industry, I have little sympathy for, industries are born and die - they are, quite simply, in perfect Friedmanite terms, being elimated because they are not competitive enough to provide what is needed (and again, what is needed is cover for everybody). It is simply not in the interest of the industry, as it stands, to provide that level of cover - it is, in fact, in their interest to see that the minimum cover is given for the maximum payout - that's basic business sense. It, therefore, is an archaism in moral terms and needs to be replaced with something that will match the required target - and, again, I'm not saying that will be a straightforward matter but it has to be met. It is, after all, addressing an issue of basic human rights (in my view).

It seems to me that the most successful experiments have been those in Canada, Britain and England (for example)... at providing that level of cover for all of their citizens...

Would it be okay for me to ask you - what, to you, does a well-functioning healthcare system look like?

[laughing dog]

Some form of the current bills will be passed. Some people's lot will be improved and some will not. From what I've read from disinterested sources, the proposals will result in more people being covered. And, I think this is just a first step in a longer inevitable jounery towards a single payer system.
At the outset, more people will be covered. But the impact is disproportionate, and it results in the average cost increasing for everyone - even before you consider the cost of taxes. If you would just read the various reports I've offered, you might see the problems that I've been trying to address. Those reports the views of those authors. I've read the CBO analysis and couple of other analyses - one by Jonathan Gruber - that do not think the adverse selection problem will be so severe.

BTW... there are no "disinterested" sources in this - else they wouldn't bother writing about it. I suspect you meant "unbiased", at least in your opinion. "Disinterested" can mean unbiased. Look it up in any dictionary.

But you've sort of taken the stance that anyone involved with the health industry is biased... which is going to make it hard for you to get any credible information. The major problem in this discussion is your persistence in attributing straw men.

[Pandora]

Would it be okay for me to ask you - what, to you, does a well-functioning healthcare system look like?

Big Picture: A well functioning health care system would have necessary coverage available to all members in the common pool, and would prevent abuse of the system from within and without.

Necessary coverage, of course is open to debate... but in my opinion it should include nearly all catastrophic coverage - with rational limitations placed on end of life care where the extension of life (and its quality) is minimal with respect to the cost of that extension. In my opinion, it should not cover regular checkups or preventive care; these are things that people ought to do on their own, similar to oil changes and tune-ups for your car. I would be fine with some subsidization for those who truly can't afford the basics... but it would have to be closely monitored.

All members in the common pool is fairly important. Common pool implies that they all contribute toward the cost of care. If they don't contribute to the pool, they should have no claim on the benefits. the topic of pre-existing conditions might come into play here... but would be dependent on the funding mechanism and participation requirements.

Preventing abuse of the system is also important. This is where the costs are controlled, and that which keeps it affordable (so far as it can be kept affordable). Internal abuses arise from fraudulent claims, adverse selection, inappropriate utilization, and administrative waste and redundancy. External abuse results from providers gaming the payment system, regulatory excesses, lack of standardization of care, and other stuff that I can't bring to mind right now.

You'll notice that what I consider to be a well-functioning system does not depend on the funding mechanism. Where the money comes from is very much secondary to the system itself. Our current private-payer system has some flaws - it doesn't live up to all of my desires for a health system. But the current bill doesn't fix any of those flaws in any meaningful way, and it makes a lot of things worse.

[Pandora]

Some form of the current bills will be passed. Some people's lot will be improved and some will not. From what I've read from disinterested sources, the proposals will result in more people being covered. And, I think this is just a first step in a longer inevitable jounery towards a single payer system.
At the outset, more people will be covered. But the impact is disproportionate, and it results in the average cost increasing for everyone - even before you consider the cost of taxes. If you would just read the various reports I've offered, you might see the problems that I've been trying to address. Those reports the views of those authors. I've read the CBO analysis and couple of other analyses - one by Jonathan Gruber - that do not think the adverse selection problem will be so severe.
:bang: ALL reports reflect the view of the authors. Those provided by actuaries are at least heavily peer reviewed, and I know that they are knowledgeable in regards to the topic of discussion. Tell me - why should I trust Mr. Gruber's opinion over that of people with a ton of experience with adverse selection? What, in your opinion, makes him a more reliable and credible source?

