Health bill, Supreme Court

 Health bill, Supreme court

See Previous HelthCareUS etc.

(SCOTUSblog)

SCOTUSblog: Our health care resource page, including briefs and documents, argument previews ..

• Argument preview: Health care, Part I — The power to decide?  
• Argument preview: Health care, Part II — Fate of the mandate  
• Argument preview: Health care, Part III — Beyond the mandate
• Argument preview: Health care, Part IV — The Medicaid expansion

 

(American Progress)

SCOTUS Preview Part I:     What The Heck Is The Tax Anti-Injunction Act?
SCOTUS Preview Part II:   Clement’s Misleading Brief, By Ian Millhiser on Mar 23, 2012
 SCOTUS Preview Part III: The Perils Of Overreach
SCOTUS Preview Part IV:   The Big Scary 

• Paul Clement's Fake Constitution
1. Clement's bad textualism
2. Clement's hyperbole about limitless government power
3. Clement's Scalia problem

Romney Celebrates Health Care Reform Anniversary By Lying About It

1. “ It’s more like double that (a trillion dollars) …Obamacare is massively more expensive than had been originally estimated.”
2. “Thirty percent of employers said they are going to drop the coverage for their employees when Obamacare is installed.” 
3. “The Catholic Church is being told that they have to provide insurance that covers morning after pills, sterilizations, and contraceptives. Despite the fact that these very features violate the conscience of the Catholic Church itself. 

(TPM HCR:  Talking point memo, health care report)

==============================================================

The Multimillionaire Helping Republicans Win N.C. (NPR summary)

• State for Sale (New York article) by Jane Mayer
• "The Official Koch Industries Reply to The New Yorker Hit Piece Summary from Reason
• The Koch response is here

===============================================================

George Washington University School of Business March 2012

The Federal Reserve and the Financial Crisis Origins and Mission of the Federal Reserve, (Videos)

• Lecture 1: Origin and Mission of the Federal Reserve
• Lecture 2: Federal Reserve after World War II

Free Enterprise market

Free Enterprise market 

Much of economics is based on the assumption that the systems that they are analyzing are a coordinated set of "Free Enterprise Markets" with entities who are guided by "Rational Actor Theory". This entry attempts to clarify my thoughts about the Assumptions and Conclusions of this situation.

Free Enterprise market. (competitive model),

• [T]he flows of services that would be offered and purchased and the prices that would be paid for them if each individual in the market offered or purchased services at the going prices as if his decisions had no influence over them, and
• [T]he going prices were such that the amounts of services which were available equalled the total amounts which other individuals were willing to purchase, with no imposed restrictions on supply or demand.

Rational Actor

Results.

First Optimality Theorem:

• If a competitive equilibrium exists at all, and if all commodities relevant to costs or utilities are in fact priced in the market, then the equilibrium is necessarily [Pareto] optimal in the following precise sense: 'There is no other allocation of resources to services which will make all participants in the market better off'

Second Optimality Theorem:

• If there are no increasing returns in production, and if certain other minor conditions are satisfied, then every optimal state is a competitive equilibrium corresponding to some initial distribution of purchasing power

See:

Kenneth Arrow’s seminal article on the economics of medical care (pdf)

JSTOR: Philosophy & Public Affairs, Vol. 6, No. 4 (Summer, 1977), pp. 317-344 (http://www.jstor.org/pss/2264946)

Kenneth Arrow Was Here (Editorial) HealthCare (4)

June 9, 2011, 5:34 pm

Kenneth Arrow Was Here

Some readers ask why my argument that relatively centralized systems work better for health care  (nyt) than the “free market” isn’t an argument for government ownership of everything.

The answer is that health care is different: it’s a sector in which basically every market failure you can think of takes place. And we’ve known that since Kenneth Arrow’s classic analysis (nyt) half a century ago.
It’s shocking, though not surprising, that we keep having to relearn this basic point.

  See:  

• The Economist’s “Democracy in America” blog has a very good illustration of the reasons our privatized, market-based system is so much more expensive, for no better results, than everyone else’s
• Kenneth Arrow’s seminal article on the economics of medical care (pdf), 
• Toward a 21st-Century Health Care System: Recommendations for Health Care Reform, Kenneth Arrow, PhD ..., April 7, 2009
• Krugman: Why markets can’t cure healthcare, , July 25, 2009

Also see: 

• In defense of Canada -- Comparison with US HealthCare
•  Paul Ryan Budget Would Make Big Changes in Medicare, March 29, 2012
• HealthCare Aug 9, 2007
• HealthCareUS Dec 8, 2008
• HealthCareUS-3 May 13, 2009

Paradoxes

The 20-th century was the "No you Can't" century in which there were a number of Paradoxes that were discovered that "proved" that not all things were possible.

