Of Obamacare & Part-Time Jobs

On healthcare and healthcare costs, I try to take a pragmatic approach. I’m for whatever combination of market and government that can deliver the best quality healthcare for the most possible. I am not a pro-market or pro-government ideologue. Obamacare — or to give it its proper name, Romneycare The Affordable Care Act — is a strange hybrid of market and government. Yet, I worry that it may encapsulate the worst of both worlds. I have listened keenly to criticisms of Obamacare — specifically, the idea that the healthcare mandate creates a subsidy for for-profit health insurers — and I have worried myself that the individual mandate creates the potential for mandates for the purchase of other market goods. Yes, there are incentives to bring down the cost of care, but evidence is so far quite mixed.

One aspect of criticism I have not paid enough attention to is the labour market impact — specifically, the idea that the employer mandate (which compels firms with 50 full-time employees or more to provide healthcare to fulltime workers) will result in a greater number of part-time jobs, and less full-time jobs. The Washington Times reports:

Since January 2009 the country has added a net total of 270,000 full-time jobs, but it has added 1.9 million part-time jobs, according to the House Ways and Means Committee.

The numbers come as Republicans argue that the president’s health care law is pushing businesses to save money and push workers into shorter schedules to avoid the penalties that come from hiring more full-time workers, who under the law will be required to be covered with health care insurance.

Yet correlation is not causation.  This effect cannot entirely be the fault of Obamacare. In this depressed economy, there has been a global shift toward part-time work. Obamacare and its employer mandate cannot be forcing employers in Europe or Britain to take on less full-time workers, and more part-time. But perhaps Obamacare is exacerbating an underlying trend. Because the shift at the margin is very pronounced:

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If it is really the case that Obamacare is disincentivising full-time work, then hopefully this shift away from full-time work is only a temporary one. Employers scared of the potential for a high-cost mandate at a time of economic upheaval might try to resist Obamacare, shedding full-time workers and hiring part timers to push themselves below the 50-worker threshold. Once Obamacare is up and running — and especially if it really does reduce costs, and if the economy is growing — employers might stop resisting, and begin hiring full-time workers again.

On the other hand, if healthcare costs remain high and rising, and employers remain resistant then the 30-hour threshold could increase in importance, and the growth of part-time work could continue. This raises larger questions. At this point, the 30-hour threshold seems ill-conceived.  Why should employers be responsible for the healthcare of a worker that works 30 hours a week, but not one that works 29?  In an era where the availability of full-time work is decreasing globally, should the government not try to avoid worsening this phenomenon with arbitrary thresholds? Shouldn’t large firms be responsible for their part-time employees’ healthcare too?

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63 thoughts on “Of Obamacare & Part-Time Jobs

  1. Romneycare is funded by a state government that cannot, by its Constitution, run deficits. Therefore, Romneycare inherently must stay solvent and cannot promise more than it can deliver. Massachusetts was operating well within its constitution to enact healthcare. The Federal government on the other hand had and has no enumerated power to legislate health care. Chief Justice Roberts had to rewrite Obamacare as a tax to give it constitutionality. The Obama administration had specifically refuted Obamacare as a tax.

    • R.T. Greenwood, here is some evidence to prove that RomneyCare is doing well largely because Massachusetts receives more than its fair share of Medicare dollars from Uncle Sam.

      “21 states take aim at Mass. hospitals’ Medicare windfall– Nantucket’s tiny hospital that funnels hundreds of millions to other institutions”:

      http://www.bostonglobe.com/news/nation/2013/01/13/states-planning-legislative-fight-for-massachusetts-medicare-windfall/HV4WGdUCSOISoTxIcbwSUL/story.html