Seriously - why don't you read the reports I've presented? Just give it a shot - they aren't even very long. Read them... then form your opinion on whether you agree or not. I find it irrational of you to dismiss them out of hand. You have no basis for doing so - they aren't partisan pieces... and your dislike of me shouldn't extend to the sources I provide. Instead of selectively reading only sources that share your outlook, why don't you go ahead and consider the opposition as well, and form your opinion once you're fully informed?

BTW... there are no "disinterested" sources in this - else they wouldn't bother writing about it. I suspect you meant "unbiased", at least in your opinion. "Disinterested" can mean unbiased. Look it up in any dictionary. Whatever. Not common usage in these sorts of discussions, but I don't really care.

But you've sort of taken the stance that anyone involved with the health industry is biased... which is going to make it hard for you to get any credible information. The major problem in this discussion is your persistence in attributing straw men.:rolleyes: Oh? So you are willing to credit health actuaries as having relevant experience, and take the time to consider their opinions? Because that certainly doesn't appear to be what you've done. I'm not attributing strawmen - I'm observing your behavior.

[laughing dog]

:bang: ALL reports reflect the view of the authors. This is untrue.

Those provided by actuaries are at least heavily peer reviewed, and I know that they are knowledgeable in regards to the topic of discussion. Tell me - why should I trust Mr. Gruber's opinion over that of people with a ton of experience with adverse selection? What, in your opinion, makes him a more reliable and credible source? Mr. Gruber has tons of experience in the health insurance industry and tons of experience modelling averse selection. My point is that there is not an uniform view of the effects of the proposed legislation.

Seriously - why don't you read the reports I've presented? Um, just because someone does not automatically agree with your posts or reports does not mean they have not read them. In fact, it may actually mean they have read them.

Just give it a shot - they aren't even very long. Read them... then form your opinion on whether you agree or not. I find it irrational of you to dismiss them out of hand. You have no basis for doing so - they aren't partisan pieces... and your dislike of me shouldn't extend to the sources I provide. This is faith-based argumentation and rather insulting its inaccurate assumptions. It is irrational to assume that someone who disagrees with a position must do so out of ignorance. It is narcissism to assume that a disagreement must be based on personal animosity.

Instead of selectively reading only sources that share your outlook, why don't you go ahead and consider the opposition as well, and form your opinion once you're fully informed? Wow - I hope the warranty on my irony meter is still in effect.


:rolleyes: Oh? So you are willing to credit health actuaries as having relevant experience, and take the time to consider their opinions? [/'quote] Here is yet another appeal to authority and a straw man. I have never said that health actuaries do not have relevant experience nor that their opinions are not unworthy. All I said is that the validity of the conclusions of a report depend on the quality of the reasoning, modelling and assumptions contained in it, and I did not agree that the training or credentials of the authors guaranteed sufficient quality.


[QUOTE=muidiri;94788]
Because that certainly doesn't appear to be what you've done. I'm not attributing strawmen - I'm observing your behavior. You are drawing persistently inaccurate conclusions, and attributing them to me - the very definition of straw men. Given your persistence in this, I hold little hope in an improvement in your observational or reasoning abilities in regards to my posts. Why not juststick with the facts or label your opinions e.g. it seems to me that you are) rather then persist with your straw men.

[Pandora]

Look Laughing Dog - I'm getting tired of this same argument with you.

If you've read the papers, why do you not comment on them at all? Your sole comment on the last three papers I've posted pretty much amounts to "The authors are biased" and "Actuaries have no special knowledge of actuarial topics". You have completely failed to address the papers at all... and you give me grief because I find your instant dismissal of them to be annoying.

