Is this a redo of the WPA?

[I_luv_saber]

Little facts to deal with: UK pays about 7.5% GDP for its healthcare, and gets results similar to ours for mortality - but we pay twice as much. France and Germany pay more than UK (in the 8% and 9% ranges) but still far less than we do - and their citizens live longer and at better health than we do. We have a worse system by any measurement basis for population health you would use: eg: infant mortality or lifespan.

I have no doubt that our current setup is flawed and needs to be looked at. But really, I don't think it's the system itself that is flawed it's the fact that it really isn't that restricted. Same problem with what happened in the economy... there was too little regulation, greed took over and did the rest (whether it be on the consumer or business level). That doesn't mean the system itself is flawed to the point you institute socialism... you simply fix what's broken.

A system of more strict regulation of insurance companies as well as pharmaceutical companies would go a long way to alleviating the problems in our system. Put caps on what can be charged, don't let insurance companies cherry pick healthy customers only, and make sure insurance companies are on the up and up when paying out (like the most common problem... wait out a settlement until the customer can't wait for the money any longer and takes an extreme lowball amount of money). Not to mention the legal side of the healthcare issues....

In addition, this would be much easier to implement than a socialized healthcare system, and, IMO, much more efficient.

[jeff]

I don't disagree with you at all. You list several of the abuses and problems we have now, and they don't require a state-provided NHS to replace it.

In fact, most of the proposals are along the lines of what you suggest, with a single payer system or a government provided health plan for those not covered by private plans. The private plans have already gone on record as saying a government plan would be inferior and more expensive, so they should have no problem competing successfully against it.

From CNN: http://news.yahoo.com/s/ap/20090611/...ealth_overhaul : "Obama says creating the option of a government-sponsored health plan alongside private insurers would increase competition and lower costs. But in answering a question on Thursday, he also said that no one — "certainly not me" — is interested in a nationalized health care system like that in Britain. The president said the government is not going to force any change upon people who are pleased with the plans they already have with their employers.

"When you hear people saying socialized medicine, understand, I don't know anybody in Washington who is proposing that," he said."

So, rants about "socialized medicine" are inappropriate, and a way to create fear, rather than a legitemate issue. Mind you - we should be so lucky as to have the healthcare systems of France or Germany.

EDIT: Fox news article http://www.foxnews.com/politics/2009...ncites-battle/ mentions the anti-Obama healthcare infomercial by Swift Boat campaign financer Rick Scott's "Conservatives for Patients' Rights". The article describes Scott as a "former hospital chief executive" without mentioning that he got booted out for illegal activities. Nice, huh? With Scott as CEO: "Columbia/HCA plead guilty to a massive array of fraud charges - which resulted in a fraud settlement of $1.7 billion dollars, the largest in U.S history. Columbia/HCA systematically defrauded taxpayers, charging Medicare $15,000 for Tiffany pitchers and other luxury goods, "exaggerating the seriousness of the illnesses they were treating," and engineering a program where doctors were granted partnerships in hospitals as a kickback for referring patients. In 1997, Scott resigned in disgrace."

If this kind of jerk is against the Obama plan (and the AMA too ) there must be some merit to it.

[Inquartata]

As someone who makes $20k a year and would be unable to afford cost of living if I weren't bumming off the 'rents

And I call b******t on that statement.

You just aren't sufficiently motivated to give up cherished luxuries and spend only on true essentials...

At some point, the marginal value of each dollar begins to decrease rapidly.

Does it?

We are facing a situation where we have people so rich that they really don't benefit from it all that much. That dollar is "worth" a lot more to someone who needs healthcare or other basic services.

The only qualified judge of what anything is "worth" to any individual is---that individual. Not you, not me, not the courts, or the Senate, or the UN, or the Vatican, or "society". Just the individual whose marginal utility is under examination...

Otherwise we go down a road where those in power get to decide what anything is worth to anyone, and allocate it accordingly.

Germany, France, Switzerland, Sweden (actually: toss in the entire Nordic part of Europe). All of these countries are extremely enthusiastic about their healthcare systems.

