The Oregon Health Plan…A Bold Experiment That Failed

September 9, 2010

Media Release
Contact Steve Buckstein
(503) 242-0900
[email protected]

The Oregon Health Plan:
A “Bold Experiment” That Failed

Cascade Policy Institute has released a new report on how well the Oregon Health Plan met its promised goals.

Conceived in the late 1980s, the Oregon Health Plan has been called a “bold experiment” designed to expand health insurance to Oregon’s low-income residents. It relied on explicit rationing of care through a prioritized list of conditions and treatments.

Launched in 1994, the OHP sought simultaneously to expand coverage, control costs, and foster provider participation.

Sixteen years later, report author Dr. Eric Fruits concludes that:

“[L]ike the experimental drug that performs no better than a placebo, the Oregon Health Plan has produced results that are not significantly different from the outcomes seen by the U.S. as a whole.”

Dr. Fruits makes three major findings about the goals of the Oregon Health Plan:

Covering the uninsured: Over the life of the plan, the share of uninsured in Oregon has not been significantly different from the rest of the U.S. for any sustained period of time. Similarly, over time, Oregon’s share of the population covered by Medicaid is virtually no different from the rest of the U.S. Data presented by the state tended to overstate the number of uninsured prior to implementation of the Oregon Health Plan and understate the number of uninsured after the plan was rolled out, thereby inflating the plan’s early success in expanding coverage.

Medicaid spending: Total Medicaid expenditures and Medicaid expenditures per enrollee have closely tracked U.S. expenditures, an indication that the Oregon Health Plan has not been any more or less successful than the U.S. as a whole in controlling costs.

Provider participation: Initial hopes for broad provider participation have been dashed by the pullout of larger managed care providers and a shrinking pool of providers willing to accept Oregon Health Plan enrollees as new patients.

Cascade Senior Policy Analyst and founder Steve Buckstein points out that “no other state has followed this ‘bold experiment,’ and now we know why.”

“Based on Dr. Fruits’ findings,” Buckstein says, “I think it’s safe to say that if we showed a knowledgeable observer the results of five random states’ Medicaid programs, they would not be able to pick Oregon out of the crowd.”

Dr. Fruits suggests one way to improve Oregon’s Medicaid results:

“A program offering some type of health savings accounts to Oregon’s Medicaid eligibles is one way that Oregon may meet many of the Oregon Health Plan goals at a lower cost and with smaller demands on administrative overhead. In addition to helping the state get out of the health care management business, a program of health savings accounts would save money by making the insured more aware of the expected costs and benefits of health care services.”

Buckstein points out that South Carolina has a program similar to what Dr. Fruits recommends: Health Opportunity Accounts that place funds in Medicaid participant accounts every year. “While still an experiment itself,” Buckstein adds, “such a program holds out promise to better meet goals that the Oregon Health Plan clearly has failed to achieve.”

###

The Oregon Health Plan
A “Bold Experiment” That Failed

by Eric Fruits, Ph.D.
with Andrew Hillard and Laura Lewis


Steve Buckstein is Senior Policy Analyst and Founder at Cascade Policy Institute, Oregon’s free market public policy research center.

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  • a retired professor

    Sounds a lot like the various experiments, advocated by left and right alike, that have been performed in education. (See recent article below with comments.) None of them really works, but there’s always another one in the pipeline!

    So maybe the left plan (OHP) hasn’t worked, but Steve Buckstein eagerly anticipates the newest right plan (health savings accounts in S. Carolina).

    Maybe this will work better. I’m not holding my breath. (For one thing, skeptical about the ability of the kinds of people who end up on medicaid to manage their monthly food stamps allotment, let alone a medical care and insurance account.) But we’ll see.

    • Steve Buckstein

      professor, if experiments fail then they should be ended. The Oregon Health Plan has just kept going, and we hope our report will encourage people to ask why.

      On your point about people who end up on Medicaid not being able to manage their financial affairs, I think that is perhaps a faulty stereotype. Give someone a use-it-or-lose-it benefit like food stamps and we shouldn’t be surprised if people manage their allotment somewhat badly. The whole idea of HSAs and HOAs is that the recipients can benefit by spending less now and saving for the future. No guarantee they will do so, but that’s what the experiment is for – to find out.

  • valley p

    Your next report should be: The American Health Care System, a Bold Experiment that Failed; Highest costs, lowest % of people covered, high comparative mortality, and least efficient health delivery system in the developed world.

    • Anonymous

      The next report should be why do so many people have cable tv, a expensive cell phone contract, internet, Eating out and other luxuries, before they have a health care plan.

      Before Obama care you could buy a health saving account (Major medical) for a 30 yr old for about $140.00 a month.

  • Bob Clark

    I think I heard even one of the chief authors of the Oregon Health Plan, none other than former governor Kitzhaber, at one point called the Oregon Health Plan a failure. So, Dr. Fruits confirms Kitzhaber’s failure, one of creating another public bureaucracy good mostly at adding government employees to the state’s payroll and driving the state’s dismall fiscal situation.

