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And in a situation where poor people don't go bankrupt from seeking even routine medical care, they might not routinely wait until their situation becomes a matter of life or death before seeking medical care. That might cut some costs. And improve people's quality of life, too!
Yeah, whatever. Most people who are wealthy have jobs. Most people who have jobs and are wealthy have jobs that provide insurance.
And there's zero chance that any law will ever be passed in this country forbidding anyone from paying out of their own pocket for any sort of medical care. Unless the care itself is deemed illegal to provide to anyone, in which case the unfortunate persecuted rich person can go to another country.
I'm sorry for your situation, but you do realize that you are already covered, in a real sense. If you need emergency care, you will be given it, and if you have no assets, you won't ever have to pay.
The issue is not that our society doesn't provide healthcare for the poor, it does, it's that we provide it in a backwardass overly-expensive way.
Our system is about 50% socialized. The question is do we cover more people, more efficiently by going closer to 100% or closer to zero. We'll never go all the way in either direction. I believe that most of the current problems are caused by too much government intervention, not too little.
If there's a health plan out there that costs what even high-speed internet does, please make sure they stay in business until I need them. (Thankfully, the one good thing left for State of Texas jobs is free health care. They pay $320-ish dollars for me.)
I disagree. And we can address what is broken without gutting the system and going to a more socialized one.
Health insurance in Texas is crazy cheap, I think b/c they don't do community rating or mandate a lot of coverages.
My sister had an individual policy when she was a grad student there that cost like $175 a month. The equivalent in NY would be like $400.
Well, the Republicans were the ones who brought CBO estimates into the discussion, and per the CBO, the bill is defecit-neutral over the ten-year window under consideration. It probably isn't in the long run, of course, but since the Republicans were the ones who defined the playing field on cost in terms with the CBO numbers being the be-all and end-all, it seems kind of churlish for them to object now, just because the metric they picked doesn't support them anymore.
"I'm going to pay for my plan by cutting out 'waste, fraud, and abuse' in Medicare." [As if that could be done, as if that would make enough of a dent.]
I can't find even one source attributing this quote to Obama. Is it a paraphrase?
"If you like your health insurance, you won't be required to change." [No mention that your plan likely won't exist anymore.]
If the plan doesn't exist anymore, it won't be because the government abolished it via fiat, so the statement is true. There will be no federal law forcing you to change. And what's the alternative? Surely you aren't suggesting that the government should mandate via legislation the preservation of all existing health plans? Isn't that the kind of burdensome regulation that conservatives usually decry?
"Illegal immigrants won't be covered." [No mention that Democrats refused to accept the amendments requiring citizenship checks. Also if he is planning amnesty for later, this would be a lie in that regard as well.]
Illegal immigrants won't be covered. The House bill explicitly states that they won't receive subsidized benefits, and credits are going to be distributed through the IRS (for which you need a valid SSN). You're unhappy that citizenship is being checked in one way rather than another, which is fine, but doesn't make Obama's statement a lie.
"The death panel thing is a lie." [Literally true, but no mention of rationing being the actual issue.]
I see. The literal truth is a lie.
So when challenged to find examples of Obama lying, you've got one thing that's apparently made up, three things that are literally true, and one thing that's true under the previously-determined grounds of the discussion.
Any actual lies?
But of course these are the famous cheese-eating surrender monkeys, so what could we possibly learn from them?
Americans like to cite our health care system as being the best in the world. Far from it. In terms of avoidable hospitalizations, our rate is two and a half times that of the French. In terms of avoidable mortality, the French have the industrial world's lowest rate, and we have the highest---19th out of 19.
We put up with our health care system out of ignorance, propaganda, and the ironic wild card of Medicare, which is so popular with seniors that it's easy to scare them into believing that extending that humane level of coverage to the general population is going to result in worse care for them. There's nothing more pathetic than to see these same people cling to their Medicare on the one hand, while screaming about "socialism" on the other.
Two Q & A's from that Rodwin interview that might be of interest to conservatives here, regardless of what they think about the French health care system in general:
It sure would be nice to get Meatwad some preventative care so he doesn't necessarily NEED emergency care...
Has any country ever done that?
In fact, has any country ever gone from a more socialized health care system to a less socialized one? With all the privatization going on the world, and the total domination of neoliberal economics, there should be some examples. What are the results?
Financing a $100 doctor visit is not something we need insurance for.
That's part of the problem with our insurance system. Imagine if auto insurance covered oil changes and car washes. Any employed person is be able to pay the $100 a year for a routine office visit. There are free clinics for those who can't.
it.
Of the 46 million number we always hear bandied about, my best guess is that about:
* 16 million are illegal immigrants
* 10 million are wealthy and don't need insurance
* 10 million are young people who can afford it but are making the rational decision to spend their money elsewhere
* 10 million are truly poor and truly can't afford it
Feel free to correct me."
Why? Your auto or home insurance doesn't cover routine care. We have no problem laying out $100 or $500 for auto repairs, but blanch at doing that for our own health. I was self-employed, and had GHI, which excludes most routine visits/tests. I knew that was coming out of my pocket, but since the expenditure is capped, it didn't worry me in the least.