      Evidently, Medicare reimburses urban hospitals within a given state is based on what the standard of living is for its rural hospitals. And because Massachusetts’s only rural hospital is in Nantucket where the standard of living is far higher than it is in most other rural communities across the US, urban hospitals in Massachusetts, most of which are in the Boston area, receive exceptionally high reimbursements from Medicare. The way Medicare reimbursement also works is that the more reimbursements one state get, the less another state gets. It’s based on the age-old concept of robbing Peter to pay Paul. This is why a coalition of states, — a coalition of Peters, if you will — who are getting the short end of stick in terms of Medicare reimbursements, have proposed legislation to put an end to this so-called “Bay State boondoggle.” Some say that John Kerry helped craft the legislation which has resulted in this boondoggle of a windfall for his state. I don’t know for sure if this is true. But what I do suspect is true is that the success of RomneyCare is mostly due to the fact that a disproportionately large amount of Medicare dollars have been flowing into the state of Massachusetts over the past several years. If RomneyCare was set up in a “Medicare-poor” state like Missouri or Michigan, as opposed to a “Medicare-rich” state like Massachusetts or California, my guess is that this blueprint for ObamaCare would fail miserably and go belly-up in a Wall Street minute!.

      • Whether Romneycare succeeds or not is not my point. My point is the Constitution says what it says, like it or not, with regard to healthcare legislation and the Constitution is a contract between the federal govt, state govt, and individuals and is a document that enumerates the powers of the federal govt leaving all other powers to the states and individuals.

        However I agree totally with John Aziz’s central point that healthcare in the U.S. is massively expensive. As such I think ANY implementation of institutional healthcare, public or private, is doomed until prices are contained.

        Btw, Romney never recommended Romneycare at the federal level. So I don’t accept Romneycare as a blueprint for Obamacare. He did say it could be a model for all states all of which MUST BALANCE BUDGETS other than Vermont I believe. I actually think the finite ability to tax state residents in a balanced budget context might be a viable market confinement mechanism for medical costs so I agree with Romney.

  2. The free market does actually work in healthcare. One need only to look at Lasik eye surgery as a prime example. This procedure, which is not covered by any insurance policy, has become dramatically better over the last decade, while at the same time much more affordable. The reason for this is that the patient and the customer (i.e. the one actually paying the bill) are the same. The only way to improve health care results and lower costs, is to remove government from the equation. We are headed for a two class healthcare system, as more physicians opt out of accepting insurance, and become private contractors for the wealthy.

    • Agreed. Know 2 people who have had this eye surgery. The price is competitive for the technology involved.

      But the 2 friends were in a lot of pain afterwards so I am scared to get done! I stick to my scratched up glasses.

  3. Perhaps the question to ask is: Should an employer be responsible for health insurance at all? If yes, why not also require employers to provide auto insurance…life insurance…and where should it stop?
    The entitlement mentality has no bounds.

    • Paul — what entitlement mentality? Have you seen healthcare costs in America recently compared to Europe? I’m not interested in entitlements — I’m interested in lowering healthcare costs.

      • Absolutely true! Unfortunately, Obamacare is far more likely to increase those costs than to reduce them.
        Lasik surgery is not covered by Medicare, Medicaid or most private insurance. It is very popular and the costs have been dropping every year. When people have to pay for a procedure out of their own pocket, prices drop. When the procedure is covered by insurance, prices rise.
        When I speak of entitlements, I am not just referring to government largesse – people who have insurance also feel entitled.

      • “Have you seen healthcare costs in America recently compared to Europe?”
        The NHS costs upwards of £2k per year.
        How much does health insurance at a hospital where you might starve to death cost?

    • You’ve nailed it, Paul! It’s unconstitutional for the federal government to dictate terms of contracts between employers and employees; and it’s foolish for state governments to do it.

  4. Employers should not be responsible for employee health insurance period! The whole concept of benefits is to create a competition in the labor force. Those employees with better qualifications will gravitate towards the companies that provide the best benefits package. Mandating benefits onto the free market is just another form of governmental control which leads to mediocrity in the marketplace.

    • I personally would not have constructed Obamacare the way it is constructed. The evidence seems to show that socialised healthcare — treating health care as a public utility — is the most efficient system in terms of keeping costs down and ensuring provision for the most people, so I would have constructed a single payer system.

      But if benefits are mandated onto the market, it makes no sense to have ones that incentivise greater numbers of part-time workers as less full-time workers!

      • A single payer system would not have fixed our problem. In fact, it would have made care available to less people, because such a system, had it been passed in the US, would have resulted in a mass exodus of physicians from the practice of medicine. Especially now, as we see massive inflation of asset prices. I guarantee you that there are a multitude of physicians that are looking at their monthly brokerage statements right now, and saying to themselves…”maybe it’s time to get out”. We are going to see massive rationing of care in the future. I know how docs think about this issue, because I am one. I retired from practicing medicine in 2005.