    I don’t think much of the savings account solution, however. The marginal rate for state income taxes is 9% so it would be a lot of paper work for meager savings. The federal health savings accounts have too many strings attached to make it very useful. So, I’m not so thrilled about the health savings account approach. I think a better idea would be to allow Oregonians to buy health insurance across state lines, and maybe even outside U.S borders. This would eliminate costly mandates which cause individuals to have to buy coverage they won’t use (e.g, wrong gender). If people can’t afford health care insurance, maybe a strict means tested health care stamp program would be a better solution. Maybe. Food stamp programs also have problems with allowing the door into the program become too large.

  • Steve Plunk

    It’s funny the only thing to ever really control health care costs without sacrificing too much on care was the HMO model. Unfortunately it became the butt of jokes and people wanted something for nothing so it fell into disfavor.

    The Oregon Health Plan was never anything more than health care welfare. It didn’t control costs so it became a failure. We can’t afford to send every sniffle to the doctor and the Oregon Health Plan did little to discourage such behavior.

    The path to correcting our problem is paved with a hundred 1% solutions. No silver bullet, no magic, just a bunch of little fixes that combined will keep costs lower and make all health care more affordable.

  • a retired professor

    It’s wonderful, everyone has a solution or two — OHP, HSA’s, HMO’s, interstate insurance, international insurance — just what the homeless mental case down the street needs! — 100 little band-aids — single payer Eurocare — the list is endless — and nobody’s cure-all is the same as anybody else’s. Just like edu-reform — so many failed experiments, so many miracles just waiting for us to accept in into our hears — I love it!

  • Bob Tiernan

    *valley person:*

    Your next report should be: The American Health Care System, a Bold Experiment that Failed

    *Bob T:*

    You are correct — the system created by government (mainly starting in the 40s) in which tax policy has been used to favor employer-based health benefits over individual-based (such as we enjoy regarding auto and home insurance), and mandated coverage has made policies very expensive, and the AMA/Government partnership has limited the number of physicians for decades, and interstate commerce in health policy shopping is severly curtailed, and health care “insurance” has been turned into per-paid medical services in which people take it for granted that insurance is needed to pay for squirts of Bactine and routine check-ups (which is like auto insurance for flat tires, tune-ups, and filling the gas tank) — you’re right: that system has failed.

    *valley person:*

    lowest % of people covered

    *Bob T:*

    Why is it that you judge this on “coverage”, rather than availability, access, and choice?

    *valley person:*

    high comparative mortality

    *Bob T:*

    Which means…..?

    *valley person:*

    and least efficient health delivery system in the developed world.

    *Bob T:*

    That makes no sense. How can you compare what we have to any number of systems with long, long waiting lists, fewer medical devices per capita, and so on? Well, you can’t.

    Bob Tiernan
    NE Portland

    • a retired professor

      Yes, we miss shopping for our own insurance, the nation is clamoring to get rid of employer insurance! And now that I’m retired I look forward to shopping around for insurance when I’m 80. Will be a motivation to all us old people to stay healthy so we won’t have to worry about pre-existing conditions.

      There may be a better system than we have, there must be — vp is right about the ghastly inefficiency of our system, we pay far more of our gdp than any other country, with spotty results, except it’s a financial catastrophe. And of course, there’s the appalling lack of coverage for so many millions of people. It’s a disgrace.

      The better system may not be Obamacare — I don’t think it is — but nobody else has spelled one out convincingly.

    • valley p

      Our health care system was not “crafted by government” Bob. Employer based health insurance came into place due to wage and price controls during WW2. Private companies added health insurance as a way to entice better employees during what was a worker shortage due to 20 million Americans in the armed services (we knew how to win a war back then. Everybody in the game).

      Medicaid was added to cover poor people who lacked employer based insurance. Medicaid was added to cover older people who were no longer working, and thus lacked health insurance. We stick temporary patches on a rotting boat and call it reform. But the holes in the boat kept getting bigger, so we now have Obamacare as a bigger, maybe better patch. We really needed a new boat.

      Insurance coverage pretty much equals access and choice to medical services. Sure, most people could afford an occasional doctor visit or spine adjustment without insurance. But 80% of health care spending in this nation is from 20% of the population. Its the cancer treatments, the diabetes treatments, and major surgeries that cost the big bucks, and that is why people most need insurance. Decoupling day to day care from the possible need for major care has not worked because of the interelationships of doctors and hospitals and insurance companies. Other nations figured this out some time ago. We…stuck in our “free market” nonsense, have not.

      Obamacare, as the retired professor points out, is a far from perfect solution. It won’t control costs enough because it did not centralize payments. There will still be huge inefficiencies as private insurance bureaucrats take 15% for administrative work while Medicare takes only 2%.

      The best system in the world with respect to value for the dollar combined with universal access is in France. They have a Medicare for all supported by taxes combined with a supplemental private insurance for easier access, private hospital rooms, and other perks. If we were rational people not driven by ideology we would have evaluated all the options out there and picked the one that has been proven to work best. We ended up with a messy compromise. Maybe it will improve things and maybe not. Most likely, it will improve some things and worsen others.

      • Anonymous

        We all should be allowed to pick the systeem that is best for ourselves and not have VP, retired Professor or presideant Obama make that choice for us.

        That is in a free country, we should be allowed to choose.

        • a retired professor

          You have a choice of “system”? You must be dictator of your own country then. It must be nice to have your freedom.

          I am stuck, for better or worse, with the system we have in the United States.

          • Anonymous

            Some people can handle freedom and choice. Others need someone to hold their hand and choose for them.