If you had posted something by an experienced climatologist discussing a particular aspect of that topic... and I then came in and said "the author is biased, I'll wait for something from an unbiased source", would you not find that to be frustrating? If I further proceeded to say "I don't think the credentials, experience, and training of climatologists is sufficient for me to accept his point of view on climatological topics", wouldn't you view that as being a rather specious dismissal?

You keep insisting that I'm appealing to authority, and implying that it is fallacious of me to do so. Perhaps we're speaking different languages, but I do not believe I have done so. I have pointed out that the authors are qualified in this bailiwick, and that as a general rule actuaries have a greater understanding of actuarial matters than nonactuaries do. This is NOT an appeal to authority, and it frustrates me immensely that you keep insisting it is. If this is an appeal to authority, then any time you accept the view of an expert for any reason, you are also appealing to authority. Your preference of Mr. Gruber's opinion is an appeal to authority as well. I have not asked you to accept their view as the only viable view. I've only asked you to read the papers and comment on the subject. I've asked you to discuss the information at hand. I've pointed out that I believe this is a credible source, and I've given you reasons why I think you should also accept it as a credible source. This isn't appealing to authority - especially as I have not attempted to make a point of my own. I just want to discuss the concerns put forth as potential (and likely) effects of the bill.

You're a smart guy. I'd truly like to actually get a long with you. I don't know if it's feasible. In any interaction we have, you seem to spend your time denigrating and condescending me, dismissing my viewpoint out of hand - often by dismissing my source without ever commenting on why you think it's dismissable. And when I get frustrated, it seems you always holler out "strawman!". I don't recall that you and I have ever actually managed to discuss anything. And on those occasions when I've attempted to appeal to you for actual knowledge and explanation of things that are in your area of expertise... I get nothing but silence. I'm offering an olive branch here. Will you try to discuss things with me and set aside your personal dislike?

[munnki]

All members in the common pool is fairly important. Common pool implies that they all contribute toward the cost of care. If they don't contribute to the pool, they should have no claim on the benefits. the topic of pre-existing conditions might come into play here... but would be dependent on the funding mechanism and participation requirements.

Hey muidiri - this is the part on which we differ most I think. I can think of many reasons why individuals couldn't contribute towards a tax-based system of health care. Capitalist systems don't guarantee people jobs. Circumstances also happen in the lives of people which mean that work is not possible for them. Capitalist systems also don't guarantee equality of wages for equality of work - a teacher or a nurse in a system like this is often paid far less then a lawyer or a stockbroker - but they work roughly the same hours and in the same kind of difficult conditions. So, if we made covering everybody a priority, and I do, then we would have to have a system which was prepared to operate with not everybody paying and with some being able to pay more than others. In other words, I would have to be prepared to pay for the coverage of somebody else and, in return, I would expect that if I were not to be able to work that I would be covered.

A system where only those who pay in get something out, while it seems to be a fair system, is in reality not fair at all. It doesn't take into account ability to pay or not to pay. And it also doesn't take into account where the money to pay came from. In a society with unequal and unfair distributions of wealth and in which people who cannot work to gain capital exist - then a pay-in/get-out system is a structurally unfair system. I know that seems counter-intuitive but it depends, in my view, on considerations of the contexts of wealth and privilege.

There will always be those who take advantage of a system like this - but it is better than not having it. I don't see why seeing the common pool as the nation and tax as the method of payment couldn't be possible - particularly in a wealthy first-world country. And I'm not convinced I'd want a handicapped sister given no care simply because she was unable to contribute through inability to work. Marx sums up my feelings on this issue very well:

From each, according to his ability; to each, according to his need.

[Pandora]

All members in the common pool is fairly important. Common pool implies that they all contribute toward the cost of care. If they don't contribute to the pool, they should have no claim on the benefits. the topic of pre-existing conditions might come into play here... but would be dependent on the funding mechanism and participation requirements.