        • “I guarantee you that there are a multitude of physicians that are looking at their monthly brokerage statements right now, and saying to themselves…”maybe it’s time to get out”.”

          If that is the case, then they should have never, “got in,” in the first place.

          Although a single-payer system is not sustainable for much longer than a corporate controlled system, most physicians seem to cope with it quite well throughout the world.

          If it is a sick-care system you desire, then a single-payer system is the way to go. Do you seeing anybody complaining [in general] about their Medicare coverage?

          The problem is not the type of insurance, but the intent of the system. This is ALWAYS the case.

        • If a Canadian style health care system (which is single payer) would result in a “mass exodus of physicians” in the United States why hasn’t such a system had the same result in Europe, Australia, Japan, or in Canada? I am curious as to why so many countries can cover their citizen health needs at 50-60% of U.S costs and do it with better results. I think health care should either be regulated in the way that water and electricity are regulated or it should be completely government run. The United States public pays far to much for it’s health care in comparison to the rest of the world. I have traveled to Canada many times over the years and I have yet to find a Canadian that wants the US health care system in their country. That is probably after discussing the matter with somewhere between 75 and 100 Canadians. Not a singe person wants the US health care system. Not one !!! They find the proposition ludicrous that there is even the suggestion that Canadians are envious of the US system.

        • Well, I live in and practiced medicine in a Canadian border town (Bellingham WA) and our hospital is full of Canadians who come down here to have tests and elective surgical procedures. Why would that be, if they are all so satisfied with their healthcare system? Canadian doctors do not start out their lives in the practice of medicine with an average of $250-300k of student debt. That is one reason why comparing how doctors would respond to the imposition of such a system is unpredictable. Unfortunately, we have not been preparing, as a society, for the demographic shifts we are seeing with an aging population. There has been no effort to increase the number of medical students in the piipeline, nor address the cost of educating them. So if you want a socialized medical system, perhaps the best place to start, is with the funding of medical education. Perhaps initially offer an optional tract that would allow someone to enter and complete medical school with no out of pocket cost, in exchange for trading so many years serving at a public health clinic in an underserved area. If Obamacare is fully implemented, and tens of millions are added to the rolls of the insured…there will be a massive strain on our medical care system. There is plenty of hard data to show that when people have insurance, they use the system more, and often times for things that don’t really need care by a physician. This increased pressure on the system will only serve to increase the stress physicians feel when trying to provide care, avoid getting sued, and earn an income commensurate with their years and cost of training. Look at any recent survey of physician job/life satisfaction, and you will see the future is bleak, as many of these people will decide that if they want to remain married, and not become a raging alcoholic, they will need to leave the practice of medicine as these new stressors get piled on.

        • DM, the answer is not more physicians, hospitals, tests, procedures, etc., instead, it is taking the onus off of the providers and putting it back on the patients. Patients must be made responsible for their own health care.

          Canadians come to the U.S. because the American system caters to super high tech tech medical/surgical treatment because this generates the highest profits. If you have run out of options, this is where you would naturally gravitate.

          I completely agree with you that all health care workers should receive remuneration commensurate with their training; the problem is that it is impossible to figure out what this might be in the current fascist system we now enjoy.

          The solution to any problem is always the same, individualization through simplification.

        • Dungeon Master,

          Although medical-school graduates are saddled with enormous debt due to high tuition costs, their residence training is fully paid for through the Medicare Trust Fund. There is no other profession that I can think of, besides a few professions in the military, whereby the on-the-job training is fully paid for by the taxpayer, so it’s very hard for me have any sympathy for any medical-school graduate who’s up to their eyeballs in tuition debt.

          And since many medical residents can afford to buy a house and keep a spouse and a newly born baby at home on a residence salary, their take-home pay can’t be all that low. From what I’ve read, their salary range is from $45,000 to $65,000. The taxpayer doesn’t subsidize the training of nursing-school or pharmacy-school grads, much less the training of engineering or computer science grads, then the taxpayer shouldn’t be subsidizing the training of medical-school grads either.