            I prefer freedom and choice by me, not others for me.

          • Anonymous

            What you’re saying is not exactly clear. You prefer the freedom to choose between private health insurers operating within a system that inflates costs and whose main interest is generating a profit? Or, you are not impressed by a system that attempts to control costs (single-payer) and is not driven by profit?

          • Anonymous

            I prefer the free market and my health saving account to anything the federal or state government proposes.

            The state and federal government has never been able to control costs of medical care. but they do put a lot of mandates on the insurance companies to make them less able to to lower or keep their prices down.

            If you want single payer health care, you and anyone that agrees you must force the rest of us to go on you plan. That is not how a free country should work.

          • Anonymous

            “I prefer the free market and my health saving account to anything the federal or state government proposes.”

            Why should a “free market” exist for healthcare? Are you aware that demand for healthcare is perfectly inelastic?

            “If you want single payer health care, you and anyone that agrees you must force the rest of us to go on you plan. That is not how a free country should work.”

            So? Do you have a problem with the rule of law? Do you feel that you are being robbed by the government when you pay taxes? When tax dollars on spent on the military, road building, public education, etc…?

          • Anonymous

            I prefer to have a choice in heath care because I want the best for me and my families health. I don’t think you, President Obama, Earl Blumenauer, Ron Wyden or a bureaucrat really care about me or my families health. Other than wanting to have complete control over it.

            You do care a lot how I spend my money and you want to control that too.

          • Anonymous

            What are you talking about? I couldn’t care less how you spend your money, and I agree that Obama et al probably don’t care about you or your family any more than you care about me or my family. How would a universal healthcare system prevent you from having “a choice in health care”? If you can afford private care you can get private care. End of story.

            Btw, health care does not and will never exist in a “free market”.

          • Anonymous

            You want a single payer monopoly, run by Who?

            I don’t want it

          • a retired professor

            That might be fine, but it doesn’t really get to the crux of the matter. We all will live in some kind of more or less artificial, contrived system. It might be what we have now, or it might be Steve Buckstein’s health savings accounts, or it might be Obamacare, or it might be something else. (It’s very unlikely to be the kind of system I might contrive.) Some sort of system of rules and means for providing the medical care that is possible. If there is not an “insurance system” in place, most people would not be able to consider, say, a kidney transplant. Without a “system” of medical research having been in place, kidney transplants would not exist.

            As for wanting to be free to make your own health care decisions, I would like that too, in principle, but in reality that’s not always possible. When I was employed by the U of O, or the state of Oregon if you prefer, the last dozen years or so I had exactly one choice of insurer, offered by the employer. There had been more choices, but they cut back on that, ostensibly to cut down on costs (government efficiency, you know). I supposed I could have exercised my freedom and bought my own, private, separate health insurance, but that would have been kind of extravagant. I was lucky, though — lots of people don’t have the means to get much of any insurance.

            And you know, we’re not always in the position to make our own decisions. You might find yourself incapacitated — Alzheimer’s is going to hit an awful lot of us sooner or later — or broke, or otherwise not in a position to run your own show. At that point, you’ll have the ‘system”, whatever it is, to deal with your needs. It might be your kids, or the state, or a charity ward, or they might just throw you out in the street. But the “system” is what you will have.

          • Anonymous

            President Obama and the Democrats have cut the heart out of my high decidable affordable Health Saving account.

          • a retired professor

            Ah, they don’t like your system.

            How did they do that? Or is this in the future?

            It will be really interesting to see if the Republicans will have the will and the intellectual fortitude to modify the Obama system into something better. I’m not holding my breath. They had their chance in the Bush years to come up with something better than what we have now — anyone could see we weren’t going to go on with that much longer — and they utterly blew the chance.

            Maybe they’ve improved themselves since then. I hope so, but I doubt it.

          • Bill Udy

            Modify? I thought i heard some of them say Repeal In Its Entirety? That’s easy to say, but repeal would have to be followed by reforms to remove the federal government from health care. No more federal regulations, paperwork requirements, etc. I guess that is “modifying” Obamacare plus “Bushcare”, “Clintoncare”, “Reagancare”, etc.

          • a retired professor

            “remove the federal government from health care”

            No more Medicare, no more Medicaid. No more Veterans Administration, I guess, no more federally sponsored medical research. No more Centers for Disease Control? A big agenda you have there! You’d have a lot of angry people out there, not least a lot of angry Republicans.

            Just rescinding Obamacare is beyond anything that is likely to happen. Just for starters, very unlikely that the Republicans will have the votes to overcome an Obama veto. And once Obamacare is in effect, it will be very difficult to overturn, even with a Republican president. Look how the Republicans did at reversing social security and medicare.

          • Bill Udy

            Precisely correct. That is why, with the federal govt so far off the reservation (Constitution), that it is unreformable. You mention some things the govt is doing that are not authorized by the Constitution. The govt will never give up these programs for the types of reasons you list.

            All the comments here seem to endorse this without saying so explicitly. I see opponents of Obamacare (govt provided health care) offer up various fixes, tweaks, reforms, etc., but don’t we all know none of these will work? None of these can make govt provided health care outperform a free market in health care.

            Some may of those suggestions may slow the decline, but what government program has ever worked? As one Harry Browne audience member offered as an example of a successful govt program, “the weather bureau?”

