Comments on FiveThirtyEight: Politics Done Right: George F. Will Admits Public Option Will Cut Costs...

@Lehman: Let me add to Alan's comments, somebody ...

2009-08-12T17:41:21.040-04:00

@Lehman:

Let me add to Alan's comments, somebody is making the rules right now. It is those CEO's and officers of big insurance companies that are "constrained by profit," and that means our health care is constrained by profit. The people making the decisions right now over who lives and who dies or who lives in untreated misery or who can be insured or will not be insured are making those decisions to maximize profit.

For the same reason I don't want our police or judges or safety and health inspectors or army deciding what to do based on what is most profitable to them, I'd rather leave the life-and-death decisions to government employees that get paid the same amount no matter how they decide, so their only goal can be maximising the total benefit of the program within the budget Congress determines through the setting of the premiums.

Would you want to live in a place where trial judges earned six figure bonuses based on how many of their trials ended in convictions?

Life and death decisions should not be in the hands of people that get financially rewarded for deciding on death.

Lehman said "But the reasons it might save money i...

2009-08-12T17:08:03.991-04:00

Lehman said "But the reasons it might save money is because it would either offer less care, reimburse less, and by dint of it's huge membership, it would set all the rules."

You know, of course, that insurance companies have an overhead of from 30% to 50%. This overhead pays for profits, CEO bonuses, advertising, lawyers to fight your medical claims, research to determine which people are too expensive to insure, etc.

Government-sponsored health care plans such as Medicare and the VA have overheads of about 1%. This small overhead is the government's biggest advantage, as it will have a lot more money to pay for the care of sick people.

"Plus, not only is the government not constrained by profit, it can print it's own money."

Obama has said that the public plan must pay for itself and not rely on tax dollars from the government.

Health care reform has been in the works since 1945, when Truman tried to pass it. These bills have been considered for some time, read carefully by many people, and noisily debated in numerous arenas.

And it is not "socialism". In a socialist health care system (like England's), the government owns all hospitals and clinics, and the doctors and other health care professionals work directly for the government. Nobody is proposing anything like this.

Your talking points sound like they come from Rush Limbaugh and Fox News.

Sir, I agree that the government option would pro...

2009-08-12T15:48:54.891-04:00

Sir,

I agree that the government option would probably be cheaper, but therein lies the problem. If the government gave a decent policy that actually saved the person money, people would flock to it. Gradually, it's market share would increase to the point that it would be a monopoly. But the reasons it might save money is because it would either offer less care, reimburse less, and by dint of it's huge membership, it would set all the rules. Plus, not only is the government not constrained by profit, it can print it's own money. Then, we have the government in charge of a huge percentage of this country's economy. As past performance indicates (and what do we really have but past performance on which to gauge future actions) the government could possibly be the worst money manager in the history of the world (maybe second to tthe Weimar republic). Politicians are swayed by lobbyists and polls, addicted to campaign contributions and spending tax money without heed for debt or fiscal prudence.

In a perfect world, the government would be able to take in ALL our money and distribute each according to his need, but that doesn't work in the real world. It has been tried again and again. It's called socialism. I am not throwing that term around lightly, but that is what a so-called Government option will lead to. It has to. That is its intent. I am against this health care bill becaus eit has been thrown together quickly, not read, not debated, its opponents villified by the very peiople elected to serve them.

Whatever "needs" to be done, this ain't it and this ain't the way.

@Brian Engel: Except, of course, companies are NO...

2009-08-02T13:29:31.744-04:00

@Brian Engel:

Except, of course, companies are NOT incentivized to get better insurance, they are incentivized to make the claim of having insurance at the lowest possible cost, and this often translates into the appearance of coverage without being actual coverage.

The problem is statistical. If you have 50 employees or so, the chances of somebody actually encountering a life-threatening disease during their working years is actually pretty low, so the effects of your employees actually seeing "bad insurance" bankrupt somebody is slim. Odds are, if you sign up for bad insurance, you save money and never suffer a loss for it. And the probability is squared: If you DO suffer a loss for it, you can switch to some alternate flavor of bad insurance and claim the problem is 'corrected,' even though it isn't, and start the clock over.

I have been a business consultant for thirty years. I am not sure they are always doing it consciously, but management (and politicians) continuously sucker the workers (or voters) that are apparently incapable of logical analysis. Or maybe they are being suckered themselves; I don't know what is in their heads. But I do see the facts: People think they are safe when they are not, and think they are in grave danger when they are not.