        • I agree wholeheartedly with your plan Cynthia. While in training, we should then be able to bill separately for any work we do….because in all actuality, after the first year of residency, a resident is simply serving to make the lives of the attending physicians easier by doing much of their work for them. Additionally, under your scenario of completely unsubsidized medical training, we physicians should be free to charge whatever rates we wish for our services and also be paid at 100% of what we charge…not some miniscule % that Medicare decides to pay. What other typical businesses exist out there where a service is provided, and then the person providing the service has to spend tens of thousands of dollars per year on staff, just to be able to collect the payment for the service they have already rendered? This is the way it should be for any medical care that is not a life threatening emergency. Physicians should be able to have a menu of all their fees for non-emergency services, and anyone that sees them is obligated to pay the rate listed. BTW, this would be one way to lower costs….real price competition.

          The last time I checked, nursing students didn’t work 120 hours a week, sometimes working 48 hours straight with no sleep during their clinical training…like I did when I went through residency. Let’s say an average of 100 hours per week, at $50,000 salary per year during residency. That works out to about $10 an hour. The starting hourly pay at In-N-Out Burger is higher than that right now.

        • “Additionally, under your scenario of completely unsubsidized medical training, we physicians should be free to charge whatever rates we wish for our services and also be paid at 100% of what we charge…not some miniscule % that Medicare decides to pay.”

          DM, you are living in some kind of dream world if you think you could just charge whatever you wanted in a free-market. Before Medicare/Medicaid, fees when quite reasonable and affordable for the vast majority of people to pay all medical coats out-of-pocket.

          It is only with the advent of government subsidization/insurance did fees skyrocket due to the investment in technology out-running the ability of the society/individuals to pay for it.

          It is this paradigm [maximum corporate profits] that has created tremendous imbalances in the system, creating higher physician fees for a couple of decades until the insurance companies perfected their financialization scheme, and threw us into the scrapheap of labor-for-hire [cheap].

        • I was trying to make the point that there is no true price discovery in medicine when a third party is paying for the services. You are right about it being a fantasy…The government and corporate interests are too entrenched at this point to have such a system. Having a system whereby doctors can expect to be paid what they charge, for non life threatening care, would however, lead to lower cost, higher quality care. If patients were involved in actually paying for their care, they would demand better care at better prices over the long term. The current system of dissociation of the user of the service from the payor for the service creates the worst of all possible outcomes. Doctors get away with substandard care / too expensive care (i.e. ordering tests without regard to cost/benefit analysis) because for most patients…they pay their co-pay, and don’t worry what the cost is. We will soon see the “haves” going to concierge medical practices run by many of the best doctors, and the rest of the people filing in like cattle to be seen by doctors employed by large hospital systems.

      • John: Evidence seems to show that Obamacare is a already a “train wreck” — higher cost, less coverage, more one-size-fits-all, etc., than the expensive quasi-government mess we have now. There was reportedly a “Keogh Report” revealing previously covered-up egregious disadvantages in the UK national healthcare system — true? We hear lots of complaints from Canadians too.

        It is obvious that the “most efficient” system for a safety net (charity, a “hand up not a hand out)” in healthcare, food, clothing and shelter is to offer it “in kind” — clinics, mess halls, thrift stores, dormitories, etc. If one can get and keep a job that provides partial-payment of healthcare of his choosing, he will. If he can’t, he will fall back on second-best from private or public charity.

        I hope it’s not “too much of a stretch” to compare the ideal of socialized medicine as a universal entitlement to the disastrous attempt at global hegemony and enforced peace and democracy. For the US, the latter is unnecessary as we reach energy (oil) independence in spite of opposition from Obama’s corrupt administration.

        • I visit Canada regularly. In over 10 years I have yet to find that elusive Canadian that would prefer the U.S. system to their own. Sure, they have complaints. Everyone has complaints about health care in every country in the world (I have traveled to many countries). You will never find anything devised by man that you can’t find something wrong to complain about. So your “lots of complaints” statement means nothing. The health care costs in Europe and Canada are 50-60% of those in the United States. Further, their satisfaction with their system is at higher levels than in the United States. If you tell a Canadian that you hear on television they would prefer the United States health care system, they look at you with astonishment. Sort of like you just spotted Elvis Presley. Please don’t use Canadians to buttress your argument because that is utter nonsense. If you don’t believe me, go to Canada and ask them personally as I have done over the years.