Physics

. Relativity -- Large Physics

1. No material particle can be accelerated to the speed of light.
2. The Speed of light is a constant and is not observed to be changed no matter the speed of the observer.
3. There is no absolute space frame, e.g. one can not determine if one is stationary relative to any absolute space.

. Quantum Mechanics -- Small Physics

1. Many measurements are intermingled in that one can not measure both with infinite accuracy, e.g. Position and Momentum.
2. The state of a system often is indeterminate, with no hidden values, and only exists when an observation collapses the state.
3. Small particles (or waves) sometimes seem to be Particles, when their position is measures, and Waves when their path is measured.

Arrow's impossibility theorem (for voting) -- There is no voting system that is a fair way of determining group Public Good from individual preferences if the system is meant to satisfy: "

1. unrestricted domain, -- It should yield a unique and complete ranking of societal choices for any set of individual voter preferences.
2. non-dictatorship, -- It cannot simply mimic the preferences of a single voter.
3. independence of irrelevant alternatives -- Changes in individuals' rankings of irrelevant alternatives (ones outside the subset) should have no impact on the societal ranking of the relevant subset.
4. Pareto efficiency, -- If every individual prefers a certain option to another, then so must the resulting societal preference order. (note: monotonicity, non-imposition, and independence of irrelevant alternatives together imply Pareto efficiency)

Practical Paradoxes

the following seem to be paradoxes, but are not proven.

. Democratic Trilemma -- Fishkin -- No democratic system seems to satisfy the following three objectives.

1. Participation -- All qualified members of the society shall participate in the determination of the policies of the society.
2. Equality -- They shall be equally deterministic of the policies.
3. Deliberation -- They shall spend sufficient time to thoughtfully evaluate the values and implications of their decisions.

HealthCareUS-3

1) VOUCHERS -- Each person gets a yearly voucher to pay for the actuarial cost of their basic Health Care that can be used to purchase Health Insurance from any conforming health care insurance vendor.

• The actuarial cost = The median cost based on the risk factors, e.g. Age, Weight, Gender... for the person and the area in which the person lives, to provide the health care for that individual
  
  
• A conforming vendor = An insurance company who will accept all people and provide full payment for the covered treatments.
  
  
• Note: The Government, e.g. Medicare will be the default vendor but the vouchers will be augmented, primerally by having the goverment provide centrallized billing, payment, approval free, so that the other insurers will be able to make a reasonable profit from just providing equivalent service and can increase their profit by providing extras such as:
  

• Additional insurance -- Coverage for additional services can be offered at additional charges.
  
• Reduced medical treatment costs -- Any savings will be shared 50% 50% by the patient and the insurance company, see 2)
  
• Wellness support -- Any improvement in the patients risk factors will lead to a 50% - 50% savings for the first 5 years to the insurance company and the patient, and after that 50% to the patient.
  
• etc.
  

2) SAVINGS -- Any savings in treatment costs will be shared 50/50 by the patient and the insurance company.

• The patient and the insurance company can negotiate with the medical provider to obtain less expensive (equivalent) treatment,
  
  
• Such negotiation may be done with medical providers within the area, or by getting the treatment in other less costly areas throughout the world from certified facilities.
  
  
• Any savings will be shared by the patient and the insurance company so that both have "skin in the game", while still assuring that no one is denied treatment.
  
  
• Similarly: The insurance company can pay for wellness services, e.g. Weight Reduction, Cholesterol Drugs... and any reduction in risks will be shared for 5 years even if the patient enrolees in another plan. After 5 years the patient continues to be rebated 50% of the risk savings.
  

3) ADMINSTRATION -- The Government will offer to do all the Record Keeping, Billing, Paying, Results collection, etc. at no charge.

• This will be a mechanical process which will, in no way determine the HealthCareUS policies
  
  
• This is estimated to currently cost the insurance companies 10-30% of their costs and thus will be a "hidden" subside to the independent insurers.
  
  
• Obviously, if the insurance company has negotiated a different rate, they can get a rebate from the medical provider to be shared with the patient.
  
  
• Any rebates will be reported to the government to be used to adjust the median costs for next year's vouchers.
  
  
• This will centralize the Doctors billing and approval for the HealthCareUS procedures so that the Doctors paper load is decreased.
  
  
• The results of the procedures will also be reported to the government so that the Cost/Benefit for various procedures can be computed by them or other interested parties.
  
  
• This will also allow the quality of medical care can be made available to the insurers and the patients so that they can determine which providers to support.
  