I only did a cursory check for one country, but found this:

"Like every other nation, France is wrestling with runaway health-care inflation. That has led to some hefty tax hikes, and France is now considering U.S.-style health-maintenance organization tactics to rein in costs. Still, some 65% of French citizens express satisfaction with their system, compared with 40% of U.S. residents."

from http://www.businessweek.com/magazine...8/b4042070.htm

Better than us, to be sure, but I'm not sure that 65% expressing "satisfaction" ( with, I suppose, 35% expressing DISsatisfaction ) qualifies as "extreme enthusiasm"...

Nobody wants to eliminate them - they just want them to be better.

"Nobody"?

Not one person?

There's not a single Canadian or British Milton Friedman?

I suspect that there is a small but measurable support for abolishing just about anything one could name...

France and Germany pay more than UK (in the 8% and 9% ranges) but still far less than we do - and their citizens live longer and at better health than we do. We have a worse system by any measurement basis for population health you would use: eg: infant mortality or lifespan.

Not for any I would use, you may recall.

I mean, I cannot recall ever hearing that the US sustained several thousands of deaths due to a heat wave because most of our doctors were off on their state-guaranteed 6-week vacations at the same time...

THOSE particular French citizens certainly did not live longer and better than ours.

[Fencer X and Y]

Little facts to deal with: UK pays about 7.5% GDP for its healthcare, and gets results similar to ours for mortality - but we pay twice as much. France and Germany pay more than UK (in the 8% and 9% ranges) but still far less than we do - and their citizens live longer and at better health than we do. We have a worse system by any measurement basis for population health you would use: eg: infant mortality or lifespan.

Not agreeing or disagreeing with you but I'm just wandering what would happen if you only compared middle classes or upper classes and see which systems have the best healthcare. I'd imagine it would be similar for the middle classes and probably a bit better in the US for the really rich. There is anecdotal evidence out there that those who can afford it, come to America for treatments.

[Greybeard]

Where do I get my numbers? Out of thin air like many studies. I'd just like to know, why does an MRI cost several thousand dollars? Why does my bi-weekly blood test cost $150? Why is Keppra $100 a pill? Why do a lot of Doctors avoid HMO's to avoid the capitation? True, all I have are anecdotal stories of people I know from other countries and their distaste for national health. I agree also that people who need healthcare need it. Trust me, I shelled out plenty to hit my maximum out of pocket this year and I don't happen to have a spare couple of thousand. Heck, my medication alone, through mail order insurance to be cheaper is $5k a year.

What point am I try to make? crap, I don't know, I want some answers on the backrground stuff to see why it is so expensive anyway and I hate being told who I can see. On a radio talk show here yesterday an Irish woman was talking about how long her child had to wait just to get his tonsils out (a couple of years) Oh crap, I am just b!tching and don't know where to turn now

[jeff]

Not agreeing or disagreeing with you but I'm just wandering what would happen if you only compared middle classes or upper classes and see which systems have the best healthcare. I'd imagine it would be similar for the middle classes and probably a bit better in the US for the really rich. There is anecdotal evidence out there that those who can afford it, come to America for treatments.

No doubt about it. But if we only had to devise a healthcare system for the rich then it would be a much smaller task.

BTW, even in UK, people with the means "jump the queue" and pay for medical care that they could get for free if they were willing to wait for it.

[jeff]

I only did a cursory check for one country, but found this:

"Like every other nation, France is wrestling with runaway health-care inflation. That has led to some hefty tax hikes, and France is now considering U.S.-style health-maintenance organization tactics to rein in costs. Still, some 65% of French citizens express satisfaction with their system, compared with 40% of U.S. residents."

from http://www.businessweek.com/magazine...8/b4042070.htm

Better than us, to be sure, but I'm not sure that 65% expressing "satisfaction" ( with, I suppose, 35% expressing DISsatisfaction ) qualifies as "extreme enthusiasm"...

We are talking about the French, aren't we? People with 240 types of cheese, and they ask who is satisfied? Hah! What an opportunity for griping. And, 65% would be considered a landslide in an election here.

If the question was "would you be willing to do away with this system and replace it with a USA-style system I expect the numbers would be higher.

"Nobody"?

Not one person?

There's not a single Canadian or British Milton Friedman?

