Re: One-Handed Applause (Josh Cohen & Brink Lindsey)
 

thanks, for your reply, it has helped me refine my original questions.

A. Insurance:
A means of indemnity against a future occurrence of an uncertain event; The business of providing insurance; Metaphoric: Any attempt to anticipate an unfavorable event; Blackjack: A bet made after the deal, which pays off if the dealer has blackjack; An insurance policy
en.wiktionary.org/wiki/insurance

An indemnity is a sum paid by A to B by way of compensation for a particular loss suffered by B. The indemnifying party (A) may or may not be responsible for the loss suffered by the indemnified party (B). Forms of indemnity include cash payments, repairs, replacement, and reinstatement.
http://en.wikipedia.org/wiki/Indemnity

B. Health Care:
Health care (often healthcare in British English), is the treatment and management of illnesses of the elderly, and the preservation of health through services offered by the medical, dental, complementary and alternative medicine, pharmaceutical, clinical sciences (in vitro diagnostics), nursing, and allied health professions. Health care embraces all the goods and services designed to promote health, including “preventive, curative and palliative interventions, whether directed to individuals or to populations”.[1] The definition of health care is continously evolving, and varies significantly between different cultures.[2]
http://en.wikipedia.org/wiki/Health_care

considering A. (Insurance) and B. (Health Care) as separate entities, how do we(the royal we) structure the optimal relationship between A and B? in other words, to get the best B.(for everyone) what would A. look like?

what is the relationship between the quality of B. and the cost of A.?

then too, what is the relationship between the quality of A. and the cost of B.?

if B. is considered a right, rather than a privilege, what does this say about A.?

presently:
1. is the cost of both A. and B. too high(according to whom, for whom, and why)?

2. is the quality of both A. and B. the same for all?

The sound of one hand slapping might be, the fact that , if one has enough money, one can get the best B. in the world, without being concerned about A. and the practical issues of reform of A. and B. are for us non-rich!!!

Re: One-Handed Applause (Josh Cohen & Brink Lindsey)
 

I am of the opinion that the key elements here are to spread the risk of illness (and therefore the cost of A) across as wide a pool as possible to have a risk level that is as close to the average in the population as possible and therefore the lowest cost possible. Therefore I favor (in this order) the following possible options for the structure of this relationship:

1. a federal no-interstate-barriers insurance exchange with mandatory individual purchase (and true fines on the mandate) and heavy subsidies--this would be something akin to the Wyden-Bennett bill, and also to the system currently employed in the Netherlands and Switzerland

2. single payer, as in a single state-sponsored entity that is the insurer for all, where the 'premiums' paid in are taxes--this would be the system currently in place in France

I do not favor (3.) mixes of these two nor do I favor (4.) direct state-provided care.

Eh, I believe this question hinges on what you believe about prescription drugs. The element of the cost of A that is directly related to the quality of B (as opposed to being related to the risk factor of the patient) is the quantity/variety of drugs covered. Those who look at the drug industry as a bunch of patent-grabbers who marginally tweak drugs to get new patents so that we have on our insurance-covered list 6 drugs that do the same thing etc, those people are inclined to support the solutions that most dramatically lower the cost, which would be solutions 2. and 4. Those people who see the variety of drugs as a sometimes inefficient, but still the best we've got, route to medical innovation are inclined to favor more expensive systems that make more room for a large pharma sector. Those people generally favor scenarios 1. and 3. This is of course my assessment of what people with particular goals desire, based on my reporting on this topic in the past, not a statistically proven thing.

None. The absolute cost of particular care procedures is determined by other, downstream, problems in our care system. These are things that Atul Gawande immemorialized in the New Yorker. Reforming these would be health care reform, not insurance reform.

Nothing, as far as I can tell. Advocates of 4. will argue that insurance, making a market for rights, is wrong/unconstitutional. Philosophically, I understand this. However, as a practical matter, I have come to the conclusion that systems of A provide the form of B (see your first and second questions above) that I like best. So I would prefer to achieve B through A.

The cost of B is high for the various qualitative reasons Gawande has outlined. The cost A is too high not only because of those reasons, but also because the system of A we have is not all-encompassing enough to effectively pool risk across the population and reduce the cost to whatever would be the cheapest given our current quality of care.

The quality of A is about the same for all those who can afford to buy it, but the quality of B varies greatly between roughly three tiers of people: those with insurance, those who are rich enough not to need insurance and can pay for their own top-notch procedures, and those who don't have insurance because their care is too expensive (so they are denied) or they are too poor to pay, and therefore cannot afford all the care they need.

That's my take on all of this. Others will differ I'm sure.

Re: One-Handed Applause (Josh Cohen & Brink Lindsey)
 

thank you! well said, i'll take your thoughts into consideration!!