For both management and politicians this is a happy confusion. If people in danger think they are safe, the hard work of addressing the danger can be avoided; in fact working on the danger is seen by those people as wasted energy, because they don't understand the danger.

On the other hand, if people are actually safe but believe they are in danger, it is an excuse to take their money and liberty in order to "protect" them from the non-existent "danger," and then that power or cash can be used for any purpose whatsoever, with a guaranteed "successful" outcome: See, the danger you feared never came to pass, it was a good thing you gave me your money because it let me save you from a terrible evil.

I won't sully this observation with examples, but I will say it has been the same game going down for centuries.

One part of the argument presented on why public h...

2009-08-01T12:54:02.406-04:00

One part of the argument presented on why public health insurance isn't efficient is that the costs and benefits are hidden to most employees. What I don't understand is why companies themselves aren't incentivized to get better bargains on health insurance since they're the ones footing the bill. They should have the incentive.

health care isn't like a market product. classica...

2009-07-30T11:36:30.987-04:00

health care isn't like a market product.

classical economics assumes perfect information,
substitution, complemantary offerings, openness,
rationality, no barriers to entry.

but health care?

it takes years to become a doctor, you need to go to
an AMA school, doctors know more about procedures and prices then you do. Is there a price list? is there a list of options for every procedure?
when you are hurt, you are not rational.
and nobody goes to a discount brain surgeon.

so forget that this is a market system

Dr. Who mistakes stating a series of unsubstantiat...

2009-07-11T09:37:20.605-04:00

Dr. Who mistakes stating a series of unsubstantiated opinions for making an argument. A valid argument involves presenting verifiable facts supporting one's position. Dr. Who has yet to do that. He merely recites a number of tenets of his politico-economic dogma. Consequently, his "argument" against the public option is no argument at all, just an opinion.

I love the post office. I never understand why an...

2009-07-07T22:28:39.079-04:00

I love the post office. I never understand why anyone would prefer UPS or Fedex b/c the post office does it better. We also have the best military in the world run by our government, or should we call it socialized military? You think the post office runs poorly, try administering insurance benefits with Blue Cross or Aetna for awhile....

it will deliver the same service Hahahahahahahah...

2009-07-07T22:22:03.934-04:00

it will deliver the same service

Hahahahahahahahaha!

Have you kids been to the Post Office lately? A public housing project? A V.A. hospital?

"Same level of service..." Hahahahaha!

The other major issue here that makes the notion o...

2009-07-07T16:57:50.807-04:00

The other major issue here that makes the notion of a free market in health care is that of transparency of cost/benefit. Even if you ask your insurance company if something is covered (as I have done) you cannot get a reliable answer. Imagine asking "does the car that I am considering have cruise control?" only to be told by the used car salesman "I can't tell you until you buy it." Not even a used car salesman could get away with that, but insurance companies and healthcare providers do it all the time. Then they blame each other when the consumer is stuck with the bill. The notion that there can be fair competition in such a non-transparent system is ridiculous. If a public plan was just as good/bad as a private plan, but was transparent, I would jump at the chance to buy it.

Oh I just love these comments about 18-29 (or 18-4...

2009-07-05T19:06:23.969-04:00

Oh I just love these comments about 18-29 (or 18-40) year olds choosing not to save insurance because they don't get sick and therefore why should they be forced to pay for insurance to subsidize others. And claims that people this age don't get sick by unforeseen illnesses. Well, I know that young people like to *believe* they are invincible but belief and reality are often two very different things.

I happen to know one uninsured young person who got shingles! His magic 8-ball apparently didn't see that coming. Since he was uninsured, he didn't want to see a doctor until he was absolutely forced to by a severe infection of his eye that landed him in the emergency room. He was left with a huge hospital bill he couldn't afford to pay.

Another case in point - when I was young I had an uninsured friend who got an ear infection and couldn't afford to go to the doctor. Then he ended up in the ER with a burst eardrum and permanent partial loss of hearing in one ear (and a huge ER bill).

And in the meantime who foots the bill for that? People like me, who DO pay for insurance because OUR medical costs are increased to cover young people who either can't afford insurance or who think they are invincible and will never get sick. Yeah, right.