If more people paid out of pocket, you can bet the $300 physical and $5000 MRI would disppear damn quick. I've had doctors tell me, if your insurance doesn't cover a surgery and you have to pay cash we'll cut a deal.
Ray, I know people who work for pro-reform groups and, uh, against current proposals. I don't know anyone (professionally) against something like universal coverage. It's a moral issue* and one that the rest of the first world already settled. [Again, caveat: I was hit by a car as a kid. We had substandard/inefficient medical coverage and I never got appropriate medical care. Accordingly, I occasionally limp or am in some discomfort. So, on a personal level, I have a dog in this fight - though I don't think my opinions (again, mostly concealed here) reflect that too heavily, if at all.]
* Also a business one, as none of the people I'm thinking of would benefit from people being uncovered. Since any mandate would cost somebody money, I can think of people who would oppose it.
As for claims that this'll pay for itself - it won't. There's a lot of low hanging fruit whereby we can cut costs but ... well, Occam's Razor man. Not to rely on truisms, but the following are what you want from a health care system: low costs, responsiveness, high quality, ease/range of access**. You can't have it all - ultimately, we're going to have to pick and choose whether we're explicit about it or not.
The status quo is unsustainable. It's hard to disagree with that.
I agree, though I mean it in a broader sense than how we account for who pays for what and how (for example, I heard (may have misheard) on NPR an estimate that one in three Americans born in '00 will eventually be diagnosed with Type-II diabetes. Yipes).
Crispix, not knowing where that 6% figure is coming from, that sounds very conservative and probably does not account for buy down (moving to plans with less rich benefits).
As for: "And there's zero chance that any law will ever be passed in this country forbidding anyone from paying out of their own pocket for any sort of medical care" - there are viable systems where that kind of provision makes sense. We are highly unlikely to ever adopt them.
Eggs-actly. The notion is absurd.
Many people only want to pay for insurance for catastrophic injuries and illnesses, and are happy to handle the rest as the need arises. That would correct a lot.
In fact, has any country ever gone from a more socialized health care system to a less socialized one? With all the privatization going on the world, and the total domination of neoliberal economics, there should be some examples. What are the results?
Health insurance has only really been around for 60 years, too soon to see the full evolution.
You will start seeing it. With the aging populations and declining birth rates pension and medical costs will start bankrupting nations.
Except I don't think opponents understand the equation.
When it comes to (1)universal coverage - we technically have that... at least, from the perspective that if you show up at emergency room - the hospital MUST provide care. But it's an unfunded mandate and has been for more than 25 years. Under the current plans, the mandate is that one must have coverage. For the multi-millionaires that pay totally out of pocket? Have at it - and just pay the fine. It's a drop in the bucket in the grand scheme of things - a tiny fraction of a fraction of a percent.
Right now - the costs of EMTALA's unfunded mandate are already being passed along. Both private and public programs face increased payment rates to cover the ER shortfall.
That's part of the problem with our insurance system. Imagine if auto insurance covered oil changes and car washes. Any employed person is be able to pay the $100 a year for a routine office visit. There are free clinics for those who can't.
You know how many visits I've had to make in the last 3 months because of this wrist? (Nerve damage, I basically have drop wrist, they don't know what really caused it.) One month I made 7. I could handle $700 out of nowhere, but if I had a wife and kids, even double income? That would be killer.
Yes, but again, how much coverage? We already do this partially in the U.S. with free emergency care if you can't pay.
The issue is what level of care is guaranteed to all, and what level is a luxury good. I would gladly sign away my right to ever get covered for an organ transplant in exchange for lower insurance premiums. At some point of spending healthcare is a luxury. Until we define that point, we can't build a reasonable system.
You find a routine annual checkup for $100 a year, with its normal battery of tests and lab reports, and you're not going to be an American. Where do you get numbers like this?
Of course if you're in one of those managed care plans like Kaiser, those annual checkups have a tiny co-pay, something like ten bucks. But of course your "choice" of physicians is limited to the ones on Kaiser's roster, and if you're trying to obtain an individual policy with the remotest blip of a "pre-existing condition," forget it. I got turned down by Kaiser for glaucoma, which had been stable for five years, and still is. My wife got turned down by them for her Crohn's, which has been stable since 1990.
Contrast this to France, where you have your choice of any doctor you wish, and you can't be turned away for a pre-existing condition. But again, what can we possibly learn from those cheese-eating surrender monkeys?
The problem I have is that I want those 10-15 million people to have "insurance" also. I'm just not excited with the other costs that will come with that under the President's current direction. If someone came up with a plan that only addressed those 10-15 million- and left the rest of the health care question for another piece/pieces of legislation- would you be OK with that?
Many people only want to pay for insurance for catastrophic injuries and illnesses, and are happy to handle the rest as the need arises. That would correct a lot."
Your faith in the average person's ability to spend an unplanned-for $100 is almost charmingly naive.