Hey muidiri - this is the part on which we differ most I think. I can think of many reasons why individuals couldn't contribute towards a tax-based system of health care. Capitalist systems don't guarantee people jobs. Circumstances also happen in the lives of people which mean that work is not possible for them. Capitalist systems also don't guarantee equality of wages for equality of work - a teacher or a nurse in a system like this is often paid far less then a lawyer or a stockbroker - but they work roughly the same hours and in the same kind of difficult conditions. So, if we made covering everybody a priority, and I do, then we would have to have a system which was prepared to operate with not everybody paying and with some being able to pay more than others. In other words, I would have to be prepared to pay for the coverage of somebody else and, in return, I would expect that if I were not to be able to work that I would be covered.
I think perhaps you overgeneralized my generalization. I tried to keep the wording independent of funding mechanism. As a general rule, everyone pays taxes. Some people sometimes don't pay taxes, and are net users of the system... but generally speaking, all of us are expected to pay taxes. If you didn't pay them this year, at least you've paid them in prior years, right? And you hope to pay them in future years, right? So if a system is tax-based, then in general, everyone contributes to the pool. Exceptions may occur, but rarely. I worded it this way in opposition to schemas in which the user of the system is by definition not a contributor - Medicare, for example. Additionally, I was careful in my wording - contributions need not be equal, nor even proportional. While I'm not a big fan of progressive taxation, it would still work in my version of a well-defined system.

A system where only those who pay in get something out, while it seems to be a fair system, is in reality not fair at all. It doesn't take into account ability to pay or not to pay. And it also doesn't take into account where the money to pay came from. In a society with unequal and unfair distributions of wealth and in which people who cannot work to gain capital exist - then a pay-in/get-out system is a structurally unfair system. I know that seems counter-intuitive but it depends, in my view, on considerations of the contexts of wealth and privilege.

There will always be those who take advantage of a system like this - but it is better than not having it. I don't see why seeing the common pool as the nation and tax as the method of payment couldn't be possible - particularly in a wealthy first-world country. And I'm not convinced I'd want a handicapped sister given no care simply because she was unable to contribute through inability to work. Marx sums up my feelings on this issue very well:

From each, according to his ability; to each, according to his need.

We'll never see eye to eye on this particular quote here ;). I view it as one of the biggest con jobs ever. It encourages need and penalizes ability. And that's always going to be a losing combination. It asks that we value those who can't more highly than those who can, and that we adore those who need above those who provide. It makes ambition, integrity, and drive into sins to be hidden; and it makes beggary a noble endeavor.

It also makes me wax poetic :p.

It's probably in both our best interests to simply not go there.

[munnki]

We'll never see eye to eye on this particular quote here ;). I view it as one of the biggest con jobs ever. It encourages need and penalizes ability. And that's always going to be a losing combination. It asks that we value those who can't more highly than those who can, and that we adore those who need above those who provide. It makes ambition, integrity, and drive into sins to be hidden; and it makes beggary a noble endeavor.

It also makes me wax poetic :p.

It's probably in both our best interests to simply not go there.

It's really down to how you interpret it and see it being applied. There are multiple ways of looking at it (that quote, that is) - my way is outlined and contextualized by my comments above. But I'm happy to, as you say, not go there if you wish... but I don't think it has to be interpreted to mean what you interpret it to mean - if you're with me. And nor do I want to encourage a society that's based on mediocrity or laziness.... I just don't care for societies which reward corruption, greed, lying and which reserve the highest salaries for the worst of its members either... There needs to be a happy ground between utopian idealism (and that's the idealisms of the right and the left [cause things don't just resolve to the best when Friedmanite ideas are applied nor did they when Leninist-Marxism was applied]) and the mess we're in... is what I'm saying.

[Pandora]

We'll never see eye to eye on this particular quote here ;). I view it as one of the biggest con jobs ever. It encourages need and penalizes ability. And that's always going to be a losing combination. It asks that we value those who can't more highly than those who can, and that we adore those who need above those who provide. It makes ambition, integrity, and drive into sins to be hidden; and it makes beggary a noble endeavor.

It also makes me wax poetic :p.

It's probably in both our best interests to simply not go there.