I suspect that there is a small but measurable support for abolishing just about anything one could name...

*smacks forehead* Note to self: don't use that rhetorical device with Inq, who will jump on modifiers like "everybody", "nobody".

Perhaps Canada is lucky enough to have no Milton Friedman.

In the UK, the Tories are to the left of our Democrats (National Health is a given even to them), so I think it might be the case there too.

Not for any I would use, you may recall.

I mean, I cannot recall ever hearing that the US sustained several thousands of deaths due to a heat wave because most of our doctors were off on their state-guaranteed 6-week vacations at the same time...

THOSE particular French citizens certainly did not live longer and better than ours.

Lack of doctors wasn't the issue - in fact, it was the 6 week vacation of the old folks' relatives that was the issue. Leave Granny in the flat and take off for Nice. It doesn't take a doctor to get elderly people out of apartments lacking A/C and drop them in the Pompidou center to cool off, instead of dehydrating in a 5th floor walk up.

[jeff]

Where do I get my numbers? Out of thin air like many studies.

You know that 73.6% of all statistics are made up on the spot, don't you?

I'd just like to know, why does an MRI cost several thousand dollars?

Because the boxes cost several hundred thousand dollars and you also have to pay the tech to take it and the radiologist to read it.

Since we're doing anecdotes in this thread I'll tell one too. Some years ago a friend contacted me because their HMO refused to permit an MRI for her husband. The doctor was ordering this because he suspected a tumor on his spine. The MRI stonewalled until threats to involve regulatory agencies were made, at which point they backed down and permitted it. Point being: (a) regulation keeps the bastards in line, and (b) if you worry about rationed healthcare resulting from government healthcare, start worrying about HMOs that already do it. Fortunately these people were smart, persistent professionals who know their rights and had employer advocates on their side. Those with fewer resources would be unsuccessful.

Why does my bi-weekly blood test cost $150? Why is Keppra $100 a pill?

Why does a plumber's visit cost $150? For the Keppra, because it's still under patent and the manufacturer can charge whatever it wants. Also, the number of doses sold may not be as high as, say, Lipitor - or Viagara!, so the economy of scale isn't there.

Why do a lot of Doctors avoid HMO's to avoid the capitation?

(Capitation, per se, seems to be used less now than a few years ago) Because they get paid maybe $15 to $30 for an office visit or consult of a given complexity, which means they lose money for every patient.

True, all I have are anecdotal stories of people I know from other countries and their distaste for national health. I agree also that people who need healthcare need it. Trust me, I shelled out plenty to hit my maximum out of pocket this year and I don't happen to have a spare couple of thousand. Heck, my medication alone, through mail order insurance to be cheaper is $5k a year.

Everything you've described is a consequence of our current healthcare system, not a national healthcare system that might replace it. I don't understand your complaining (not without justice) about the current system when those problems could be eliminated by a system like the other first world countries.

Heck, one of the reasons the meds are more expensive here is because we subsidize the rest of the world - which pays much less. As in "go to Canada and get your drugs for less".

What point am I try to make? crap, I don't know, I want some answers on the backrground stuff to see why it is so expensive anyway and I hate being told who I can see. On a radio talk show here yesterday an Irish woman was talking about how long her child had to wait just to get his tonsils out (a couple of years) Oh crap, I am just b!tching and don't know where to turn now

In UK and Canada, there are often delays for surgical treatment of non-emergency problems. That's the knee-replacement and so forth. So, the kid has a drip in his throat till his case is handled - it never was emergent (I don't get it, though - most of the time now they handle this with antibiotics).

BTW, don't say government provided programs are slow to do this and use knee replacement or dialysis wait times in Canada as justification. In the US, the vast majority of both of those procedures is done by government program (Medicare), so you're just comparing one government program to another. The Canadian program has done a good job funding GPs, and not so good funding surgeons.

[I_luv_saber]

In fact, most of the proposals are along the lines of what you suggest, with a single payer system or a government provided health plan for those not covered by private plans. The private plans have already gone on record as saying a government plan would be inferior and more expensive, so they should have no problem competing successfully against it.