Other young people I know have gotten or have had: Lyme disease, severe migraines, facial tics, epilepsy, kidney stones, broken arm, unforeseen car accident (other drivers fault) -- all of these were unforeseen and not the result of "lifestyle" choices.

Why market economics and the profit motive don't m...

2009-07-02T01:12:03.421-04:00

Why market economics and the profit motive don't manage health care well: some observations.

When the ambulance comes because a person is down, they pick up the person and take them to the ER whether or not there is payment available. This is true for many procedures; medical professionals are duty bound to save lives and reduce suffering regardless of ability to pay. This makes it hard to apply market economics.

When I hate my service at a hotel or restaurant (or in some cases an airline in a city with some real airline competition) I can go to the competition within days (hours, in the case of the restaurant). When I hate my health care plan provided by my employer, I get to beg my HR department to change plans next year. Competition has a dramatically reduced impact in such a situation.

Insurers spend 30% of their income on administration. Much of that is aimed at reducing utilization of benefits by policy holders. How many industries are there that encourage their customers not to use their service? Again, very hard to apply the profit motive to a firm that wants NOT to be used and profits more when it is avoided.
The free market model tends to presume that vendors want to be patronized, not ignored.

There is currently little or no economic incentive for cost saving preventive care. Preventive procedures are often completely non reimbursable by insurers. Public health physicians and primary care physicians, the doctors most likely to use preventive measures, are the worst paid specialties in medicine. If it were not for medical ethics and health care really were a purely profit oriented business, doctors and medical clinics would largely sit by and watch as diabetics and high blood pressure and other high risk patients worsened and needed more expensive and more profitable procedures such as major surgeries.

If we really want a society where you get no health care that you and your insurer cannot pay for, then you get a society where the free market can function well to allocate health care among those who can afford it due to their own or their insurers' financial resources. You also get a society with a higher death and disability rate, and that's leaving out the moral turpitude involved in such a callous system.

abba: I am neither a conservative or libertarian,...

2009-06-30T18:27:56.415-04:00

abba:

I am neither a conservative or libertarian, and I ask you this: Why do you care?

However the government keeps its insurance company solvent; it does it with tax dollars, borrowed money, printing money or whatever. That money comes from the citizens, either directly as taxes or indirectly as inflation.

But that is good news. It would mean they are not making a profit on the organization, and we are all paying exactly cost for the service. Exactly.

Not contributing to line anybody's pockets is a great thing, and the cost will also not include any multimillion dollar executive salaries, bonuses, or stock options.

Now it may not be the most efficient thing in the world, but studies have shown that giant corporations are not much more efficient than large government organizations anyway, and that includes the military and the postal service and NASA.

The fabled laziness of government workers is exactly that, a fable, a fiction.

I would love to see a public plan that barely breaks even. I think the health care industry is misleading us about its profits, since other countries get this job done with better service, lower mortality rates, less wait time and better health indexes for less than half our average cost per person.

Don't forget, all those salaries, bonuses, million-dollar offices, private corporate jets and lavish parties are counted as business expenses, not profits.

Ultimately to me it makes no difference if cutting out the profit reduces costs 1% or 50%, I think it is morally wrong to extort people in life-and-death situations for a profit, and that is what our health industry does.

Were I a conservative, let alone a libertarian, I ...

2009-06-30T15:31:09.399-04:00

Were I a conservative, let alone a libertarian, I would ask whether the government prices below the private provider because it elects not to cover the marginal cost of providing the service, that premiums (Taxes? Fees?) reduce the cost to the insureds, but force the government itself to make an incremental contribution to keep the pool solvent.

While the private insurer may be able to use cash flow from another line of business to keep this one cash flow positive in the short run, in the long run it will cease to exist.

There is an example from the 20th Century that mir...

2009-06-28T08:39:27.843-04:00

There is an example from the 20th Century that mirrors the health care debate. When the Tennessee Valley Authority and the Rural Electrification Program were begun, two main benefits were that many people would get electricity who did not have access, and , the cost of electricity which was growing beyond the means of many consumers would be reduced. Opposition to the TVA and the REF mirror the arguments against health care: that it was socialist and that it would drive private utilities out of business. Rural electrification and government competition that reduced costs set the stage for the development of the Southern United States and the boom that began after WW2. Health care reform that includes a public option will have both a social and economic benefit. Further expansion of the current system without public competition will lead to further deterioration of the social and economic fabric of the US.