          • a retired professor

            Leaving aside the question of Constitutionality — didn’t Jefferson believe that the Louisiana Purchase was unconstitutional? — many of those programs I would not want to give up. I don’t believe that a pure “free market” in health care would “work”. And I don’t believe that government programs never work. Examples: Manifest Destiny; the Normandy Invasion; land-grant universities; the Hubble Space Telescope; the national parks; and yes, the modern social welfare system.

  • Rick Hickey

    One difference between HSA’s & OR. Trail card…As I witnessed again yesterday at Circle K…A man buys several bags of potato chips & other Junk food, then convinces the clerk to give him cash back and then uses the cash to buy…Beer & Cig.s

    HSA’s only allow true Medical treatment reimbursement, earn interest on the funds not spent and do not have a “lose it or use it” feature.

    Mr Buckstein, may I call your attention to the Failed experiment of the”Healthy Kids” plan up the road in Washigton? (Considering that it may have similar results as ours) I have a report from a State Senator that their plan A. Inlcudes a high % of persons on the plan that were not previously covered under Medicaid because of their “Immigration” status (Feds do not knowingly cover illegals except for “emergencies”). B. A significant number of people now on the plan did have their own med. insurance and dropped it to take the tax payer Gov’t option instead.

  • Spikez

    Bob T: Who has had mandated coverage since the 40s? Availability and access in our current system are only found in “coverage.” “High comparative mortality” means more people die at a faster rate in our hospitals than in, say, Taiwan. As for the efficiency, you are an idiot if you think we get what we pay for in our HMO system. Worst business model on the planet.

    Also, once again, Bob Clark proves his mental illness.

  • Reper

    I would keep in mind that no state system is free from influences of the problems of federal and indutsry failures.

  • Bill Udy

    Here is a case of where the moral argument against government programs might be more persuasive than raw data, or at least equally persuasive.

    For the government to take money by force from some people, and turn around and give that money away to someone else, is just plain wrong. Most people are willing to pay for goods or services that they actually receive, but are not willing to have government reach into their purse or wallet to take money out and give it away to undeserving recipients.

  • Rupert in Springfield

    It’s really not worth getting into the health care argument with liberals, since you can sink their arguments in one shot.

    Liberals complain we have the most expensive health care system in the world, and least efficient and therefore government should run it.

    Well, government runs the education system.

    And we have one of the most expensive and least efficient education systems as well.

    “But Europe spends less and they have a higher life expectancy” will be the clarion call of the Guatamalen vest wearing sensitive pony tail guy.

    “Why yes caring new age guy, and Europe also spends less per pupil on education and does a better job as well.”

    “Oh but thats apples and oranges……why…..why you cant compaire the two…..I mean there are endemic problems of culture and sensitivity and demographics that apply in education….. I mean you just dont understand”

    “But of course none of these endemic culture sensitivity pottery stuff would occur in the health care system would it pony tail guy?”

    “Yes…. thats right… I mean you just can’t compare the two…….we have to spend more on education and less on health care and then both will be better…..”

    “OK pony tail guy. I’m afraid we have reached the end of the Joan Baez record, frankly I get worried when Joans screeching sounds more sensible than yours”

    “You just dont know what you are talking about”

    “Yes I do liberal pony tail guy – Joan Baez is one of the truly annoying singers of our world, only topped by the Linda Ronstadt version of Blue Bayou, which is a truly awful horribleness from an otherwise excellent singer.”

    “No, about health care, you don’t know anything”

    “I know Ron Wyden is running away from Obama care faster than quicker than Joan Baez could clear out a Rolling Stones show.”

    “And quit picking on Joan! you’re a Nazi!”

    Liberals advocate cutting what we spend per patient in order to emulate the European model. When liberals avocate for cutting education spending to do the same, they will have some credibility.

    After the debacle of OHP and the fact that even Ron Wyden is running away from Obama care its pretty clear – the nation is saying thanks but no thanks to new and exciting liberal silliness.

    • valley p

      Speaking of health care, have you ever had yourself checked out Rupert? This tendency you have to make up people to argue with is a bit weird, especially when you have actual liberals right here you can test yourself against. I’m sure there is a clinical description for your condition.

      In short…yeah, its worth comparing education as well as health care for value to money. Show me the overseas education model you want us to adopt and explain why.

      • Anonymous

        “I’m sure there is a clinical description for your condition.”

        Rupert was diagnosed awhile back… narcissistic personality disorder. The DSM-IV describes it as “a pervasive pattern of grandiosity, need for admiration, and a lack of empathy.” Sound familiar? Unfortunately, he refuses to get help.

        • Rupert in Springfield

          >Rupert was diagnosed awhile back… narcissistic personality disorder.

          Considering I actually post something on my own, rather than waiting around to contribute nothing more than dopey insults I would say your future as a psychologist, or a writer for that matter, doesn’t show a lot of promise.

          >The DSM-IV describes it as “a pervasive pattern of grandiosity,

          Sorry, your finding my use of language so threatening that you can only contribute insults, and not anything of value, constitutes insecurity on your part, not grandiosity on mine.

          >need for admiration,

          I would say your thinking I need admiration from you is really a little self absorbed and kinf of creepy.

          Hey! Is this creepy anonymous stalker troll? Just curious.

          >and a lack of empathy.

