LESSONS LEARNED #21: “The reason why health insurance is so expensive is because it is not insurance.” -Old Pithy

Posted by PITHOCRATES - July 8th, 2010

THE LONGER YOU live, the more you see and hear.  Here’s a smattering of our collective experiences.

YOU CAN LEARN a lot working in a small business.  I did.  I did about everything you could in a small business.  Including keeping the books.  And getting fired.  Over money.  It’s always about money, isn’t it?  And broken promises.  But I digress.

The business owner had a couple of kids.  As did some other ‘key’ employees.  I didn’t.  I was a young, single man.  Rarely went to the doctor.  So the ‘Cadillac’ health care plan we had meant little to me.  But it was important to them.  So important that it was a serious financial burden to the company.  The owner scrimped and saved elsewhere to maintain it.  Including my salary.

I helped to bring us through a difficult time.  I did my part.  Now it was time for the owner to do his part.  But he forgot those promises.  (Important life lesson?  Get things in writing.)  We had words.  I considered my options all the while dealing with one of the ‘key’ employee’s wife.  Who was always calling to bitch about the medical plan.  She didn’t like her co pays, that the non-generic drugs cost more, being billed for something that SHE thought should have been covered, etc.  I talked to her (it seemed like) at least once a week.  So and so who worked at such and such didn’t have to pay for this or that or the other thing.  And, perhaps, in some fairyland, they didn’t.  Our plan was good.  Above average.  She just didn’t want to pay for anything.  In fact, she wanted the business to pay for the things the plan didn’t cover.  She wanted it all.  But didn’t want to pay a dime for any of it.

She thought it was an outrage that she had to pay her bills.  But she took the health care.  Just wanted others to pay for it.  Even if cuts had to be made elsewhere.  Even if others didn’t get promised raises or bonuses.  As long as the cuts didn’t affect her. 

My experience is only a microcosm, but it applies to the big picture.  Our health care system is the best in the world.  But the way we go about paying for our health care is threatening to destroy that great system.  We’re voting ourselves the treasury.  We want more and more things but forget that old saying.  There’s no such thing as a free lunch.  Costs are costs.  And someone has to pay them.  If we don’t, others have to.  Until they choose not to.  And then what are we going to do?  Run to government?

Well, yeah.  There has to be someone we can take more money from.  Make those young and healthy people buy insurance so more people contribute into the big insurance pot and bring down the cost per person.  If they pay more, I wouldn’t have to pay as much.  Or my fair share.

Don’t like that?  Why, then let’s just nationalize it.  Wait a tic, nationalize care sucks.  So let’s not nationalize it.  Let’s do that other thing.  It’s just like nationalizing but we get to keep the things we have now.  Single payer.  Yeah, that’s it.  Let’s go with a single-payer system.  We keep the care we have and tax the rich to pay for it.

Or let’s be like Canada.

I DROVE INTO Quebec once from upstate New York.  At Canadian customs, the guy asked if I had any cigarettes. 

“No,” I said.

“Really?” he asked.

“No,” I said.  “I don’t.”

“Come on.  You must have some cigarettes.”

“No.  I don’t have any cigarettes.  I don’t smoke.”

“I don’t believe you.”

“Well, I don’t.”

He stared at me, smiling.  Waiting for me to break, I guess.  I didn’t.  I was confused.  Customs never interrogated me like that before.  He kept staring.  And smiling.  I looked backed.  Befuddled.

“Okay,” he finally said.  “You can go.”

And I did.  Found out later what that was all about.  Obscene cigarette taxes.  In an effort to stop people from smoking cigarettes.  But it opened a huge black market.  Drug dealers switched from smuggling in drugs to smuggling in cigarettes.  It was as profitable.  And less punishable.  If caught.

CANADA HAS A large tourism industry.  And high taxes.  They tax everything.  Making it costly to be in Canada.  They have a Value Added Tax (VAT).  It’s called the Goods and Services Tax (GST).  That means they tax most goods and services you pay for from the first level of being to its final delivered form.  They tax the thing you buy. And they tax the things that made that thing you buy.  At every level, when someone adds value, they add another GST.  Taxes upon taxes.  They can collect a lot of money.  But they also raise prices.  Which makes everything more expensive.  So Canadians can’t afford to buy as much as they once did.  Less demand contracts supply.  Lays people off.  They spend less.  Pay less in taxes.  Collect unemployment benefits.  Government collects less and spends more.  Deficit spending.  They raise taxes to offset the deficit spending.  And the cycle repeats.

There’s been talk about establishing a VAT in the United States.  Because of out of control government spending.  Those who support it say it will help the economy.  They lie.  Taxes don’t help economies.  At least, they haven’t yet.

