As much as we spend on medical care that doesn't make us healthier, we spend more on wars that don't make us safer.
I'm a bit of a die-hard let-the-bozos-starve sort of wack-job libertarian. So, what's a bigger infringement of rights? Take hundreds of billions of dollars from US citizens, and spend it enforcing arbitrary rules on a populace that doesn't have representation or a vote? Or take billions from US citizens and spend it patching up said citizens when they fall down or get sick?
I hate taxes. Really, I do, as much as anyone you'll ever meet. And I hope that the market could someday solve this problem more efficiently. But I also think that killing people is a lot more evil than healing people. I voted for Ron Paul largely because he was the only candidate who said outright that he would shut down all unwanted military bases in his first year.
Dismantle the military empire, and you've got money for medical care. Additionally, adding a base level of safety net could be a disruptive force that allows smaller and more agile companies (ie, in the 1-10 employee range) to get more done with less overhead, which is exactly the sort of thing that needs to happen if stuff like this is going to be solved cleverly.
Come on, we're hackers, right? Think about it. This is a complex problem with a ton of moving parts, and that's kind of what we do, isn't it? So, apply the same maxims that serve you so well in dealing with software:
Measure before you optimize. Solve the big problems first. Patch the in-production product, and THEN design its replacement. The perfect is the enemy of the good.
As much as we spend on medical care that doesn't make us healthier, we spend more on wars that don't make us safer.
A bit of a false dichotomy, don't you think? I agree with most of the rest of your post, though I think that the primary effect of increasing the safety net will be moral hazard issues, not people jumping to do a startup now that they have a safety net. People who do startups are incredibly rare, and somehow I doubt that's because of any safety net issues.
The source of the huge costs in medical care are the way medicare/medicaid completely dominate the market with their hair-brained payment schemes. The way that insurance is tied to employment for tax reasons, the cartel that controls the supply of doctors (AMA), and hosts of other barriers and redtape that may improve the quality of healthcare, but make it unaffordable to a large portion of the population.
The source of the huge costs in medical care are the way medicare/medicaid completely dominate the market with their hair-brained payment schemes.
Medicare and Medicaid appear to be similar to the systems that most other countries (e.g. Britain, Canada) have in place to pay for healthcare (except that in most other countries everyone is covered). How do you explain that, in those other countries, the per-capita costs of healthcare are lower than in the US?
The way doctors are reimbursed is based on a formula that ranks the amount of effort the doctor has put in and not on the actual value they are providing. This means that specialists, tests, and other advanced areas receive the bulk of the money regardless of the actual impact on the patient. This leads doctors ordering unnecessary tests and a lack of general practitioners and an abundance of specialists.
I don't recall exactly how Britain and Canada do it, but I'm pretty sure it's not the same way.
Here's how it works:
The RBRVS Fee Schedule.[6]Medicare uses the resource-based relative value scale (RBRVS) to pay for physician services. Under this formula, Medicare officials compute the “objective value” of an estimated 7,000 procedures.[7] Each component of a medical service is assigned a weighted value that is calculated by using social science measurements of the time, energy, and effort required to perform a given procedure, including resource inputs such as medical equipment, malpractice insurance, and administrative costs. These weighted “values” are then converted into dollar amounts and used to determine the fees that Medicare pays to physicians for those services.[8] The diagnosis related group (DRG) system reimburses hospitals using a similar strategy.[9]
Most other countries are poorer than the US; the US has a GDP per capita 50% higher than the EU and (for example) 40% higher than France. Since a medical procedure takes the same amount of time in either place, the cost will be proportional to wages.
Additionally, the US is far more unequal than most other countries. At the top of the skill chain, the gap increases significantly [1]. The US costs more simply because doctor's salaries need to be competitive with banker and programmer salaries.
[1] I know a few FOB Indians who had multiple jobs/offers, they say the US can often pay double what the EU does.
I'm a bit of a die-hard let-the-bozos-starve sort of wack-job libertarian. So, what's a bigger infringement of rights? Take hundreds of billions of dollars from US citizens, and spend it enforcing arbitrary rules on a populace that doesn't have representation or a vote? Or take billions from US citizens and spend it patching up said citizens when they fall down or get sick?
I hate taxes. Really, I do, as much as anyone you'll ever meet. And I hope that the market could someday solve this problem more efficiently. But I also think that killing people is a lot more evil than healing people. I voted for Ron Paul largely because he was the only candidate who said outright that he would shut down all unwanted military bases in his first year.
Dismantle the military empire, and you've got money for medical care. Additionally, adding a base level of safety net could be a disruptive force that allows smaller and more agile companies (ie, in the 1-10 employee range) to get more done with less overhead, which is exactly the sort of thing that needs to happen if stuff like this is going to be solved cleverly.
Come on, we're hackers, right? Think about it. This is a complex problem with a ton of moving parts, and that's kind of what we do, isn't it? So, apply the same maxims that serve you so well in dealing with software:
Measure before you optimize. Solve the big problems first. Patch the in-production product, and THEN design its replacement. The perfect is the enemy of the good.