          Well, since I regularly display empathy on this exact topic your comment is especially idiotic.

          I have quite roften said, when the subject comes up, that Kitzhabers Oregon Health Plan was actually a very good idea in its concept of listing procedures and paying for that which funding would allow.

          Oh well, better luck next time, keep trying slugger!

          • Anonymous

            “…nothing more than dopey insults…”

            Dopey insults? Aw shucks. I thought it was kind of funny (and I know it was plenty insightful).

            “I would say your future as a psychologist, or a writer for that matter, doesn’t show a lot of promise.”

            Noted, Rupert. Glad to have your expert opinion.

            “Sorry, your finding my use of language so threatening…”

            Feeling a little more than important than you are, aren’t you? It’s okay, Rupert, we understand. Your intellect is truly devastating. We cower in fear.

            “…that you can only contribute insults, and not anything of value, constitutes insecurity on your part, not grandiosity on mine.”

            Oh? What do your insults constitute, Rupert? Pray tell.

            “I would say your thinking I need admiration from you is really a little self absorbed and kinf of creepy.”

            Did I say you needed MY admiration? I don’t think I did say that, did I? But go ahead and take a bow anyway. You deserve it.

            “Hey! Is this creepy anonymous stalker troll? Just curious.”

            I am the individual that you have elevated to “stalker troll” indeed. Interesting that you regard yourself as being stalked. I wonder what type of mind perceives this scenario as such? Hmm…

            “Well, since I regularly display empathy on this exact topic your comment is especially idiotic.”

            Hahaha!!!

            “I have quite roften said, when the subject comes up, that Kitzhabers Oregon Health Plan was actually a very good idea in its concept of listing procedures and paying for that which funding would allow.”

            Yes, I could feel the empathy oozing from your previous comment wherein you mocked your fictitious “caring new age guy”. Your heart obviously bleeds. Mother Theresa has got nothing on you.

            “Oh well, better luck next time, keep trying slugger!”

            No luck is needed, my friend. Your role as OC’s resident wingnut blowhard clown is quite secure.

      • Rupert in Springfield

        >This tendency you have to make up people to argue with is a bit weird,

        Not really. Fictitious discusions are actually fairly wide spread in novels and that sort of thing. You would know this if you read, but we all know you don’t so I guess its a new phenominon to you.

        >when you have actual liberals right here you can test yourself against.

        Well, testing myself against you isn’t much of a test since you rarely actually read what you are replying to.

        >Show me the overseas education model you want us to adopt and explain why.

        Again, read the post. Virtually every European country spends less than us. I have gone through this with time and time again. We have the models of Charter schools, which get 80% of funding per student and do a better job. We have the model of private schools, where teachers make significantly less than public school teachers, and they also do a better job.

        And no, your nonsense about private schools being taught only by those who are nuns or who have sworn a vow of poverty doesn’t hold a lot of water.

  • skippy

    Buckstein likes a program from South Carolina, the state known for dirty politics. Ha! It must be one heck of a plan.

  • Bob Tiernan

    *valley person:*

    Our health care system was not “crafted by government” Bob. Employer based health insurance came into place due to wage and price controls during WW2.

    *Bob T:*

    And just who was responsible for the wage and price controls? (By the way, with those benefits, workers still shifted to other employers who were not able to lure them with a higher wage, so
    that idea didn’t prevent what government tried to stop, i.e. workers shifting to other employers).

    But anyway, what you’re not grasping is that this was not a good model to enlarge, and the government encouraged this afterwards and fostered it by creating priviliges in the tax codes
    later on, i.e. allowed companies to write off the costs of such plans while preventing individuals from doing so. Gosh, guess what was likely to grow after that? the government simply took an easy
    way out and created an imbalance that was the opposite of a free market system. Imagine if your auto insurance or home insurance was tied to your job. Sounds stupid, right? Of course it is.
    But that’s what government did regarding health insurance.

    Bob Tiernan
    Portland

    • valley p

      Rupert writes: “Not really. Fictitious discusions are actually fairly wide spread in novels and that sort of thing. ”

      Yes, so I’ve heard. Its also fairly widespread that people with your condition do not think they have a condition. The voices inside their heads are real to them.

      “Virtually every European country spends less than us.”

      Not good enough Rupert. So they spend less. What do they do differently with the money they spend? Do they pay teachers less? Do they prevent teachers from joining unions? Do they have larger classrooms? Do they use technology differently? Do they hand parents vouchers and let the educational free market take care of things?

      Turns out they pay teachers MORE than we do. Starting teacher salary in Germany is about $43,000 a year. And teachers get paid for their training. And they get 14 paid weeks off a year. The average teacher salary in Switzerland is nearly double that of the US. Nearly every Euro nation spends MORE than the US on education as percent of its GDP. Teachers are of course WAY unionized in Europe.

      And…do we really spend more? Not for primary and secondary education. Luxemberg, Norway, Iceland, Switzerland and Austria out spend or equal us per student in dollars spent per student. We spend more on “tertiary” education, or post high school, than any other nation, and that skews total education spending to make it look like we spend the most on everything. We don’t.

      But you knew that right? https://www.eric.ed.gov/PDFS/ED506349.pdf

      And tot he extent Euro countries spend “less,” is it perhaps because the national governments pick up the entire cost of health care and pensions, leaving schools to only have to pay salaries?