  
• If an insurance company is accepting HealthCareUS vouchers then it must at least report the costs and results of their services.
  

4) COVERAGE -- The procedures covered by the HelthCareUS will be determined as those that have highest benefit within the amount of money allocated by the government/tax payer.

• Note: Any additional procedure can be covered by additional insurance or by direct payment for the patient, as is done now
  
  
• Note: Any plan must determine which procedures they will cover, so does HealthCareUS, but in this case, those procedures are determined by the amount of money that we democratically determine to spend and then by the procedures that are most cost effective, rather than by some bureaucrat or CEO.

5) GRANDFATHERING -- Any current plan will be "grandfathered" in except that the tax benefit will be limited to the Voucher amount and any tax benefit over 50% of the voucher will be available only if the current plan provides at least the coverage of the HealthCareUP plan.

Also see:

• Is Health Care Special? By UWE E. REINHARDT (NYT, Economix) 8/6/2010
• Toward a 21st-Century Health Care System: Recommendations for Health Care Reform, Arrow...
• Why markets can’t cure healthcare - Paul Krugman Blog - NYTimes.com
  
• Uncertainty and the welfare economics of health care - Kenneth Arrow
  
• Vote: YES or NO , results , poll comments (please use the WeMatter area)
  
• HealthCareUS (12/08/2008),
  
• HealthCare goals (08/09/2007)
• A Comprehensive Cure: Universal Health Care Vouchers, Ezekiel J. Emanuel, R. Fuchs, - The Brookings Institution 07/01/2009
  
• Signing On to an Obama 'Dream'." - WSJ 05/12/2009
  

HealthCareUS

Health care

1) - Vouchers -- Provide Health Care insurance vouchers for every American, roughly $5,000 to allow them to purchase a basic coverage.

1) Details -- The vouchers will be set at a level so that they will pay for the cost of providing treatment at median costs for all the procedures that are authorized. Of course this coverage is for basic treatment and does not cover all possible procedures, luxuaries (private rooms, etc.) which can be covered out of pocket or by extra cost insurance. By default the vouchers will be handled by the government, USHC e.g. Medicare, but can be transfered to aemployer or insurance company who offers similar or improved insurance.

2) - Opt-in -- Requre that all insurance companies, hospitals, Doctors, etc. either Opt-in to covering all and accepting the coverage for the defined treatments or accept no vouchers or payment under the systems and post a notice that they are not in the USHC system.

2) Details -- The insurance company can opt-in to compete with the USHC system if they feel they can offer the same or better service to all patients due to their added efficenty, better nogotiating skills, perhaps better pro-active care, etc. Note: Any insurance company can pay for pro-active care and will collect 100% of the estimated savings if the patient goes to another provider. Similarly the Doctor can either offer to treat the covered procedures at the median level of payment, or opt-out and have these procedures paid for by the patient or by insureance that is not accepting vouchers.

3) - Shared Savings -- If the patient can get the treatment for less from a certified provider, then they and the insurance company splits the savings.

3) Details -- This allows the patient to get treatment fully covered, or negotiate with the provider, in the area, in some other state, or even abroad, and get less expensive treatment and split the savings with the instrance providor. Thus the patient has some "skin in the game" giving him a reason for controlling the price of the treatments. Similarly the insurance company is encurraged to point the patient to less expensive treatment, while still allowing the patient full freedom to choose their own doctor. Note: This will allow competation not only within the local area, but also between other areas in the country and the world, if they can offer equivalent treatments.


Obliously, all the technical improvements that lead to more cost effective treatment and better patient information will be included.

HealthCare

Objectives of a Health Care system (HCS)

1. Universal "critical" treatment -- There are a number of deseases/treatments that we, as a society do not want to have un-treated, either because not treating them is not compasient or because not treating them will probably harm society. The HCS should ensure that these are treated.
   
2. Take advantage of Market for Pricing and Selection -- The Free Enterprise market is effective at ensuring that the cost of services is related to their benefits and thus any HSC system should allow the Market to encurrage people to reduce their "over utilization" of the system by charging them for the services and rewarding them for choosing the more inexpensive ways of getting the service that they need. Conversely the market shoulld be used to encurrage the service delivorers to be economical in their practice while also permitting them to offer a verity of services and convieniences as their end customers will pay for them.
3. Encurage preventive care and healthy behavior --
   
4. Information Technology application -- Computers, the Internet, etc. probably can be effectively used to reduce the costs, medical errors, and increase the job satisfaction by, say: 10%. The HCS system should have a program for a reasonably funded prject to develop the 'best of class medical IT techniques, an environment for profitizing their use, and ensuring that the barriors to their implication are eliminated.