That's where the idea of catastrophic insurance with an MSA comes in. Say the plan has a $5,000 deductible and your employer contributes $1,000 per year to the MSA. You save up that money from year to year, or and your own contributions (before tax) and then when you have a bad year, you pay for it from the account.
The second thing is that we as a society have to become savers. The idea that an average family with a $50,000-75,000 income can't handle an unexpected $1000 expense shows how crazy a consumption/debt culture we've become.
Emphasis mine.
http://www.seiu.org/2009/09/domestic-violence-victims-have-a-pre-existing-condition.php
Insurance companies have used the excuse of "pre-existing conditions" to deny coverage to countless Americans. From cancer patients to the elderly suffering from arthritis, these organizations have padded their profit margins by limiting coverage to patients deemed "high risk" because of their medical condition.
But, in DC and nine other states, including Arkansas, Idaho, Mississippi, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, and Wyoming, insurance companies have gone too far, claiming that "domestic violence victim" is also a pre-existing condition.
But if you happen to get sick twice, you're out $5000. The large majority of Americans can't afford a sudden $5000 check. I'm middle class, and I maybe could pull that off, if I moved to a different apartment and got a second job.
There's also a huge gender bias - women need significantly more primary care than men, on average, and so their employer fund is likely to run out a lot quicker. For the average woman, one ill-timed illness would be enough to set them out a couple grand.
HSAs fundamentally fail for anyone middle class or below. You can't keep yourself or your family from having a couple ill-timed illnesses, and most people can't afford a sudden $5000 check. I guess you could say you're willing to pay that price, morally, in order to cut health costs and avoid government control. I think that's a terrible choice, from an ethical perspective. People aren't to blame for their illnesses, parents aren't to blame for having sick kids, and health luck should play as limited a role as possible in a person's economic life.
edit to add probly be dead from being sent to the sand box but thats a moot point right now
Could you please lay out in advance which choices you believe are so bad that a person deserves to live at risk of bankruptcy? How would you feel if the person had children, or if it were the children's illnesses involved?
EDIT: to clarify, my point is that I don't think this is a situation most anyone "deserves". It's a basic point of human compassion that lives are complicated and economic life is tough, and I don't know how my life would be going had I had a different upbringing, had different events impacted me. There's tons of evidence, for example, that the economic class of your parents is a better predictor of your future economic class than any single set of decisions. The world isn't set up the way Ray thinks it is.
What's "free emergency care?" I'm poor, I cut my finger off, I go to the Emergency Room, they sew it back on. I don't have any money, so does the hospital just write that $9000 off? ########, they do. They charge me for it, they keep sending me bills I can't pay, and they send me to a collection agency which ##### my credit for the next seven years. Which kind of screws me if I'm trying to apply for a school loan to get some education and get a better job. Which keeps me poor, which keeps me relying on this so-called "free emergency care," and so on, ad inifinitum.
And now I feel like #### for ever having criticized your typing.
Sorry, man.
Well, it would be a max of $4000 per year.
The fact that people don't have savings of even 10% of their income is a major problem in America. I'd say 100% of your income in liquid savings is the minimum to feel secure against job loss, sudden expenses, etc.
Of course that's not the American way. We're supposed to go into debt to buy a big-screen TV and take a cruise. Maybe I'm just fossil; I lived in a 1 BDR appartment until I was 36, and put 35% down on my house.
* in the past, the kinds of health expenses you can incur now simply didn't exist. (To my knowledge - speaking opinion here, not from study or facts) Where we set thresholds for lifetime/yearly maxes makes a big difference here.
* people do a lousy job timelining health states. I'm not convinced that this is 100% an education issue.
* health care is a highly inelastic good with large, two-way information asymmetries.
I'm not leading to any specific point here (at least not one I feel comfortable detailing in this forum), but if we went to a largely HSA/MSA type world, there would likely be some negative consequences for at least the first generation of users as they learn what they should or should not do (presuming that they do it) and can figure out how best to listen to health care professionals, especially with care that is above the "preventative line".
***************************
meatwad, I don't understand what you mean by:
if there is a public option then i think insurence companys will be forced to actually play the market like any other industry instead of the #### they pull now. and with playing the market costs will come down.
Most insurers are in competition (to varying degrees) with other firms - there are very strong internal pressures to keep costs down / customers happy. [Fill in joke here, particularly about the latter.] Presuming no significant change in the system other than a public option existing (so, no socialized medicine type deal: please note that medicine <> health care <> health insurance), primary mechanisms for cutting costs through a public option could include:
* lack of a profit motive (relatively small factor, actually - a good chunk of insurer profits stem from collecting premiums prior to paying out claims (and then investing the money) - accordingly, it's a volume industry, like supermarkets.
* bargaining power (if docs, drug companies, etc... have to work with public entities because that's where the customers are, prices should fall - but that's an extension of the existing dynamic.)
So, while a public option could make a difference on how your insurance works, it doesn't necessarily make a big difference in how costs are controlled. (The devil is in the details, of course - I'm trying to speak abstractly.)