      Stick with fiction writing Rupert. The world of reality is not your thing.

      “And no, your nonsense about private schools being taught only by those who are nuns or who have sworn a vow of poverty doesn’t hold a lot of water. ”

      No, it doesn’t hold water with you because you are a leaky boat when it comes to information that contradicts your beliefs. But the fact remains that 90% of private schools are religious, and that half of those are Catholic, and many of the teachers are nuns. So comparing private and public school costs has no relevance to anything.

      Bob T writes: “And just who was responsible for the wage and price controls? ”

      That would be the federal government Bob. The darn “liberals” who thought they had to mobilize the nation to win a war. They did not have faith that the free market would win the war for us.

      “But anyway, what you’re not grasping is that this was not a good model to enlarge, and the government encouraged this afterwards and fostered it by creating priviliges in the tax codes”

      Au contraire, I agree with you. It was not a good model. And it remains not a good model to this very day, which is why it costs too much and delivers too little.

      The government, or at least the democratic part of it starting with Truman, recognized the problem with this model since the 1950s. But the other government, your Republican/conservative part, fought every effort to change it, always arguing that we had the best health care system in the world, (rich) people come here from all over for our doctors, other countries have waiting rooms (like we don’t!) and so forth. Reagan argued that Medicare would destroy all of our freedoms. Segregationists argued that it would integrate hospitals and white people might have to sleep in beds previously occupied by dark people. So we have stayed with the system we have all these years, tinkering here and there, plugging holes now and then, continuing to spend way too much for far too little.

      Imagine government requiring me to have auto insurance! How ridiculous. But wait….they do!

  • Roger

    I was able to get a new hip, some lipo, and some drug counseling…all for free.
    So I would say the plan is working just fine.

    • rural resident

      You needed a new hip and drug counseling, Jerry? You’re in worse shape than I thought.

      • a retired professor

        Very good. I think you’re right, it’s Jerry. I wondered, when I read that, who it was, Jerry didn’t come to mind. He’s getting a little more subtle!

        But then again, maybe too much time in Arkansas really did that stuff!

  • Bob Tiernan

    *Bob T:*

    And just who was responsible for the wage and price controls?

    *Valley Boy:*

    That would be the federal government Bob. The darn “liberals” who thought they had to mobilize the nation to win a war. They did not have faith that the free market would win the war for us.

    *Bob T:*

    Several things here. You confirmed my point that government action helped (if inadvertently at first) create the health care system we have today. They increased this after the war by granting businesses privileges while denying them to individuals. Gee, guess what would happen with that imbalance?

    Point two, note that you seem to believe that wage and price controls were about helping to win the war. In this example being cited, the government was trying or hoping to prevent skilled workers (and even unskilled workers) from changing employers right in the middle of war production, for they felt it was not good to have shipbuilders lose some welders one week, and riveters and so on, and have to spend time replacing them in the middle of a run.

    By banning companies from offering higher wages, this was a way top deal with this possibility. But if the goal was to limit workers moving from employer to employer, then the government could have dealt with that by banning the job-switching outright instead of using wage controls. One result was that benefits were used a lure, successfully, and this was follwed by more distortions that helped create the stupid job-based health care coverage system we have.

    Oh, and interesting to note that the big bad free market, as you see it, is not good for “winning wars”. Yup — it’s that government you think is so saintly that can give us the militaristic controls, as Woody Wilson showed during World War One, far more than FDR did later on.

    ========================

    *Bob T:*

    But anyway, what you’re not grasping is that this was not a good model to enlarge, and the government encouraged this afterwards and fostered it by creating priviliges in the tax codes.

    *Valley Boy:*

    Au contraire, I agree with you. It was not a good model. And it remains not a good model to this very day, which is why it costs too much and delivers too little.

    *Bob T:*

    Nice switch there — your earlier claim was that we have a free market health care system that has had little or no government role in its creation.

    The system we have, which is still far better when it comes to results than what you give it credit for, is an example of what you get when government bright boys manage “the market” bit by bit, creating even more and larger distortions to allegedly offset distortions they created, and mandating things that they think the market “should do”. This is that mixed or highly regulated market people like you have told us for decades would give us the best of all possible worlds. How wrong you were.

    It’s a stupid system, and of course the government is its usual narrow-minded self when trying to “correct” it again, this time in the form of ObamaCare Part One.

    *Valley Boy:*

    The government, or at least the democratic part of it starting with Truman, recognized the problem with this model since the 1950s. But the other government, your Republican/conservative part, fought every effort to change it, always arguing that we had the best health care system in the world, (rich) people come here from all over for our doctors, other countries have waiting rooms (like we don’t!) and so forth. Reagan argued that Medicare would destroy all of our freedoms. Segregationists argued that it would integrate hospitals and white people might have to sleep in beds previously occupied by dark people. So we have stayed with the system we have all these years, tinkering here and there, plugging holes now and then, continuing to spend way too much for far too little.