      • So what other industries do you want the government to take over, so the collective can have their products be “cheaper and more available”? Trying to say that one could just suddenly impose a single payer system on the United States, and the end result would turn out exactly like you think it should is short sighted. This is not Europe, and ignoring the effects on the supply of labor (doctors) by doing so here ignores a major and highly probable unintended consequence of your supported plan of action.

    • Karl,

      Since it looks like we won’t be able to level the playing field for all Americans by having Medicare-For-All, then we should at least level the playing field for all Americans by eliminating employer-based health insurance plans, including plans that cover government workers at all levels of government, and plans that cover career politicians, many of which are covered for life!

      It’s welfare for the rich as its worst for a multimillionaire plutocrat like Dick Cheney–who, by the way, is a war criminal in the eyes if the Hague — to be handed a million-dollar winning lottery ticket for a heart transplant, that’s paid in full by the the US taxpayers. Dick Cheney has got more than enough money to pay for his own health insurance. In fact, he’s got more than enough money to pay for all of his healthcare, including his million-dollar heart transplant, out of his own personal bank account.

      Another advantage to getting rid of employer-based health insurance is that it will encourage workers to move and seek employment elsewhere, or make it easier for them to strike out alone as entrepreneur without having to worry about losing their health insurance. I can’t think of a better way to support entrepreneurship, besides having Medicare-For-all, than to let employer-based health insurance go the way of the dinosaurs!

      • Ideally, you get the government and the corporations out of health care and give it back to individuals.

        Human compassion is manifest only through individual human beings, rarely if ever through groups.

  5. Gentleman I fear we have been infiltrated at all levels of Government and the bureaucracy by Fabian Socialists who care not for the country but their globalist agenda. See Agenda 21. I am seeing this at the local Government level, school boards, State Level, State bureaus like Roads and Infrastructure. It is amazing what one learns being a Politician. You get access to people who would normally never take your call. I am learning a lot and enjoying myself!

    We are at war with a people who car e not for the individual and what is right but what is good for the Kollective and power. Pretty scary actually how deep it runs. How do we re-educate the indoctrinated?

    • “How do we re-educate the indoctrinated?”

      Who among us is not indoctrinated?

      It’s only a matter of degree, no?

      • Doggone it, Imp. Every time I raise you up as an exalted example, you fall off your perch! I am not indoctrinated! You are not indoctrinated! Buddy is not indoctrinated! {Unless you mean the definition: “To imbue with learning”, and that’s NOT what Buddy meant}. Anyone who sees that human good must come from the individual is not indoctrinated with the evils of our time and history.

        There are a hell of a lot who are, and “we have our work cut out for us”.

        • DG, unless you hold yourself out to be a fully enlightened being, you are indoctrinated.

          And after all, isn’t indoctrination simply a lack of awareness?

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  7. The patient has arrived at the ER with a massive coronary, and we huddle around his left foot wondering what to do about his in-grown toenail.

    The problem with health care is that it is not health care, but instead, a system designed to heal, repair, replace, and otherwise manipulate body parts, something that is so outrageously absurd, that only the United States could completely immerse itself in such a grandiose adventure.

    As I have previously pontificated, the ONLY solution to the health care mess is prevention only. This would be health care.

  8. People should take good care of themselves and live heathy life style try to stay in healthy state as much as possible. Most cases their health problems are due to their own doing. Moreover people should accept it when the worst come the worst. When ones time’s up and one can’t afford to hang on , one must go and gladly because one shouldn’t expect others to pay for one’s hanger on time.

  9. I find people who abuse their bodies, abuse the trust of tax payer, abuse their neighbours by keeping a poor house, and demand the Government print money out of thin air to be the perfect Democrat voter.

    • I abhor generalities – people who say “always” or “never” are usually wrong at least part of the time – but I must agree that your conclusion is mostly accurate.

    • Yes, the Republican are so wise. If only “they were in charge”. I don’t know any republicans that abuse their bodies, rip off the tax payer, have a dirty house or take any government money for any reason. Darn those democrats for ruining a perfect world.