As for "doctors will order tests and what not for no reason other then they know they will get more money from insurance that also must be stopped", you need mechanisms to do this. This is over-simplified, but overtesting, etc... happens because we're in a fee-for-service framework (they get paid for doing tests, not for keeping people healthy) and because of lawsuits. [BTW, those arguing for tort reform - bear in mind that these lawsuits serve positive ends as well, as an agent to encourage non-malpractice.] If you want that changed, address that specifically. (EDIT: Hey - there's your next post!)
* in the past, the kinds of health expenses you can incur now simply didn't exist. (to my knowledge - speaking opinion here, not from study or facts)
* people do a lousy job timelining health states. I'm not convinced that this is 100% an education issue.
* health care is a highly inelastic good with large, two-way information asymmetries.
Correct.
There are several separate problems though.
1) Large emergency expenses. This needs to be addressed by a combination of catastrophic coverage for all those who can afford it, and some level of comprehensive, but probably lesser, care provided to the indigent.
2)Routine expenses who's cost is inflated b/c of insurance coverage. Ofice visits, MRIs, lab tests, etc. have very high list prices b/c most people are covered by insurance, and pay only a fixed co-pay or small %. These are huge profit centers for Drs. and hospitals which are used to offset care for the indigent and those that don't pay.
These costs can only be driven down by people spending their own money and being price sensitive.
3) People think health care should be free. They think this even though their employers are spending >$10,000 per family on them and these premiums have eaten up all their wage increases for the past 15 yrs.
People have to start realizing that all that fancy treatment costs money. Most people with sore shoulders only need advil, not an MRI. But as long as the MRI costs the patient $20 and the hospital makes money, guess what's going to be prescribed, and guess what the patients will demand.
More generally, I really don't like how this thread has been turned into a referendum on whether various folks "deserve" the sympathy of those who are not currently in any financial or health straits. I can take the libertarian argument that justice requires government inaction in these situations. I can take the libertarian/conservative argument that massive government programs run unknown risks and might have worse consequences. I find the argument that people at risk of bodily suffering or financial ruin are probably to blame for their situation to be truly ugly, and suggests a basic lack of compassion, a basic inability to put yourself in someone else's position.
Information assymetries and extreme time constraints are built into medical care at a foundational level, and prevent the functioning of the market you've imagined.
I simply asked what life decisions he has made. I didn't advocate not helping people who can't afford coverage. I don't get why people see the question of personal responsibility as an affront.
* Okay, on point 2 - there are other ways to drop prices, but in the current or your semi-proposed frameworks, that's the way. FWIW, in the absence of government action, I think we're moving to the world you describe anyway - though very slowly.
** Especially on point 3. I forget if you mentioned that you read the Atlantic article or not - anyhoo, you'd agree with it, I think.
This.
As to the rationing aspect, I just don't see it. It certainly doesn't happen in the nefarious bureaucratic way it is portrayed in the collective imagination. My daughter was born with a heart murmur. The pediatrician thought it was probably nothing but wanted it checked out to make sure. We had an echogram at the children's heart clinic the next day. What rationing? It is true that Canada has something like 10% the MRI machines of the United States.
As to an above post concerning the impossibility of combining lower costs with improved care this is empirically false. We know this because there is an entire industrialized world of natural experiments to examine. A single payer system will both lower government expenditures at the same time as covering more people for more things.
This issue is surprisingly simple. It's win-win for everyone involved. If you pay taxes your taxes will go down. If you're not covered now you are covered. If you live in fear of medical bankruptcy now you don't have to live in fear anymore. If you run a business your employee compensation costs will go down and you will make more money.
And to the myth of increased choice. I've never lived anywhere where I had less choice of health care providers than in the United States. Your insurance plan dictates who your doctor is. The irony is that the United States is living its own nightmare scenario.
In the United States the evil State (the insurance company) tells you where you can go to get treated and what treatment your allowed to have. Isn't this exactly what people are supposed to dislike about socialism?
In Canada, by contrast, the State doesn't tell you what doctor you have to see and it doesn't tell your doctor what treatment your allowed to have. All it does is pay the bills according to negotiated prices. Now that sounds like it may be expensive but it's not, comparatively speaking since the Canadian government spends less per capita than the American government.
[Edit] Oh, and Der Komminsk, I don't actually want you and your family to go to a dark, dark, place.
Health insurance companies and health care operate on basic capitalist financial principles. These principles are used to make money for the owners of said companies, and care of humans is at best perhaps a distant tertiary factor in this principle. You want care - or anything - you pay for it. If you can't pay for it, you need to use said principles to get more money. If you fail or are unable for any reason, you are ultimately not part of the equation, the individual problems you have will be dismissed as collateral damage to those who find the principle more important than individual small-sample-size outcomes. If you feel this is not the most noble of principles or possibly even a flatly incorrect principle, you work for reform.
I know this is the simplest of summaries, but it seems accurate. Am I wrong about something big?
Has it? I'm not seeing much of that (and don't think I'm guilty of it).