    *Bob T:*

    Wow, that was some diatribe. Interesting that you’re blaming the big bad Republicans for how the employer-based health insurance system was distorted and “corrected” and fine-tuned more and more (i.e. made worse). Odd, since the Democrats held the House of Representatives for 40 years until January of 1995, while the Senate was in the hands of Democrats for most of those 40 years, and we had quite a few of those years with Democrats in charge of the whole show (White House, House of Reps, the Senate), under Kennedy, Johnson, Carter, and even first two years of Clinton. Instead of blaming the Republicans, you should simply acknowledge that both parties were taking the easy way out by encouraging this system more and more rather than actually try to deal with its long term problems and how anti-market it was and has been. They saw it as something that wasn’t broke (most people have few problems with it) and therefore didn’t want top rock the boat. Going to anything approaching single payer was and is no solution for it involves the same distortions, many of them on steroids.

    *Valley Boy:*

    Imagine government requiring me to have auto insurance! How ridiculous. But wait….they do!

    *Bob T:*

    As usualy, you missed the point, and had to lie about it. The point about auto insurance is that no one is forced to buy it for you can opt for other modes of getting around, and it has nothing at all to do with your ability to drive. More importantly (and this is what you ignored in order to make a cheap point), one’s auto insurance is not tied to one’s employment. Or do you think that auto insurance tied to your job is a good idea?

    The other thing here is that because auto insurance is more market driven than health care insurance (even if mandated, albeit for drivers only and not the millions who use the bus, walk, etc), and doesn’t have a lengthy and absurd list of mandated items to be covered, it’s a better deal by far. My auto insurance has barely gone up over 20 years, and even went down at one point. If you want to compare the two, then you’d have to imagine auto insurance being mandated to cover oil changes, tune-ups, flat tire repairs, fluid checks and so on.

    Again, you need to rethink what insurance is really supposed to be. Our government-designed health care system is not insurance so much as it’s pre-paid medical care. You keep thinking in terms of “coverage”, as if someone who prefers to pay out of pocket for routine check-ups and visits to doctors is not “covered”. Of course they are. Insurance is best used when something expensive is required. An insurance policy that covers serious things like heart attack and stroke treatment, and cancer, and any other condition that requires many thousands of dollars to treat, would cost a fraction of what it costs to try to cover or pre-pay every doctor visit whether for poison ivy cases, ingrown nails, dog bites, annual checkups, and so on. Only cry-babies like you would think that insurance is needed to make a “co-pay” for a $50 doctor visit, or to pay for half of a tube of ointment for a rash.

    That you think the free market system is what gave us this, and the costs and prices of it, reveals your ignorance.

    Bob Tiernan
    Portland

    • valley p

      Oh Bobby, your semi libertarian brain is so interesting. Yes government policies, across the board, influence private economic decisions. And I suppose the absence of government would end that problem. Yet the government exists, and it responds to issues with policies.

      Your faith in the private market is touching. I lack that faith. I’m reality based, and look at 1929, the S&L debacle, dot.com bubble, real estate bubble, beanie baby bubble, Enron, Bernie Madoff and a lot of other evidence as demonstrating that the private market unfortunately needs a baby sitter else it will wreck us. And the only entity that can perform that role is government.

      Parts of the economy can function ok with little or no government interference. But parts cannot. Economists refer to these as “economic utilities.” They are services that are necessary to modern life that can be provided by a regulated private sector, a public sector, or a combination. Electricity is the classic example. Everybody pretty much relies on it, it does not matter to us where we get it (though cost does matter,) and it is produced and delivered by public and/or private entities.

      Health insurance is a service that can be and is provided by private and public entities, both in the US and the world over. It could be left to unregulated free enterprise, but there would be huge cracks that many millions would fall through. Private insurance would not cover 80 year olds (at affordable rates). It would not cover kids born with disabilities. It would not cover people who got sick before they bought insurance. And it would find ways to kick people off insurance after they got sick. We know all this from experience. Whether we set a tax code to favor group or individual insurance is really not germane. As a free market, health insurance just has too many failures. Its in the nature of the beast.

      “This is that mixed or highly regulated market people like you have told us for decades would give us the best of all possible worlds. How wrong you were.”

      There you go with that “people like me” again. I’ve looked around at what works and what does not. The best out there, cost and delivery, is a 2 tier system. A baseline public insurance like good old Medicare part A backed up by a supplemental, not mandatory but highly recommended extra insurance to cover more things better. Doctors and hospitals remain private sector, and you go wherever you want for care. Simple, affordable, effective.

      The hybrid system Obama was able to get through the bizzaro world of the senate is experimental and flawed. Its not something I would design or advocate. It improves on the existing dysfunctional, overly expensive nonsense we currently have by plugging a few more holes and better regulating the playing field. In the end, it will still be more expensive and less effective than other, simpler systems, including single payer, but also more highly regulated private utility systems like in the Netherlands.

      “Nice switch there — your earlier claim was that we have a free market health care system that has had little or no government role in its creation.”

      Right. The government did not *create* the private employer insurance based system. It has over the years plugged various holes in that system at great cost. The current hybrid was not designed. It was fabricated from a part here, a part there, with lousy tools and duct tape. It was “created” by both the public and private sectors.

      “Interesting that you’re blaming the big bad Republicans for how the employer-based health insurance system was distorted and “corrected” and fine-tuned more and more (i.e. made worse).”

      Not just the Republicans. I should have spelled out “Republican/conservative *Democrats* for you, but I thought adding conservative would make my point. It was the southern democrats, who later migrated to the Republican party, who stopped Truman and subsequent efforts due to racist reasons. But key Republicans supported them, from Goldwater to Reagan.