To Mr. Will: You sated, in part, as follows: "Co...

2009-06-27T15:36:45.993-04:00

To Mr. Will:

You sated, in part, as follows: "Competition from the public option must be unfair because government does not need to make a profit and has enormous pricing and negotiating powers. Besides, unless the point of a government plan is to be cheaper, it is pointless:...".

No, Mr. Will, you have tricked us one too many times by using the word "profit" in patriotic terms. Profit is a political necessity in our "free market system". And it is determined by the amount over cost, if any, that a willing buyer and seller agree to pay for the goods or services bartered.

Today, Mr. Will, there is no free market system in health care. I cannot elect to forego paid medical care. In the weaththiest country in the world my uninsured body would be left to die slowly in the middle of the street as long as it did not impede the flow of traffic. I cannot negotiate the prices of medical procedures, drugs, hospital costs and other charges. We are not permitted to know the amount of "profit" generated by HMOs, so-called non-profit hospitals, the use of an MRI machine or drugs. We do know from leaked sources that a 4,000% mark-up on drugs is common - when sold in the US.

I cannot negotiate the cost of my medical insurance. There seems to be a paucity of choices among both health insurers and banks. And, by simply applying the causation theory of conmpitant variation, anyone with interest can graph in visual rality what used to be referred to as price fixing prior to the administration of Ronald Reagan. All these people are making "profit" at my expense but I must unwillingly pay what they demand simply because I do not have any other options.

If profit is a totem of patriotism, as you believe, at what point does amount profit become unpatriotic? There is a point, you know, because over 100 years ago Messrs. Rockefeller, Carnegie and others crossed the line. The lessons learned 100 years ago from the their versions of unbridled greed including, without limitation, child labor, the Triangle Shirtwaist factory fire, the inability of any government to control the plague of 1918, greedy lenders suing farm owners for mortgage foreclosure deficienies after acuctioning off their valuable dust bowl lands for pennies, the tragedy of older people starving to death in the 1930s and dying from the lack of any medical care in the 1960s - have all been so conveniently overlooked by you and others who have had the luxury of an affordable education.

I will now remind you, Mr. will, of the central issue in all of our current problems that you work so hard to obscure. It is unbridled, institutionalized, greed. Your social circle is too small and life experiences too limited for you to understand that We The People need the ability to "opt out" of the system of economic slavery imposed by your cocktail party guests and justified by you in the daily newpaper opinion articles for which I assume you are extremely well paid.

The government "option" is the only way out.

To Mr. Will: You sated, in part, as follows: "Co...

2009-06-27T15:31:11.093-04:00

To Mr. Will:

You sated, in part, as follows: "Competition from the public option must be unfair because government does not need to make a profit and has enormous pricing and negotiating powers. Besides, unless the point of a government plan is to be cheaper, it is pointless:...".

No, Mr. Will, you have tricked us one too many times by using the word "profit" in patriotic terms. Profit is a political necessity in our "free market system". And it is determined by the amount over cost, if any, that a willing buyer and seller agree to pay for the goods or services bartered.

Today, Mr. Will, there is no free market system in health care. I cannot elect to forego paid medical care. In the weaththiest country in the world my uninsured body would be left to die slowly in the middle of the street as long as it did not impede the flow of traffic. I cannot negotiate the prices of medical procedures, drugs, hospital costs and other charges. We are not permitted to know the amount of "profit" generated by HMOs, so-called non-profit hospitals, the use of an MRI machine or drugs. We do know from leaked sources that a 4,000% mark-up on drugs is common - when sold in the US.

I cannot negotiate the cost of my medical insurance. There seems to be a paucity of choices among both health insurers and banks. And, by simply applying the causation theory of conmpitant variation, anyone with interest can graph in visual rality what used to be referred to as price fixing prior to the administration of Ronald Reagan. All these people are making "profit" at my expense but I must unwillingly pay what they demand simply because I do not have any other options.

If profit is a totem of patriotism, as you believe, at what point does the amount of profit become unpatriotic? There is a point, you know, because over 100 years ago Messrs. Rockefeller, Carnegie and others crossed the line. The lessons learned 100 years ago from the their versions of unbridled greed including, without limitation, child labor, the Triangle Shirtwaist factory fire, the inability of any government to control the plague of 1918, greedy lenders suing farm owners for mortgage foreclosure deficienies after acuctioning off their valuable dust bowl lands for pennies, the tragedy of older people starving to death in the 1930s and dying from the lack of any medical care in the 1960s - have all been so conveniently overlooked by you and others who have had the luxury of an affordable education.