I'm fine with this, providing that it's not optional for everyone, just those that are unable to obtain insurance any other way due to finances or because of the kind of work they do (or insurance companies won't insure them, though I think that should be addressed whether or not such an idea is implemented).

I think the argument of why they would have a hard time competing is that government plans are vastly more inefficient, but that, simply due to their size, they could bring it at a far lower cost to the consumer... to a point that most companies would have a hard time competing. I think we'd be better off regulating and making sure insurance companies and pharmaceutical companies are on the up-and-up.

That said, I am for a system that includes (or rather, makes a better, further reaching) safety net.

From CNN: http://news.yahoo.com/s/ap/20090611/...ealth_overhaul : "Obama says creating the option of a government-sponsored health plan alongside private insurers would increase competition and lower costs. But in answering a question on Thursday, he also said that no one — "certainly not me" — is interested in a nationalized health care system like that in Britain. The president said the government is not going to force any change upon people who are pleased with the plans they already have with their employers.

Again, I see problems when you are affording that option to anyone. I fear a government healthcare version of Walmart. Walmart moves in, and due to their massive size are able to bring products to consumers at a price lower than small businesses are able to compete with. Not only that, but even people who could afford to go to more quality stores will often go to Walmart to save a buck or two. This situation would be far worse when you are talking of the government BEING that big company. I see no reason this would not happen in healthcare... basically wiping out the private healthcare business except for those who are very well off... the rest of us would be stuck with the Walmart version of healthcare, a prospect I don't find too appealing.

I would rather implement regulation like we are doing to credit companies now, Insuring (ba-da-chi!) that we minimize the dirty practices often done by insurance and pharmaceutical companies. The same way we regulate, say, utilities such as electricity, which people (basically) must have. If you don't, then you basically have a guy in a desert selling water for $100 a glass, and when you're talking about basic things necessary to life, we need to be sure that doesn't happen.

$.02

EDIT: I'd also note that of the multiple tax credit systems proposed... every single one of them would pay for my insurance and then some. That being said, I don't want government giving me money to pay insurance companies while insurance companies are grifting everyone. Either way, they need to regulate them more heavily, IMO. I wouldn't be opposed to such a system after regulation is implemented.

If this kind of jerk is against the Obama plan (and the AMA too ) there must be some merit to it.

Meh... a broken clock is right twice a day

I would note though, that these people are generally not only against the Obama plan, but against change PERIOD... I'm not in the latter column, and indeed, I think most people agree SOMETHING must be done. Most Republicans are willing to look for a solution, but are just dead set against government hands directly in the pot. I think you'd be more likely to get stiffer regulation through (even though I've no doubt they don't like that either), as it's better (to them) than the alternative...

That makes $.04

[Phaeton]

As an introductory note: I'm not from the "ex Milty Veritas" school of thought. For some reason mentioning him really doesn't add much credibility in my eyes. I find this quest for alter-Friedmans to be a bit bizarre.

The difference between our system and some of the systems mentioned is efficiency. We've discussed it a bit this in this thread, and I hear it discussed all the time. The difference is not whether one or the other is more efficient but how one or the other is more efficient. The US healthcare system may be more time efficient, but I don't know if that is the issue as much as preventing mortality and being cost efficient are.

I really think there needs to be a more thorough investigation of international models to see why they fail and what could be done here. I'm not aware of this currently being done, but I think it would be a valuble use of resources. We need a comparative metric. Even if we don't end up with an identical system, knowing data can't hurt.

[jeff]

I'm fine with this, providing that it's not optional for everyone, just those that are unable to obtain insurance any other way due to finances or because of the kind of work they do (or insurance companies won't insure them, though I think that should be addressed whether or not such an idea is implemented).

So, you propose a means-tested national insurance?

I think the argument of why they would have a hard time competing is that government plans are vastly more inefficient, but that, simply due to their size, they could bring it at a far lower cost to the consumer... to a point that most companies would have a hard time competing.

That assumption needs to be validated. Actually - and this is a point worth emphasizing - the government plans are far more efficient (vide Phaeton's comments, with respect to money). It's not just due to low reimbursal rates, but to much lower overheads than the private sector insurers.