      “Our government-designed health care system is not insurance so much as it’s pre-paid medical care. ”

      Medial insurance is not the same as fire or auto insurance. It is much more like old age insurance, or social security. Bingo.

      Yes Bobbie, I’m ignorant because I don’t think like you do. I think trying to decouple expensive hope-I-never-need-it care from day to day care is not very workable for all sorts of reasons I don’t feel like going into here.

      And when was the last time you had a $50 doctor visit by the way? That fee would not get you past a waiting room. Maybe a naturopath, but not an MD.

  • John in Oregon

    This is a two part comment. Retired Proff, I have to say I understand your frustration with the solution of the week club. The OHP, HSA’s, HMO’s, interstate insurance, international insurance and the list goes on. For the moment lets set aside the homeless mental case down the street as a special case to be considered later.

    Something like 90 percent of medical care is routine, scrapes, sniffles, broken bones, shots and stuff like that. Like they way about projects that last 10 percent is complicated and costly. Lets stick with the 90 percent for the moment.

    A year ago Robert Weissberg produced an illuminative piece called “Midas Muffler Not Canada is the Model for Health Care Reform”. Yupp the same Robert Weissberg retired proff mentioned in an earlier thread.

    Listen up VP this answers your silly question > *[W]hen was the last time you had a $50 doctor visit by the way?*

    Weissberg’s article is about a free market health care innovation, Convenient Care clinics located in local retail outlets ‘such as Wal-Mart and Target, national drugstore chains CVS, Walgreens and Rite Aid plus supermarket chains like Safeway and Kroger.’ These clinics provide no appointment walk-in medical offices with extended hours (including evenings and weekends) with a small staff treating commonplace illnesses. No waiting, prices posted at the door. Typical visit, $50.

    That’s a huge chunk of routine medical services delivered inexpensively. A huge load taken from backs of ER, Urgent care, and Doctors offices geared up for more complicated health care services. And it’s a free market solution that came about in spite of the complicated government rules, regulations and payment roadblocks.

    Now consider the next step. What is insurance?

    In its most basic form insurance is a bunch of people who get together to share risk just in case something unexpected happens. Everyone in the bunch puts a little money in the pot each month to cover an unexpected and unusual lose such as a fire or crash on the highway.

    Would you buy food insurance? I see the eyebrows clicking now. That’s just stupid. You don’t use insurance for things you normally buy everyday. Lets say you did anyway because of tax regulations. What would happen? Well some people would go directly to the Waygu steak, costing $100 per plate. Insurance is OPM after all. Other peoples money.

    Food insurance companies would put restrictions on payments to control costs. Food markets would complain about the massive food reimbursement paperwork. Government regulators would pile on more pages of regulation. Some would suggest allowing food insurance across state lines. Others would demand single payer food insurance.

    Convenient Farmers Markets would spring up attached to local hardware stores. Low income families would buy food out of pocket for less than food insurance premiums. Others would buy food on the black market as low cost foreign food is smuggled in. Foodicade funding would be undercut as the number of uninsured free fooders grew. House Speaker Tulip and Senate majority Quill would appear on the federal office building steps to confront the PEA Party marchers. Waving signs Pfed Enough Already.

    Over the top? Of course. BUT. Notice how silly the anti-free market claims and assertions that government regulation is needed when its not about health care.

    That’s what’s happened with medical insurance. A young family can buy $10,000 deductible major medical and $50 out of pocket convenient care doc visits. Better care at less cost.

    The remaining 10 percent of health care is more expensive. Soooo Obamacare has provisions to force young people to buy the expensive government insurance. The young must buy in order to pay for seniors care. That plus the money that seniors have been putting into their health savings accounts over the last 40 years. Thank god that Ted Kennedy set up those accounts called Medicare.

    But. Wait. A Wall Street Journal analysis finds Medicare cuts of $4.95 trillion. “These draconian cuts in Medicare payments to doctors, hospitals and other health-care providers that serve America’s seniors were the basis for the Congressional Budget Office’s official “score”—repeatedly cited by the president—that the health-reform legislation would actually reduce the federal deficit.”

    Obama pledged that “If you like your health plan, you will be able to keep it.” “If you like your doctor you can keep your doctor.” With Medicare reimbursement slated to be cut to half that of Medicade the pledge does not apply to America’s seniors. As a senior if you like your health plan you can’t keep it. If your mother likes her doctor she can’t have one. Obama’s health care rationer Doctor Donald Berwick wants us seniors to know we got our health care back when we were 20. Soooo sit down, shut up and vote Democrat.

    So that leaves the homeless mental case down the street. Years ago the state housing of marginally competent patients was a disgrace. I really don’t need to recount that past history. In response peoples right advocates filed lawsuits and worked to weaken state custody laws until the state could hold only those who pose an immediate threat to self or others and only so long as the threat remained immediate.

    The result. State Hospitals were closed and patients cut loose on the street. Isnt it ironic that those least equipped to enjoy individual liberty are those that receive the most.

    One last thought. The UK National Health System is in a state of collapse. Britain attempts to decentralize and privatize in a last ditch effort to save the system. Do we want to import a health care system in systemic failure?

    BTW retired prof, Robert Weissberg penned another article titled “Should the Worst Schools Get the Best Teachers?”, You may find the article interesting if you haven’t seen it.

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