Information assymetries and extreme time constraints are built into medical care at a foundational level, and prevent the functioning of the market you've imagined.
This is a better way of phrasing (and spelling) something I tried communicating earlier and, I think, a hole in the Atlantic piece. Which is not to say that that isn't necessarily the best option, but I thought the author was a little too casual in moving past it.
More generally, I really don't like how this thread has been turned into a referendum on whether various folks "deserve" the sympathy of those who are not currently in any financial or health straits. I can take the libertarian argument that justice requires government inaction in these situations. I can take the libertarian/conservative argument that massive government programs run unknown risks and might have worse consequences. I find the argument that people at risk of bodily suffering or financial ruin are probably to blame for their situation to be truly ugly, and suggests a basic lack of compassion, a basic inability to put yourself in someone else's position.
I'm not judging anybody, and I firmly believe in a strong charity sector to handle those who fall into misfortune, even through their own fault. But, I want to be clear it is charity. There is no right to consume all your income and have someone else pick up the tab for your medical care. Any reasonable system has to have most working people paying the average cost (averaging unexpected catastrophic events across the pop.) for their own health care.
But if I come to the hospital with a head injury, how am I supposed to "shop" for the best price on brain imaging? Should I forego testing if their estimate comes in too high? How can I possibly know for what sort of head injury imaging must be done immediately and costs accepted, and for which kinds of head injuries imaging might be reasonably delayed or foregone?
Information assymetries and extreme time constraints are built into medical care at a foundational level, and prevent the functioning of the market you've imagined.
No, of course not in that situation. But the vast majority of health care is non-emergency. for an MRI, or routine surgery, or even a non-emergency bypass, you damn well should be shopping around, both on price and qualit (i.e. success/survival rates).
2) Personal responsibility is a great thing. But people's lives are irreducibly complex, as are all human events. To understand choices made, and their effects, requires a lot more than reading a blog post. A position of advocacy for personal responsibility, and careful management of one's own life, combined with compassionate humility regarding the choices of others, is to me the best path.
3) The reduction of one's health and financial situation to a function of personal responsibility is not only problematic due to ethical epistemology, but also because luck is such a huge factor in human events. As you know, random chance affects baseball statistics not merely in big freak plays (sun glare blinding the right fielder leads to inside-the-park HR), but in tiny things, like a swing that's 1/10 of an inch lower than intended leading to a fly out, or a batter putting good wood on a nasty slider and singling to left center. Baseball events are functions of random chance in millions of ways. And baseball is far simpler than life - it has clear rules and agreed upon aims. I would think that understanding the sabermetric theory of random chance in baseball would help to illuminate how the various situations that folks find themselves in, financially, healthwise, and so on, are not functions of personal responsibility in any simple way.
This system would have a more general problem - the provision of health care depends, at a basic level, on deep trust between medical practitioner and patient. This is because patients cannot be expected to have sufficient medical knowledge about their situation to determine their own course of treatment, because medicine is some complicated ####. It's the information assymetry again. Then, the more we incentivize doctors to be salespeople and patients customers, the more we damage that trust.
This issue is surprisingly simple. It's win-win for everyone involved. If you pay taxes your taxes will go down. If you're not covered now you are covered. If you live in fear of medical bankruptcy now you don't have to live in fear anymore. If you run a business your employee compensation costs will go down and you will make more money.
You really this the U.S. government is going to bring efficiency to the sector. HAH! Whatever single payer would eliminate in terms of bureaucracy, it would lose twice as much in fraud. Americans are not Canadians or Britains. We are not orderly and law abiding. Many, many people and doctors will rob the system blind.
Look, other countries do spend less, and do get good outcomes. But you can't deny that some people, particularly the elderly will get less care than they get now. Also doctors, nurse, hospital workers, etc. will get paid less.
There are no costless solutions.
Don't make Ryan cut you, #####.
Phew! That was like the time Sam Hutcheson thought I was an umpire.
I'm not going to get into a detailed debate about the virtues of American v. Canadian systems - 1) I'm pretty sure that I'm not allowed to and; 2) my comments ultimately would go back to my comment about how we have to pick and choose what we want to maximize and what we can live without. There's not (in some senses, anyway) wrong answers - we just need to figure out what we value as a society. If we don't do so explicitly, we still have made a choice (what, am I channeling Rush now? The band, not the guy. Eh, when discussing Canada...).
If I was going to play the anecdote game (and I'm not a big believer in anecdotes for this type of debate), I know people who had good experiences in the Canadian system and people who had bad ones, just like here. I specifically know people who had problems with getting MRIs and other imaging services in Canada and are bitter about it and the resultant consequences (well, two people - but that's a lot of Canadians for a guy living in the American South).
As to an above post concerning the impossibility of combining lower costs with improved care this is empirically false.
It depends on how you define improved care. We're not healthier than other countries and our care is waaaay more expensive. Part of that is lifestyle, part of that is systematic. If you can afford care, however, you get outstanding service in this country - tops in the world by many metrics (I've got WHO data in front of me, in fact).