It's really down to how you interpret it and see it being applied. There are multiple ways of looking at it (that quote, that is) - my way is outlined and contextualized by my comments above. But I'm happy to, as you say, not go there if you wish... but I don't think it has to be interpreted to mean what you interpret it to mean - if you're with me. And nor do I want to encourage a society that's based on mediocrity or laziness.... I just don't care for societies which reward corruption, greed, lying and which reserve the highest salaries for the worst of its members either... There needs to be a happy ground between utopian idealism (and that's the idealisms of the right and the left [cause things don't just resolve to the best when Friedmanite ideas are applied nor did they when Leninist-Marxism was applied]) and the mess we're in... is what I'm saying.

Hmm. Is suppose the interpretation could shift it some. I agree there has to be a happy medium. I'd like to see the best and most able, most dedicated etc. be rewarded. I'd like to see people willingly give a hand to those in need. I don't think that the marxist approach can accomplish it, even though I fully understand the allure of that ideal. If people actually worked the way that marx wanted them to work, it'd be a great approach. But you need to find the path that works with human nature - encouraging the best aspects, and discouraging the worst. I don't think that communism does that... nor do I think that the caricature of the robber baron does it either. I think it is possible to do so, but not necessarily easy to get the ball rolling.

I often wish it were possible to discuss the concepts involved in "how the world ought to work" without any of the labels we have invented. They're too fraught with suppositions and assumptions, and often end up acting as roadblocks to rational conversation.

I'd be willing to discuss it with you :)... just maybe in a different thread?

[munnki]

We'll never see eye to eye on this particular quote here ;). I view it as one of the biggest con jobs ever. It encourages need and penalizes ability. And that's always going to be a losing combination. It asks that we value those who can't more highly than those who can, and that we adore those who need above those who provide. It makes ambition, integrity, and drive into sins to be hidden; and it makes beggary a noble endeavor.

It also makes me wax poetic :p.

It's probably in both our best interests to simply not go there.

It's really down to how you interpret it and see it being applied. There are multiple ways of looking at it (that quote, that is) - my way is outlined and contextualized by my comments above. But I'm happy to, as you say, not go there if you wish... but I don't think it has to be interpreted to mean what you interpret it to mean - if you're with me. And nor do I want to encourage a society that's based on mediocrity or laziness.... I just don't care for societies which reward corruption, greed, lying and which reserve the highest salaries for the worst of its members either... There needs to be a happy ground between utopian idealism (and that's the idealisms of the right and the left [cause things don't just resolve to the best when Friedmanite ideas are applied nor did they when Leninist-Marxism was applied]) and the mess we're in... is what I'm saying.

Hmm. Is suppose the interpretation could shift it some. I agree there has to be a happy medium. I'd like to see the best and most able, most dedicated etc. be rewarded. I'd like to see people willingly give a hand to those in need. I don't think that the marxist approach can accomplish it, even though I fully understand the allure of that ideal. If people actually worked the way that marx wanted them to work, it'd be a great approach. But you need to find the path that works with human nature - encouraging the best aspects, and discouraging the worst. I don't think that communism does that... nor do I think that the caricature of the robber baron does it either. I think it is possible to do so, but not necessarily easy to get the ball rolling.

I often wish it were possible to discuss the concepts involved in "how the world ought to work" without any of the labels we have invented. They're too fraught with suppositions and assumptions, and often end up acting as roadblocks to rational conversation.

I'd be willing to discuss it with you :)... just maybe in a different thread?

Surely... although it being 2am here (and snowing... snowing... snowing!) I shall have to leave that til tomorrow... I'll set up a thread then and pm you...

[laughing dog]

Look Laughing Dog - I'm getting tired of this same argument with you. I can see why. You trot some straw men and then get upset when someone points that out. Given the persistence of this trait (the rest of your response in this post is just another classic example of your flinging utter nonsense) I think the best solution is for me to use the ignore function. That way you don't get tired and everyone else does not get tired of the same stuff between us.