In order not to hurt their tourism industry the Canadians (for a time, at least) let tourists get a refund on the provincial and GST taxes paid while in Canada.  Canadians have no choice.  But tourists do.  They could choose not to go Canada.  So they allowed the refund because they knew that higher taxes don’t stimulate consumer spending.  And they wanted stimulated consumers to come to Canada to spend.

SOME CANADIANS DO have a choice, though.  Those who live near the US-Canadian border.  I’ve worked with Canadians who traveled to America to work.  They love their country.  Believe America could learn a lot from her.  But they buy their gasoline in the States.  And everything else they can to escape their own high taxes.

WHEN MY DAD was in the hospital for quintuple bypass surgery, a few of his nurses were Canadian.  They said a lot of Canadian doctors and nurses crossed the border into the United States for better paying jobs.  My dad had no complaints.  They were good nurses.  He was grateful for their care.  That’s what high paying jobs do.  Attract high quality talent.

I SAW A fund drive once while in Canada.  There was a sign on the lawn with a colored-in bar showing where they were in achieving their goal.  A hospital was raising money to buy something.  An MRI machine.  For there was none in this medium-sized Canadian city.

I WAS AT a small community hospital (in an American city) walking the grounds with the facilities manager.  He had to close a small road intersection on campus that doubled as the helipad.  The university hospital’s medical helicopter was making a test flight to this small hospital.  I asked him if they flew in many patients here.  He said no.  But they flew critical patients at this hospital to the university hospital (about 30 miles away) where they had a better chance for survival.

I ONCE WENT on a skiing vacation throughout New England and Quebec.  I skied Jay Peak, Mont Tremblant, Mont-Sainte-Anne, Sunday River, Stowe and Killington.  I remember a helicopter flying overhead at one.  (It’s been awhile, but I think it was in Canada).  There was a sanctioned FIS ski event there.  Part of the requirements for a high-speed ski event is a readily available rescue helicopter to immediately air-lift a seriously injured skier off the hill.

NATASHA RICHARDS HAD a freak accident while taking a ski lesson at Mont Tremblant in Quebec.  She fell.  Like we all have while skiing.  She got up.  Like most of us do.  Laughed it off.  She felt fine.  But there was now a silent killer at work.  She declined immediate medical attention.  After awhile, she started to feel ill.  She would subsequently die from an epidural hematoma due to a blunt impact to the head.  A shame it was only blunt.  Had it knocked her unconscious, she may have survived.  That would have demanded immediate medical attention.

She died because her initial injury was not painful enough.  She therefore had little cause for concern.  As many of us no doubt would have if we were in her place.  Critical time was lost.  Time that she couldn’t get back.  There’s no one to blame.  It was a freak accident.  What made the headlines, though, was an interesting fact.  The province of Quebec did not have a single medical helicopter (probably wouldn’t have made a difference for Richardson).  The province had determined that the cost of a helicopter system was greater than the perceived benefit.

SO THERE’S A smattering of health insurance, tax and health care anecdotes.  A small smattering, but nevertheless a smattering you can draw some conclusions from.  First and foremost, people are cheap bastards.  And they have an entitlement mentality.  Put the two together and you’ve got an ever-expanding, under-funded, welfare state.  And that can only lead to one place.  Bankruptcy.

You can’t keep raising taxes on people to solve problems.  They’re just not going to whistle a happy tune and keep paying.  They will make efforts to evade those taxes.  Or they’ll simply cut back on their spending.  And when they do, they will create other problems in the process.  Those unintended consequences that have bedeviled government planners since the dawn of government planning.

The Canadian health care system is not the utopia some claim it to be.  It’s big.  And costly.  Bureaucrats conduct cost-benefit analysis.  It’s cold and impersonal.  What is the cost per unit life saved by having a medical helicopter system?  Does the mean wait-time justify adding another MRI in a geographic region?  Or would the resultant excess capacity from a second MRI be too wasteful?  And what is the acceptable mean wait-time for a procedure?  Would a 2% cost savings from a reduction in staff be acceptable if the corresponding rise in mortality rates is kept at or below 1%?  It’s all very analytical and rational.  But when it’s your loved one in a critical condition, you’re rarely analytical and rational.  And you’ll do just about anything.  Even go to the United Stated and pay out of pocket for medical care.

Of course, if the United States adopts a Canadian system, the Canadian system should improve.  Without those better paying jobs a short drive from the border, those doctors and nurses would probably stay in Canada and work within the Canadian system.