I think we'd be better off regulating and making sure insurance companies and pharmaceutical companies are on the up-and-up.

That said, I am for a system that includes (or rather, makes a better, further reaching) safety net.

Agreed.

Again, I see problems when you are affording that option to anyone. I fear a government healthcare version of Walmart. Walmart moves in, and due to their massive size are able to bring products to consumers at a price lower than small businesses are able to compete with. Not only that, but even people who could afford to go to more quality stores will often go to Walmart to save a buck or two. This situation would be far worse when you are talking of the government BEING that big company. I see no reason this would not happen in healthcare... basically wiping out the private healthcare business except for those who are very well off... the rest of us would be stuck with the Walmart version of healthcare, a prospect I don't find too appealing.

Well, there is a competitive pushback. First there is so much lobbying strength against the idea that there is very real risk that the program won't happen at all, or will be crippled to ensure that insurance companies can continue without any change. You know, the guys that promised in Washington a few weeks ago that they would dramatically reduce costs, and then a few days later said, in effect, "we didn't mean any of that".

Another pushback is that the providers would not be government employees like in UK. So, if reimbursal rates are low many provides will refuse to participate - driving quality down and waits up, and driving business to the other insurers.

So, there will be some checks and balances - and at the very least there's a chance to influence policy in the public and political sphere.

Also, there's the experience in places like Massachusetts, where IIRC the plan isn't a government insurance, but a mandatory one with subsidies. Kind of like the Swiss plan, I think.

I would rather implement regulation like we are doing to credit companies now, Insuring (ba-da-chi!) that we minimize the dirty practices often done by insurance and pharmaceutical companies. The same way we regulate, say, utilities such as electricity, which people (basically) must have. If you don't, then you basically have a guy in a desert selling water for $100 a glass, and when you're talking about basic things necessary to life, we need to be sure that doesn't happen.

$.02

No argument from me! In fact, there are state laws in some but not all states, with varying degrees of regulation (and most people don't even know if they do have recourse). Having regulation along the lines you suggest would be a great improvement.

EDIT: I'd also note that of the multiple tax credit systems proposed... every single one of them would pay for my insurance and then some. That being said, I don't want government giving me money to pay insurance companies while insurance companies are grifting everyone. Either way, they need to regulate them more heavily, IMO. I wouldn't be opposed to such a system after regulation is implemented.

That might be a working system - for those who are employed.

Meh... a broken clock is right twice a day

Channeling Inq? (That was a joke...)

I would note though, that these people are generally not only against the Obama plan, but against change PERIOD... I'm not in the latter column, and indeed, I think most people agree SOMETHING must be done. Most Republicans are willing to look for a solution, but are just dead set against government hands directly in the pot. I think you'd be more likely to get stiffer regulation through (even though I've no doubt they don't like that either), as it's better (to them) than the alternative...

That makes $.04

Good value for money....

[Greybeard]

I am not qualified to do anything but spout rhetoric. I know it needs to be fixed. But I do not know how to do it. All I know is I am alive because of the coverage I have and I want to continue being treated by these doctors. I should not be alive and I am thanks to these angels on earth.

Getting off my soapbox.

[I_luv_saber]

That might be a working system - for those who are employed.

Yes, I meant working in conjunction with public coverage for those unable to get their own for whatever reason, not just by itself (actually, I'm pretty big on public programs, providing they are made as efficient as possible, and are only put in place where really necessary, this being one of those situations, IMO).

Which is also part of the reason I think such a system would work so well... especially here. Not much needs to be fundamentally changed. Stricter regulation (government basically controlling things indirectly, like utilities) and a reform of our current "safety net" would be all that is needed. It would take some fine-tuning to find how everything needs to be set up in order to see that everyone is covered... if not privately than publicly... but I think it would be easier, less costly, and more efficient than most other systems proposed. Hell, it would at least be better to try such a thing before making other, more drastic changes I think. That being said, the one huge hurdle it would have to jump is the insurance and pharmaceutical companies lobbying power... but I still think it has a better chance than an open government insurance plan.

I'm open to ideas and modifications, though...

Channeling Inq? (That was a joke...)

Hey, hey, hey.... hey.