I will now remind you, Mr. will, of the central issue in all of our current problems that you work so hard to obscure. It is unbridled, institutionalized, greed. Your social circle is too small and life experiences too limited for you to understand that We The People need the ability to "opt out" of the system of economic slavery imposed by your cocktail party guests and justified by you in the daily newpaper opinion articles for which I assume you are extremely well paid.

The government "option" is the only way out.

I have nothing against making a profit or private ...

2009-06-26T14:11:37.370-04:00

I have nothing against making a profit or private industry, but having a public option may help address two of the biggest drawbacks of relying on private insurance: 1.) Many people are denied coverage due to a pre-existing condition, and 2.) Many people will lose their existing coverage once they develop a serious medical problem. Fortunately, President Obama is smart, honest, and caring enough to want to address these drawbacks, and having a public option may even help bring down health care costs as people make fewer visits to the ER.

ange: Those who really want to come?! I worked i...

2009-06-26T11:27:00.993-04:00

ange:

Those who really want to come?!

I worked in a hospital for years, my wife has been for 31 years, and the percentage of people that visit for entertainment purposes seems quite low to both of us.

I don't believe you are a doctor, or you would know something about triage, which is 100% about deciding who will be treated with the medical resources available. If you have 1000 candidates and only 300 can be seen, assign a nurse trained in triage to pick the 300. If the symptoms and a brief inspection are not dispositive, make it first come first served. End of story.

People, this is a free market drone masquerading as a doctor so he can claim government will drive doctor's out of business. Note he can't even spell the word "whole".

In fact, in a dozen other countries that already have government run health care, doctors are paid well (over $200K/year), and medical resources are allocated well. There is no problem keeping offices open, recruiting doctors, or keeping hospitals open. His entire post is a lie.

Nate, Here is a question for you. How does it ...

2009-06-26T10:29:35.389-04:00

Nate,

Here is a question for you. How does it make sense economically that any MD in practice who contracts with Medicare/Medicaid is unable to "balance bill." By this I mean when we accept Medicare, we contractually agree that is ALL that we will charge such a patient for our services...whether such charges cover all our practice costs. In addition, it does not allow us the ability to reduce our patient load to a manageable level. If we have room for 400 patients/week in the office and 1000 want to come in...how do we choose? Obviously, medical urgency is an easy way to do this, but it only takes care of a low number of cases. If however, we could balance bill, those who REALLY wanted to come would (the who free market thing) and those who didn't want to cover the extra charge would go elsewhere to someone who wasn't as busy. It seems that would be a much more efficient way to distribute the load. Not to mention the fact that if you are a medical practice with too high a percentage of Medicare, you probably won't survive unless a hospital is subsidizing you. Watch what happens if a public option drives reimbursement rates too low...docs won't take that plan and it will be cash only.

I'm afraid that any effective health care reform w...

2009-06-25T17:07:25.524-04:00

I'm afraid that any effective health care reform will not happen because so many are fixated on insurance as being the key issue.

A PricewaterhouseCoopers study in 2006 attributed 3 main factors for driving up health care costs.

*27% of the increase is from general inflation
*43% of the increase is from utilization & Technology

- Aging population (0.5%)

- Lifestyle, including obesity, smoking, drug abuse, physical inactivity (0.3%)

- New Treatments (1%)

- More intensive diagnostic testing/defensive medicine (0.8%)

- Increased consumer demand (1.2%)

*30% is from health care price increases in excess of inflation

- Broader access health plans and provider consolidation (1.1%)

- Costs shifting from public providers and uninsured to private payers and increased costs of labor (0.5%)

- Higher-priced technologies beyond general inflation rate (1%)

See the report at: http://www.pwc.com/il/heb/about/svcs/publication/alerts/4the_factors_fueling.pdf

Now why is insurance premiums at 1% of the inflation. Becuase Insurers are managed to earn a set return on the money that flows through their organizaitons.

The insurance carriers don't drive the price, they affect the access to care, which is a different topic.