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LESSONS LEARNED #13: “If you were to live under the socialist maxim ‘from each according to his ability to each according to his need’ you would find yourself surrounded by needy people with no ability.” -Old Pithy

Posted by PITHOCRATES - May 13th, 2010

KEY TO CIVILIZATION growth is the food supply.  Food surpluses in particular.  Before dependable food surpluses, life was short, harsh and miserable.  Especially for women.  When they weren’t working in the fields they were giving birth and raising children.  High infant mortality rates, though, inhibited population growth.  Most of the children women gave birth to didn’t survive to adulthood.  So there was a constant state of child rearing.  But few children survived to help with the business of family life.

Malnutrition and famine were common.  Feudalism provided a precarious balance between life and death.  For centuries the common people (i.e., peasants) eked out survival on their landlord’s manor.  The lord owned the land.  The peasants worked it.  Most of the bounty went to their lord.  But they kept what they grew on a small strip of land for themselves.  Just enough for subsistence.

But England changed all that.  By 1750, her agricultural output was second to none.  Private property.  Free market economy.  Capitalism.  Increased productivity.  Specialization.  These all combined to provide incentive.  Incentive produced food surpluses.  Food surpluses produced profits.  Reinvested profits improved farm yields.  This produced more profit.  And the cycle continued.  In less than a century feudalism would disappear from England.  There, you either worked land you owned or were paid wages to work land owned by others.  People began to live longer and healthier lives. 

The British Empire ruled the civilized world in the 19th century.  Representative government.  Abolition of slavery.  Free trade.  The Industrial Revolution.  These things, and others, gave them wealth, power and moral authority.  A lot of good came from this island kingdom.  Including the United States.  They weren’t perfect.  There was a learning curve.  But the modern capitalistic economy which they gave us liberated the masses.  It let us do what we wanted to do, not just what we had to do.  In particular, women, who could do more than just raise families and work in the fields.  One day, she could even become prime minister of Great Britain.

FOOD SURPLUSES BEGET industrialization.  Food surpluses beget everything, really.  Food surpluses release human capital to do everything else we do besides farming.  England was at the van of this modernization.  Others followed.  In time. 

Russia abolished serfdom (i.e., feudalism) in 1861.  Industrially backwards at the time, this liberty awakened a dormant human capital.  They followed the English model.  In time, with the advent of steamship and rail transportation, Russian grain competed with other European producers.

Joseph Stalin, looking to jump ahead in the industrialization process, implemented collective farming in the late 1920s.  He turned away from the English model.  The government became land owners.  It was feudalism on a grand scale.  Large collective farms would produce vast food surpluses that could feed industrial cities.  And there would still be surpluses left over to export to raise capital to build these industrial cities.  At least, that was the plan.

With less incentive came less productivity.  What land the former serfs had come to own was lost to the state.  The state took so much of the harvest that there was little food left for those who labored to grow it.  And the price the state paid for their crops was less than it was before collectivization.  The ‘free’ serfs were earning less and working more.  They didn’t like it.  And chose not to participate.  Collectivization became forced collectivization. 

Deportations, terror, murder and famine followed.  Perhaps more than 5 million starved to death during the famine of 1931 and 1932.  Others were to follow.

Forced collective farming produced famines elsewhere.  In China, during Mao Zedong’s Great Leap Forward, forced collectivization produced even greater famine deaths.  Historians estimate that 20-30 million, maybe more, starved to death in the famine of 1959–62.  Though hard numbers aren’t available, North Korea suffered a devastating famine in the late 1990s that claimed millions.  But in the West, in the 20th century, famine was unheard of.  When the United States suffered during the great Dust Bowl of the 1930s, there was no corresponding famine despite the loss of productive farmland.

WITH INDIVIDUAL LIBERTY comes incentive.  With incentive comes productivity.  A small island nation of free land owners could produce grain to feed themselves with surplus left over for export.  Nations with great fertile tracts farmed by forced collectivization led to famine.  Slaves have little incentive other than to subsist.  The collective good means little to them when they are starving.  They continue to sacrifice.  And continue to suffer.  Even if they do produce a few more bushels of grain.  So if the suffering is the same, what is the incentive to work harder?

As individual liberty declines, those in power tend to exploit those they rule.  In the name of the state.  Or the common good.  This is easy to see when it results in famine or revolution.  Not easy to hide those things.  But it is a little more difficult to see when the results are more benign.  Longer unemployment benefits, for example.  I mean, those are pretty nice.  Hard to see the downside in them.  As it is in other benefits these rulers give us.  So we are seduced as they whisper these sweet nothings in our ears.  And soon we willingly cede our liberty.  A little at a time.