      • Mike: Buddy in Australia and I and other Americans aren’t defending, promoting, or joining/supporting Capital Republicans. They’re called RINOs (Republican In Name Only) by some, but I call them Democratic Light. The RDP (Radicalized Democratic Party) are criminals, and the Washington Republican politicians (except for a few new faces — Paul, Cruz, Rubio, et al) are corrupt or weak cops. We seek a real Loyal Opposition — loyal to the people, not to Party, career, bribes, etc. The “grass roots” must rise up and return power to the people.

        “Inside the Beltway”, it’s Democrat vs. Republican; outside, it’s government vs. the people!

  10. The problem with market forces determining health care is that they don’t work in a pure market sense. Consumers almost exclusively use health care when it’s needed, and not be choice. Lasik is an example cited as proof that market dynamics work, but Lasik is a 100% elective procedure. When your kid falls off a play structure and injures him/herself you go to the Dr. I don’t know anyone who pro-actively calls ERs, and urgent care facilities to price radiology rates, or to see if there’s a clinic has lower rates because they don’t refer x-rays out, but do them in house.
    The ideology that “if the gov’t does it, it must be inefficient” and “the market can do it better” is typical conventional wisdom in that it’s just an oft repeated platiude. It may be conventional, but it’t not wise. Go to any large hospital. It’s size that makes for inefficiencies, and with captive customers, there’s no incentive to improve either efficiencies, or other costs because where else is the family with the child with a busted forearm gonna go?
    Everyone talks about who should, or shouldn’t provide, or pay for health insurance, but nobody debates why is it so expensive. That’s the debate we should be having, because then the solutions would center around the answer John is getting at – how do we lower health care costs? Medicare operates with lower overhead, and pays lower rates to providers, AND they still make money. Why else would health care facilities market heavily to seniors on Medicare? The insurance model is broken because it does not address the main question – why is health care so expensive to begin with. The sideshow debate about the ACA as intrusive gov’t, it’s OK for a state to do it but not the Feds, etcetera is just that – a sideshow.

    • “The insurance model is broken because it does not address the main question – why is health care so expensive to begin with.”

      The insurance model is anything but broken as it is doing EXACTLY what it was designed to do, which is, make vast fortunes for the corporations.

      This is part of the financialization process which has hollowed out the middle classes in the Western world over the past four decades.

    • The number of physicians that will accept Medicare is declining, and those that do accept it, usually limit the percentage of their patients that are on Medicare. Many do this as a public service, because if their patients were all on Medicare, their practice would go bankrupt. Hospitals receive higher reimbursement rates for Medicare patients than physicians offices do. This is why we are seeing a growing number of private practices bought out by hospital systems. The private practices are seeing their overhead go up without fail every year, and yet their reimbursement from Medicare and other insurance companies go down. Their only option in many cases, is to sell out to the local hospital, and beome an employee.

      • I accept Medicare and pretty much everybody I know accepts it too. How can you not accept medical insurance that cover so a large percentage of the population?

        I do get all the reasons why people would not like to, but the patients should not have to suffer the consequences of a complete screwed-up health care system.

        The only option for ethical practitioners is to accept less and be happy just the same. It’s should be about taking care of people, first and foremost, and although I make barely 30% of what I used to, I still get by.

        Medicine was a whole lot better before the big money came in, and it will be a hell of lot better once this entire generation of money-seekers is gone.

        • From the throng of patients — thanks for sticking with us at 70% pay cut.

          I HOPE “this entire generation of money-seekers” will someday be gone, but I wouldn’t count on it, unless ….

          We all get off our butts and use our brains, resources and contacts ahead of the 2014 and 2916 elections!

  11. the problem with obama care is that it is not insurance but rather welfare.

    true insurance would cover big risks at a price that is affordable.

    bamacare wants to give everybody everything and as a lagniappe to their socialist plans ensure everybody gets equally bad care.

    the problem is that we cannot afford bamacare.
    in the end the govt will end up printing more and more money
    to cover the massive debt it is rackign up and we will have hyperinflation and then total collapse of the usa.

    but that is exactly what obama said he wanted to do.
    he said he wanted to fundamentally destroy the usa.

    it is not clear if he is just a fascist-socialist or if he is a one world govt person , or both.

