Advice for my friends on the left. Worth every penny you paid for it.

[kirisutogomen]

If I were you, I'd restrain the urge to whip out the bullhorns and lead your comrades in an invigorating round of "YES WE DID". I'd hate to see you so soon forget the lesson of "MISSION ACCOMPLISHED"; you might want to think about the idea that maybe all that's happened is really the easiest, smallest step of the process, not the whole kit and additionally caboodle. Passing a law (overthrowing a government) is much much easier than actual reform (nation-building).

It's one of the most common political mistakes to think that passing a law is the solution to a problem. You really need to be a bit more careful about follow-through. Check to see if the law is doing what you thought it would. I especially suggest this because the just-signed law is in fact not going to do anything like what you think it's going to.

Comments

Re: long term v short term care

[firstfrost.livejournal.com]

Oh, I understand the theory, I'm just wondering how much of this particular sort of choice is happening in reality, if both A and B are achieving their costs via future individual expenses (as opposed to a 5% chance of killing you).

In that vein, there is also Treatment C, which is very cheap and kills me instantly, so I generate no more health care costs; I actually think there's more of this going on, when we call C "stop paying for any treatment", but now we're totally in cost optimization rather than health optimization, which is not what I was thinking about at the beginning of this digression.

Re: long term v short term care

[kirisutogomen.livejournal.com]

Well, I guess the question is hard to answer; how much more (if any more) emphasis would be placed on quitting smoking/not smoking, exercise, diet, etc., under a system that more closely aligned the incentives of insurers with the incentives of the insured?

My guess is that there would be some, but it's hard to collect empirical data on this sort of question. Heck, even if we switched to such a system, it would be hard to sort this stuff out, because we're talking about statistical trends in an enormously complex tangle.

I can point to stuff, like the irrational willingness to pay tens of thousands of dollars for quadruple bypass surgery while being unwilling to shell out a couple of hundred bucks on weight loss, but that doesn't really demonstrate anything, because there's all kinds of other plausible explanations for that irrationality.

So I'm left with the knowledge that theoretically this ought to happen, and the health care sector is 17% or whatever of the economy, so even an uncertain effect of a few percent is worth billions. If all I really have to go on is the theory, which is sound logic, and the expected benefit is billions of dollars, I think I'll go with that and agitate for it.

(I could make an analogy to climate change here -- the theory is sound, the evidence is somewhat sparse and doesn't actually show causality, and the stakes are high enough that we'd better be willing to take massive action based on probabilities and models.)

Re: long term v short term care

[firstfrost.livejournal.com]

If I could pay a few hundred dollars to suddenly be down fifty pounds, I would, whether or not my insurance covered it. That's not about the money. :)

My own instinct is that the big drivers for health versus costs are "increase my health, no matter what the cost I don't have to pay" from the consumer and "decrease the cost" from the insurer, and that the "decrease short term cost and/or unhealth in favor of long term cost and/or unhealth" is not very large, in comparison. But if you're only claiming an uncertain effect of a few percent, I'm not sure I can argue against that being true.