That was a relatively reasonable post. I hadn't seen it before I posted my complaint.
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Older stuff. I was referring to your initial flurry after last weekend.
Hmm. It seems that you missed my recent "real" content, and have ignored all of my older "real" content... so your argument is that the things you've selectively decided to include in your consideration don't constitute "real" content? Are you sure that makes sense?
Except that while accusing me of making unsupported assumptions, you repeat your own. I have given ample justification for my assumptions, based in logic, appeals to shared experience, and actual real-life examples.
And as someone who actually does this for a living, I have told you that your assumptions are incorrect.
If Bob comes up with a plan to reach the moon, based on Bob's logic (which doesn't include a physics background) and shared experiences with model rockets, do you think it reasonable that Bob dismiss the opinion of the physicist who tells him that his logic is incorrect because some of his assumptions are wrong?
In addition, I would claim that the burden of proof is on you to distinguish health care from other areas of the economy. You have failed to do so. Repeatedly giving examples of somebody caught in the middle of a medical emergency is a distraction. You know as well as I that this represents a tiny fraction of health care spending. Health care is 1/6th of the US economy after all.
*Sigh* I'm quite frustrated with this. That is not the only demonstration I've given. I've addressed why health care is not like other areas of the economy repeatedly, in many different ways, and addressed several key differences. You keep dismissing them out of hand.
Additionally, I've already shown you repeatedly that urgent medical situations are NOT a "tiny fraction" of the cost. They make up the bulk of the cost. I've repeatedly given you lots of information about the types of services that make up 80% of the costs incurred - and that those costs are incurred by only 20% of the population. You, however, have simply insisted that everything except literal emergency room visits is a commodity and that people can just take their time, learn about their condition, and shop around for the best price for every possible condition or illness out there.
I'm getting tired of providing you with the same information over and over, only to have it ignored and dismissed as if it's nothing more than my opinion. You've effectively taken a stance where your logic, based on your assumptions is more credible to you than my 20 years of experience and expertise in exactly this field. You've placed your assumptions above my actual knowledge and experience, and it's a bit baffling to me. That you believe in your own rightness to such an extent that you feel confident dismissing the opinion of experts is a bit off-putting.
The word you want is "jibe."
Hmm. I didn't even know that spelling existed. I was only aware of "jive" and "gibe". I always assumed it developed from jazz usage - implying that things are "in harmony" or "work together".
And you have claimed this a dozen times. I disagree.
Your disagreement with a fact doesn't make it false.
I went through this with jimbob in great detail, since he, too, misunderstood me. Do you not read my exchanges with him? If not, then you are doing me a disservice. I'll note also that the reason both you and jimbob misunderstood me probably has less to do with me being unclear (looking back, I think I was quite precise), and more to do with a desire to find weaknesses in my arguments so as to make yourselves feel better about your preconceived ideas and ideologies. Sometimes this manifests in the form of a response to a single sentence of mine out of several paragraphs filled with argument. It betrays the fact that you and he are not coming at this with an open mind.
It betrays nothing. You haven't been as clear as you think you've been. You had a nuance in there that wasn't explained until just recently, and instead of realizing where the disconnect was and fixing it, you've just repeated that we're misunderstanding you and then going on the offensive.
Ok, but why is it a terrible idea?
I'm going to decline to answer here, because guaranteed income is a completely different topic that deserves its own thread. If you'd like to start one, let me know and I'll participate. But I'm not going to derail this thread for it.
Huh? Of course not. What incentivizes you to become a price-conscious shopper is having to pay for goods and services directly out of your own pocket. The cash distribution is simply to provide poor people the means to do that. I, of course, have decided not to means-test that distribution because I think that leads to high implicit marginal tax rates, which distort incentives to make money.
Sure - but as soon as that guy hands over the cash, it's your cash that you're using out of your own pocket. It's yours - he gave it to you.
Why do you believe that your scenario is materially different?
$1,300 for an individual is high? That's the threshold. My plan is the lowest deductible plan I could find (I do this because my premiums are tax-deductible for me, so I'd rather have a lower deductible and a higher premium than the other way around), and it's $500.
I infer that you're relatively affluent. Probably not a millionaire, but at least the 75th percentile for income in the US. A $1300 hit to one's budget is completely out of the question for a very, very large number of people in the US. Most people don't have an extra couple of thousand bucks laying around. In fact, most people have low enough disposable income, that the tax advantage aspect of an HSA is completely irrelevant to them. A large number of individual shoppers don't even use the account itself - all they do is buy a high deductible plan because that's all they can afford to buy. If they do manage to put money into their HSA account, it's not for the intention of saving, so much as for the intention of spreading their cost over a longer period of time because they can't absorb the cash-flow risk.
No, it's vaguely like my idea in some respects, but it undermines my idea in others. It's too Rube Goldberg-ish for one. It's a tax-advantaged, dedicated account, so (a) people are incentivized to max out their contributions; and (b) the money can't be used for other purposes, so it really is kind of a "use-it-or-lose-it" type of deal, which like flexible spending accounts (and your complaint about the first $1K under my plan), forces people to spend more than they normally would on health care.
In red - most people don't care about the tax implications. Most people aren't affluent enough for that to be a meaningful thing to them.
In blue - not at all. It's their money to use as they see fit, whenever they want to. They never lose the funds, and when they turn 65 they can use it for other purposes. In fact, they can take that money out and use it for other things at any time, they just have to pay the taxes for it (which are substantial). But they never lose it. That's not what incentivizes them to use more health care. What incentivizes them to use more health care is the fact that their health care has no impact on their cash-flow once they have a bit of an account built up. It makes their observed cost of service $0. That's what incentivized increased utilization.
I could have predicted this. And did actually. The consequences are completely consistent with my view of consumer behavior, as well as with the policy I've proposed to remedy those defects. Note that one thing we really need to do is bootstrap our way into having a market with transparent pricing. Without transparent pricing, it's too difficult to shop around. These other ideas did not provide sufficient incentive for providers to advertise their prices. I think my policy proposal will. $4,000 per person of discretionary spending is quite a lot.
I agree that transparent pricing would be better - 100%. I disagree that your proposal will have any measurable effect on accomplishing that.
It's not a word game. As I've said before, I think everything is a choice, as long as you're conscious and in your right mind. Even in matters of life and death. Especially since it's almost always about probabilities and risk. If I have cancer, and I take this drug, I have an 80% chance of living. If I take this other cheaper drug, I have only a 75% chance of living, or 60% or 40%, or 5%. There is always a calculation to be done, and there is always a tradeoff. It simply isn't the case that people consider their lives to be priceless, at least implicitly and in real life. That's why they're willing to buy a car without airbags. Or a small car that would be crushed in a collision with most cars on the road. Or speed in order not to be late for work. I wouldn't consider my life to be priceless even explicitly. Given a choice between bankrupting my family and killing myself, I would probably kill myself.
That's a trivial version of "choice" that completely invalidates the concepts of exploitation and coercion. Hey, who cares if there's a gun to your head? You have a "choice" between turning over all of your belongings and dying.