WITH THE RISE of individual liberty, there was a corresponding decline in the ruling elite thanks to representative government.  Great Britain gave this gift to us and the United States took it to incredible heights.  The oppressed everywhere immigrated to the United States to feed a growing industrial demand.  Being new, we did not know all the affects of industrialization.  When the bad things came to light, we addressed them.  Great Britain, for example, was one of the first to protect women and children from the worse of industrial society.  Still, working conditions could be harsh.  As could life in the industrial cities.  Poverty.  Filth.  Disease.  And it was the wretched state of life in these slums that gave birth to a new school of thought on industrialization. 

In 1844 Friedrich Engels wrote The Condition of the English Working-Class to expose life in these slums.  He would collaborate 4 years later with Karl Marx on a treatise called The Communist Manifesto.  And from this Marxism, Communism, socialism, collectivism, etc., would follow.  As economic systems go, these would all prove to be failures.  But the essence of them lives on.  State planning.

You see, it was capitalism that gave us the industrial slums.  And that was good propaganda for a ruling elite looking to rule again.  So they whispered sweet nothings into our ears.  They talked about a Social Utopia.  From each according to his ability to each according to his need.  Fair taxation (i.e., only the ‘rich’ pay taxes).  Social safety nets (paid for by taxes of the rich).  Shorter workdays.  Longer paid vacations.  More government benefits.  A burgeoning welfare state.  Free stuff for everyone.  Again, paid for by taxing the rich who have exploited the working class.

What evolved was the elimination of the middle class.  You had the evil rich (and the middle class were, for all intents and purposes, rich because they didn’t need government help) whose wealth the government taxed away.  And the poor.  The poor who the government would now take care of.  If elected.  And they were.  They seduced a great many people with their utopian vision.  Even in the West. 

Great Britain and the United States would fall to this seductress, too, thanks to the Great Depression.  It was capitalism that gave us the Great Depression, after all.  The greed of the money people.  And so these great nations declined from greatness.  They became welfare states, too.  They had short respites during the 1980s.  Margaret Thatcher helped rejuvenate Great Britain.  Ronald Reagan, the United States.  But the ruling elite whispered more sweet nothings in our ears and the decline continues.

In 2010, our appetite for state benefits appears to be insatiable.  And we may have run out of wealth to tax away to pay for it.  California is on the brink of bankruptcy.  New Jersey elected a governor who proposed draconian spending cuts to stave off bankruptcy.  Other ‘blue’ states (i.e., states who vote Democrat) are also in trouble.  Underfunded pension obligations.  Demands of teacher unions.  Of government worker unions.  Everyone is there with their hand out.  None of them are willing to sacrifice for the common good.  No, they expect others to do the sacrificing.

THE OBAMA ADMINISTRATION has increased federal spending to such record levels that Communist China is concerned about our fiscal/monetary policies.  As they should be; they hold a lot of our debt.  The federal government has ‘bailed out’ private industry and taken de facto control.  They have created a healthcare entitlement that will cost more than a trillion dollars.  More spending is coming.  And it is all for the greater good.  They are vilifying those who are not poor, taxing away what wealth they can from them and giving it to the poor.  When about half the electorate doesn’t pay any income taxes, there is little opposition to raising taxes on those who do.  For if the ‘rich’ complain, the government vilifies them.

Where will it all end?  It is difficult to say.  How will it end?  Badly.  We can look at Europe who we seem to be emulating.  They’re further down The Road to Serfdom than we are.  With the excessive government spending, there will have to be greater government revenue (i.e., taxes).  Previous methods of taxation may prove insufficient.  Hello value added tax (VAT).  It’s all the rage in Europe.  It’s a multiple tax.  At every stage of production, government is there.  Taxing.  From the raw materials to the final assembly, government is there at every stage.  Taxing.  VATs will increase government revenue.  But they will also make every day life more expensive.  VATs increase the sales price of everything you buy.  And you pay it again at checkout.  It’s everywhere.  Everything will cost more.  From manicures to lattes to toilet paper to tampons.  And this is a tax everyone pays.  Even the poor.  It is a regressive tax.  The rich will pay more, but the poor will feel it more.  This hidden tax will take a larger portion of what little the poor has.

But how bad can it really get?  In 2010, I guess the answer would be to look at Greece to see what happens when a country can no longer sustain her welfare state.  And the people aren’t all that keen on losing the government benefits they’ve grown accustomed to.  It isn’t pretty.  But when you start down that road (from each according to his ability to each according to his need), the taking and giving always get bigger.  It never gets smaller.  And when you reach a critical point, government just can’t sustain it any longer.  And it crashes.  Like in Greece.

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