  12. I’m self employed
    Everyday, I go to the same office, with the same other self employed staff, working for the same company.
    Why are we self employed and not on staff? To avoid maternity pay, paternity pay, sick pay, sexual discrimination law suits, racial discrimination lawsuits, redundancy laws.
    Easy to do by having no staff.

  13. Dave (@ Aug.7, 8:41 pm)) and Aziz (@ Aug. 7, 09: 22 am):

    John Aziz’s analyis of comparative costs (using a report from the highly-suspect Washington Post) is light on WHY, as Dave notes. Let’s start with a few suspects.

    1. My wife and I (seniors) pay little attention to cost of medical care, which is mostly (thankfully!) pre-scheduled exams and tests. Why? Medicare and former employer-provided supplemental insurance make everything almost free to us. Unlike the example of Lasik, this is not a cost-efficient system, and is especially vulnerable to providers’ loading the bills with questionable services.

    2. I’m not familiar with US MedicAID, but I would suspect it’s plagued with all of Medicare’s fraud, waste and abuse, only worse.

    2. Has anyone, including the pro-lawyer Democratic Party mouthpiece WaPo, considered the costs of liability insurance in the ultra-litigious US?

    3. John: note that, above, I labeled our current “quasi-government (healthcare) system” an “expensive mess”. Investor’s Business Daily: “In its very first year, Medicare’s costs came in 50% higher than projected. By 1990, Medicare’s budget was seven times bigger than forecast. Today, it accounts for 13% of all federal spending, up from 5% in 1980.

    And, BTW, (1) the giant monopoly called “government” IS inefficient because of open and hidden political favoritism, bureaucracy and lack of competition; (2) violating the Constitution is NOT a sideshow, but accelerating erosion-corrosion of our liberty and prosperity; and (3) what about the UK Keogh Report which reportedly criticized QUALITY, not primarily waste/cost.

    • DM: I hope we are acquainting a LOT of colleagues with investors.com (Investor’s Business Daily)! It’s the best of all daily print and electronic sources..

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  15. The struggle is ALWAYS between the individual and the collective. In this era of maximum consolidation of wealth/political power, it is the interests of the collective that will be served, with the individual suffering as a result.

    Medical care is subject to these same forces. It is the institutions that primarily benefit from this health care system despite the unintended consequences of good things happening within the system [mostly technology-related].

    It’s all about the reproduction of capital, and there few better examples than health care that show why the system is called capitalism.

  16. Imp old friend (re your posts Aug 9 @4:07 pm & Aug 9 @ 4:17 pm): we share the same values but sometimes speak/write different languages.

    In my dictionary (and usage) “INDOCTRINATE” means to teach or instruct a doctrine, principle, ideology, etc.– hopefully by loving parents. Lack of awareness or “enlightenment” makes one vulnerable, but need not alter sound principles. Simply, and tactlessly, put: we are all imperfectly good, but need not become or remain indoctrinated with evil.

    John Aziz and our other economics scholars can help explore the word “CAPITALISM”, but I use it simply as the alternative to state control of ownership, production, distribution and exchange of wealth — synonymous with “free enterprise” and the typical tea party term “free markets”. “Free” describes the non-monopoly of state control, ‘though John and others warn that “corporatism” can be just as bad. I (idealistically? naively?) want government to protect against “combination in restraint of trade”.

  17. Complete awareness is enlightenment, not a lack of awareness. Vulnerability is an illness spawned by the notion that there is a self, which is clearly not the case.

    Being that all things knowable are relative, everybody who contributes here has their own sense of what is what. I am at the extreme being a philosophical anarchist, and although anarchism can not actually exist, “en praxis,” who cares? Why settle for some kid of absurd political system that only insures that the lying, cheating, and stealing become poured in concrete and anchored fifty feet into the ground? This is mass insanity!!

    I, for one, refuse to “live” in a world that demands that I sell-out at every turn, rip-off my patients [because it is "good care," that is, creates maximum corporate profits], and all the rest of the non-sense that goes on in this world.

    Not me.

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