It's win-win for everyone involved.
I'm a relativist and annoy people by couching all of my statements in a series of boring clauses and blah blah blah. So, let me be clear.
Nothing is win-win here - if it were, change would have happened long ago. There will be winners, there will be losers. Just like now.
Yes, Americans are not Canadians or Britons, but are we so absolutely different from the Canadians, Britons, Irish, French, Spanish, Germans, Swiss, Austrians, Danish, Norwegians, Swedish, Finnish, Australians or Japanese? And all those folks are much more like each other than they are like us? That seems deeply implausible. It seems much more likely that a less market-based system would cut costs.
I wish a significantly less market-based system were on the table, but it isn't. Obama's plan will be able to cut significant costs because things like Medicare Part D are so blatantly wasteful that there's free money to be had, but truly reforming the system requires getting the market out of it, or at least out of the provision of baseline medical care.
This system would have a more general problem - the provision of health care depends, at a basic level, on deep trust between medical practitioner and patient. The more we incentivize doctors to be salespeople and patients customers, the more we damage that trust.
They're already salespeople. They get paid per procedure. Plus, they are in deadly fear of being sued. They have every incentive to "sell" you more.
In a modern functioning system you could see the prices for all basic procedures on the web site of your local hospitals. If I can compare auto insurance online, why not MRIs.
The other beauty of competition is that not everybody has to shop around. The fact that some shop around for non-emrgency MRI's will drive down the prices for emergency MRI's. Just like I don't pay much of a premium if I need to buy a car today, maybe 5% more b/c of less haggling leverage.
I'll admit I had not thought of this. Though again it's not like this is the first time it has ever been done.
Some of this is true. Doctors will certainly be paid less though I doubt that the elderly will get less care. However right now there is so much money leaking out of the system that removing the non-medical inefficiencies (like spending money to not treat people) and profit driven "research"* can allow for a massive increase in more mundane treatments.
*Medical research is incredibly expensive. It is also incredibly ineffective and keeping people healthy. Which should be no surprise since it is motivated by profit and not health.
SOMEbody is going to have to pay. yes there are a lot of young healthy working adults who choose to not spend 800 bucks a month or more for basically nothing. and there are a lot of young healthy adults like me who go without because of 800 bucks a month being a LOT of money.
as for the illegals, we ALREADY pay for them - they already get all the free health care they want - they just walk into an ER. and if they are sick enough to be admitted, they are admitted, and they get operations if they need them. they just don't pay. here in harris county, 1/3 of all the county health visits are from illegals right now.
if you want a clinic appointment, the wait is about a month for not really sick right now - that wait is about 4 days. my husband has insurance and the wait for him to see his doctor (who is a allergist) is 2-3 months. if you want to walk into one of the county clinics, the wait time is 4-8 hours. if you go to the ER fast track clinic, the wait time is 4 - 18 hours.
i just do NOT believe that nobody is going to pay, except for all those millionaires who don't want it. the rest of us are going to be either forced to buy the expensive insurance or pay a lot of extra tax. i do NOT believe that the insurance companies are not going to raise prices through the roof to pay for all the extra people who can't pay. and unless they plan to have a whole lot of people seen by nurses instead of doctors, there are not enough doctors. there just aren't.
we should ask the guys here who are veterans if they go to the VA for their care if they have the money to go somewheres else
everyone talks about how if the govt take over things will be so much better because then you will get rid of waste/paperwork. MORE efficient? you have GOTTA be shtting me. you got even ANY idea how much paperwork there is for mediciad right now? this all sound like belling the cat to me. and it is just as crazy as the people who insist that education is not a right and that we should immediately get rid of public schools and let parents pay for education - and somehow, they got no plans for what would happen to the millions of people who suddenly got no school and how a huge percent of kids with no education, no school and nothing to do would end up affecting them.
as for socialist medicine being this wonderful thing, you should just go ask john brattain about the fantastic medical treatment he got. oh wait - you can't
Again, why is it that so many other countries can provide better health care than we can (see my post #109 above, which nobody seems to want to confront), with less overall bureaucracy***? Do you think that those who look at the examples of the many types of health coverage offered elsewhere in the developed world are simply making up facts? Is it irrelevant that with the tiny exception of super-advanced state of the art treatments, other countries provide better care to more people for less money? Is it really all the problem of people with SABR member type physiques and a propensity of paranoid parents to drive their kids to a school that's two blocks away?
***I invite anyone to state with a straight face that the paperwork confronting a Medicare patient matches that forced on people under 65 with individual private insurance policies. (Not to mention those without coverage who have to deal with emergency rooms.) I've had two colonoscopies in my life, one at 55 and one at 65.
The first resulted in a mountain of forms to fill out and another mountain of "Statements" explaining the breakdown of costs, written in the usual gobbledygook that no layman could possibly decipher. And of course this all arrived in stages, from (a) the doctor, (b) the hospital, (c) the labs, and (d) Blue Cross / Blue Shield. No satirist of "bureaucracy" could possibly do justice to this. And I'm talking to you, teabaggers.