If you want to control costs look at how Safeway has kept their costs flat for 5 years. http://online.wsj.com/article/SB124476804026308603.html

If you want to get all Americans insured make it a law and prevent insurers from denying coverage based on pre-existing conditions. -all parties already agree to that concept.
(though I wonder how that will work for a patient undergoing cancer treatments who wants to switch to a plan that has a better payout)

your an idiot...enough said...

2009-06-25T15:41:20.013-04:00

your an idiot...enough said...

Gruss said: If I have low cholesterol, excercise,...

2009-06-25T12:45:48.778-04:00

Gruss said:

If I have low cholesterol, excercise, eat good food (tax free), get my check-ups, and am willing to actually save money -horrors!- then I want a super low premium compared to my fat lazy-arse spend-thrift neighbor.

Of course this sounds good, and I encourage everyone to have a healthy life-style.

But suppose, through no fault of your own, you come down with cancer, have to have a liver transplant (like a certain Apple executive recently did), and have to have life-time anti-rejection treatments, for a total cost of $2 million (to pick a number out of the air).

The super low premiums you had been paying mean that your huge new expenses now have to be made up by the rest of the people in your insurance pool. You are now a free-loader.

Nobody can ever forecast what his or her health will be like in the future. The best we can do is share the risk of catastrophic illnesses. Sharing means there will always be winners and losers, in terms of the amount of money you contribute to the insurance pool versus the money you get out of it.

But look what this means to you. If you get more out of the pool than you put in (your fat lazy-arse spend-thrift neighbor), you are sicker than average, perhaps much so, which will doubtless reduce your quality of life and perhaps reduce your life expectancy.

On the other hand, if you get less out the the pool than you contribute (which is the situation you see yourself in), you are healthier than average, have a better quality of life, and may well live longer.

This seems about as fair to everybody as can be managed in this imperfect world of ours.

Here's my ideal plan: * Coverage starts @ $50k w/...

2009-06-25T12:22:40.513-04:00

Here's my ideal plan:

* Coverage starts @ $50k w/ $10k deductible,
* Unlimited tax-free HSA with premium reductions for metrics-based check-ups like low blood lipids, and
* Healthy food treated as a healthcare expense.

In other words if I needed some stitches, broke a leg, et al I'd likely pay for it myself via group negotiated rates.

Now the bleating at this point will be about the 25 year old who doesn't have the savings.

There should be 2 options: 1.) government medicare type coverage, or 2.) employer based higher premium coverage. But everyone would be required to carry insurance.

Medicare should be funded via a payroll deduction just like Social Security and as you get older the deduction should get higher until you retire. That would incent people to save and get a high deductible plan with an HSA.

For example, let's say you make $50k/yr. If you put 10% away pre-tax (let's say $3000 post-tax) per year, you'd have your $50k in 10 years.

And if you keep saving, your HSA can be used for retirement as well.

But, if someone is too stupid to save for their retirement and medical care because they need an iPod (i.e., most Americans) then they can get Medicare, but have a high payroll deduction.

That way it's somewhat fair and everyone pays their own way.

Need a nanny to help you save? Medicare is here for you!

But I want the choice to save on my own and then enjoy the benefits: ultra low cost healthcare premiums.

To be blunt:
If I have low cholesterol, excercise, eat good food (tax free), get my check-ups, and am willing to actually save money -horrors!- then I want a super low premium compared to my fat lazy-arse spend-thrift neighbor.

Another way to analyze the health insurance concep...

2009-06-25T05:38:42.992-04:00

Another way to analyze the health insurance concept is to look at the concept of "Pooled Risk." The average person has life-time medical expenses that average out to about $3,500 a year. If costs were spread evenly through your life, you could self-insure by setting aside $3,500 a year. Unfortunately, medical expenses come in big bursts that are more than most people would have in savings. The solution is to pool the risks by having a large group of people pay in. If enough people pay into the pool, the per-person cost will be approach the $3,500 average.

The problem is that ordinary people cannot pool their resources, so we have to rely on insurance companies to pool our money for us. The problem is that the primary purpose of an insurance company is not to Pool Risk. The primary governing principle is to Minimize Risk and maximize profits. As a result, they are highly motivated to only sign young health people and reject as many claims as possible. Pooled Risk and Minimized Risk are contradictory concepts and for this reason, a for-profit model is incapable of delivering cost effective health care.