The second one was just a few months ago, when I turned 65. While checking in, I handed the receptionist my Medicare card and my supplementary card (total premiums under $250 a month, which covers pretty much 100% of everything except prescriptions, which fortunately I don't need other than eyedrops). And that was it. No paperwork, no forms, and yes, of course I had my choice of doctor and hospital, the same ones I had the first time around.
Since then, I've had my annual physical, which used to cost me over $600 out of pocket, because I never used up my deductible. This time it was fully covered by the supplemental policy, with no paperwork to submit and no co-pay at all. And again, it was the same (private) doctor I've had all along.
Why should this have to wait until one is 65? Why can other countries do this and we can't? What in the hell are we so afraid of?
This is the money comment.
Americans are not Canadians or Britains. We are not orderly and law abiding. Many, many people and doctors will rob the system blind.
Is this a serious argument?
WTF?
Yes we are. All those countries were, until very recently, highly homogeneous populations with a high degree of social solidarity.
They have a sense of "we're all in it together" that positively does not exist, has never existed, and will never exist in a polyglot nation like the U.S. People in other countries (with the exception of Italy) don't have the same cultural attitudes towards rule and regulations we do.
Read up on the fraud rates in Medicaid sometime. A national medicaid based system would be a vast sucking chest wound of fraud, correuption and bureaucracy.
Apparently, you're afraid of this:
As near as I can tell, it's a claim that Americans are too corrupt to have universal health care. I find this notion hilarious, considering Italy, France, Canada (yep, we've got a bunch of corrupt bastards up here too), and tons of other nations filled with people who are every bit as greedy and selfish as Americans have all managed to put together some form of universal coverage.
For some reason, I keep picturing the conversation of:
"So Doc, how's the #######?"
"Him? He's fine."
Less. Unless you mean on a per-capita basis.
One thing to understand, Canada has a pretty screwed up system -- in no small part because we've managed to come up with the second highest administrative costs (well behind the US though) in spite of having a true single payer system.
IOW Canada should probably be used primarily as a bad example. We do a consistently poor job on the elective side but are just fine on the emergency side.
double WTF??
And do now. (Here, I could tell stories.) And do in those countries. Anti-fraud is part of any reasonable system.
Medical research is incredibly expensive. It is also incredibly ineffective and keeping people healthy. Which should be no surprise since it is motivated by profit and not health.
Well, it's both - and always will be (so long as concepts like wealth endure).
Because Medicare is already on a path to bankrupt the nation within 50 years. Give Medicare to everyone on the same terms, and the U.S. will literally be defaulting on its debt within 20 years.
You know what? Go #### yourself. You don't know #### about our system up here, and to imply that somehow our government and our medical system decided to provide John with anything less than excellent treatment is just about the most ####### moronic thing I've ever read here, and given some of the ######## that I've read here over the years, that is an incredibly impressive achievement.
EDIT: Seriously, what the #### is wrong with you? Do you even realise that what's being proposed in the states bears absolutely no resemblance to the Canadian system. Why bring something so unrelated and insulting into the conversation? Are you just trying to score some sort of ######## bonus points?
I'm hoping that was a (poor) attempt at a joke, because if not, it's just about the most offensive thing I've ever read here.
BBC, do you think John would be alive today if he'd lived in (say) Houston? If so, why?
Not true.
When HC reform in '94 went belly up, the Clinton administration did push for -- and get -- some extraordinarily strong sticks to use to combat fraud. There's plenty of evidence that hospitals are generally underbilling Medicare more than overbilling -- and studies that illuminate overbilling show they're more a result of coding errors than true fraud. For a mere fraction of what private ensurers spend on fraud prevention, Medicare has a much better rate of compliance from hospitals.
This isn't true in all areas -- DME/durable medical equipment reimbursement is rife with fraud, but CMS has instituted a number of pilot programs to go after equipment suppliers. The other prominent area of fraud comes from self-referrals.
But all in all - Medicare spends much less per program dollar in fraud prevention, but comes out ahead in terms of fraudulent claims paid.
Ummm... no.
There is really no dispute over this point. The spread is not 30% to 3%, as folks on the left would like to claim -- but a significantly higher percent of dollars paid under Medicare/Medicaid go directly towards care vs. overhead than in the private system.
This is a study from CAHI (PDF) -- a think tank funded by the health insurance industry -- so these are the folks most opposed to any sort of public option and even their own studies admit that:
Even if you exclude things private insurance has to cover in their administrative overhead -- profit, commission, taxes -- Medicare still comes out ahead. (5.2% overhead for Medicare, 8.9% for private insurers excluding tax/profit/et al -- 16.7% if you include them).
No one familiar with the numbers seriously contends that public programs - Medicare/Medicaid/SCHIP/etc - don't have lower administrative costs than private insurers... even the industry itself does not deny this.
Is every other country going to be bankrupted within 20 years?
i do NOT believe that the insurance companies are not going to raise prices through the roof to pay for all the extra people who can't pay. and unless they plan to have a whole lot of people seen by nurses instead of doctors, there are not enough doctors. there just aren't.
Why are there not enough doctors? Because it's very hard to become a doctor. Why is it so hard to become a doctor? Because the existing doctors are protecting their privileged status. So for a basic problem, why not be seen by a nurse practitioner who can do the exact same thing as a doctor? "Doctor" is just a word.
True.
Because Medicare is already on a path to bankrupt the nation within 50 years. Give Medicare to everyone on the same terms, and the U.S. will literally be defaulting on its debt within 20 years.
If you believe this, then as an alternative, how would you deal with the fact that two thirds of personal bankruptcies in 2007 were caused by medical bills? (A rate that went up by 50% from 2001.) Is that to be considered some sort of collateral damage, the acceptable price that we pay for the wondrous benefits of our existing health care system?
It would be one thing if these evocations of the Socialist Bugaboo were accompanied by a concrete plan that addressed the catastrophic results that our health care system bestows upon millions of people, a plan that went beyond offering a few thousand bucks in subsidies and a message "you're on your own." It would be even nicer if some of these teabaggers acknowledged a modicum of collective responsibility to someone beyond their own circles, rather than sounding like college sophomores drunk on an Ayn Rand novel. Heaven forbid.
No. But I'm sure they quickly make up for that advantage with fraud. The estimates I've seen is that 10% of Medicaid/Medicare total spending is out-and-out criminal fraud. Not to mention the soft fraud.
Meatwad, if you care to, can you explain in a sentence or two what life decisions you made that led you to the point where you cannot afford insurance?
- i can do that for me too
i did 2 really REALLY stupid things when i was 19
1 - i got married
2 - i got my own house as a wedding present
as far as any kind of health care besides what i can get from the county clinics, me and my twins are permanently uck-fayed. and if anything medical that is serious happens to me, i'm a dead woman. and really the only way out of this situation for me is to divorce my husband and marry a man with $$$
SO, i'm sure that you think that my refusal to abandon my husband and whore myself out is stupid
shrug
i'm sure you are going to tell me to get a job. and the only kind of job i could get that pays more than minimum wage is prostitution and that does not come with an insurance plan you know what i'm saying. and, by the way, that minimum wage job - it probably don't come with health insurance neither. that is, if i could even get it because i'm sure they would find plenty of preexisting conditions
I hope not. As they get fatter like we (Americans) are, they might. They're worried about it, I know that - some systems are getting more liberalized (to go back to an earlier question) accordingly.
why not be seen by a nurse practitioner who can do the exact same thing as a doctor? "Doctor" is just a word.
Well, there is a real distinction, but I agree with you. I see a NP for most of my minor care (minute clinic type deals) at considerable savings. If some idiot had me designing a top-down system revamp (market forces and all that aside), we'd (collectively) do that kind of thing more often.
Like most services for poor people, most of the paperwork for Medicaid comes from trying to prevent people from using it if they don't fit the criteria. Especially since it's funded by states, which can't run deficits. If it's a humongous hassle to qualify for a program, it's good for the government's budget because people can't figure out how to qualify or they don't have enough free time to do it. This is the result of not having any universal programs that everyone is eligible for (unless you're a veteran or over 65, in which case, if you're sick, you're probably more satisfied with your health care than the average sick person).
RDF, man. (What's Obama's stance on neck-stabbings, huh, leftys?!?!?)
While there is merit to this position it is also true that anecdotes are indicative of experience and experience is surely relevant. I've been involved in major medical procedures in three different countries and the difference, while perhaps not generalizable, I think is relelvant. My son was born in Seoul, I had surgery in DC, I had routine care as a State employee in Wisconsin, and my daughter was born in Canada. So I've seen a lot of the differences first hand and I know where I'd want to live if health care was the sole factor.
If he was pro-neck-stabbings, don't you think there would be a lot fewer righties?
SO, i'm sure that you think that my refusal to abandon my husband and whore myself out is stupid
shrug
No, Lisa, but what I can't understand is why you think your personal situation would be any worse if we overhauled the system that you're stuck with right now. Why do you concentrate on the government's love of bureaucracy and ignore the private insurance sector's even greater love of it? (You're well short of 65, but read my post # 168 above.)
If you believe this, then as an alternative, how would you deal with the fact that two thirds of personal bankruptcies in 2007 were caused by medical bills? (A rate that went up by 50% from 2001.) Is that to be considered some sort of collateral damage, the acceptable price that we pay for the wondrous benefits of our existing health care system?
These aren't mutually exclusive - there are other responses that may do a better job with cost controls + limit people from that kind of extreme exposure. (For example, under snapper's "plan" you either wouldn't have or would have far less of those kinds of bankruptcies.)
This is not to deny, by any means, that this isn't a serious mark against the status quo.
He's probably looking to nationalize the lucrative neck-stabbing industry under a soon-to-be-named Neck-Stabbing Czar.
So I've seen a lot of the differences first hand and I know where I'd want to live if health care was the sole factor.
Me too. It depends on what I have (healthwise) and how much money I've got. :)
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