Health Care Reform in the US

[jeff]

prototoast - don't take it personally. I mean you no disrespect at all. I'm just tired of bringing out the same items and repeating myself.

You have a point of view I disagree with - how can I cross the gulf with somebody who thinks that people who don't have coverage got what they deserved, that denying healthcare to people is a moral option, or that it meaningfully hurts his 'freedom" to pay into a pool that will benefit him as well. Ah, the new "I got mine, Jack!" society. But you've been pleasant and trying to reason with me even though you presumably disagree with my position as strongly. If I jumped off threads because I thought the other guy was repellent - well, you ain't in that category! Now there are some people.... whew....

BTW, while I take my little break, I'll just point out that the poll in this thread (remember? It's a poll!) has the following main responses:

#1 Force companies to reduce costs of prescription medicines. (well, that's popular)
#2 Expand Medicare/Medicaid to cover more people. (uh, that's called "socialized medicine")
#3 Canada's system, only with faster response times. (that's socialized medicine, too).

So, there's a clear preference by the people who bothered to vote. "Pay-as-you-go health care. Eliminate insurance." got 0 votes, btw

[Greybeard]

Yesterday on the radio I heard the overspending going on in medicare. How they stopped the going out to bid process and paid googahs more than they needed to. And this is the government that wants to run our health care system.

[jessicasimpson]

Yesterday on the radio I heard the overspending going on in medicare. How they stopped the going out to bid process and paid googahs more than they needed to. And this is the government that wants to run our health care system.

Why do you hate America?

[Greybeard]

Au Contraire. I just don't think we need to be the world police. Why should we trust the care of every American to a group of people who don't know how to save and run a business. There was a classic line in the movie "Dave" when he has his friend come in to help him find money to keep a cause alive and his CPA friend tells him if he ran a business like this he would be out of business.

America is the greatest country on earth. Education, medicine, technology, we got it all.

[jessicasimpson]

Au Contraire. I just don't think we need to be the world police. Why should we trust the care of every American to a group of people who don't know how to save and run a business. There was a classic line in the movie "Dave" when he has his friend come in to help him find money to keep a cause alive and his CPA friend tells him if he ran a business like this he would be out of business.

America is the greatest country on earth. Education, medicine, technology, we got it all.

are we trying to tell the world how to run their healthcare? wouldn't most of the world just laugh at us if we did? I am not sure where this is comming from.

As far as education, is america even in the top 10? nope
health care, top 10? wrong again
technology? well probably, but everything technology based I have was made in Asia, exepppt for my toaster from mexico.

or are you saying that America is the only country in the world that has these 3 things?

Edit: answering in french does not help your cause

[Capt. Slo-mo]

America is the greatest country on earth. Education, medicine, technology, we got it all.

Might want to talk to this girl's parent's about that.

There's always room for improvement.

[Hauptman]

There was a classic line in the movie "Dave" when he has his friend come in to help him find money to keep a cause alive and his CPA friend tells him if he ran a business like this he would be out of business.

Unfortunately, the whole business of "doing business" has changed.

It used to be that businesses were interested in making a profit and then passing those profits to the owners (or stockholders). Now the interest has shifted to doing whatever is possible to raise the stock prices, cash out, and move on with whatever deals the CEOs and insiders can get away with.

The Internet boom and bust of the late '90s and the more recent collapse of venerable Wall St. have made it clear to me that the fundamentals of business have been thrown out the window. I have very little faith left in our current system, and I believe that without fundamental change we will see a collapse that will be as bad as the Great Depression; the recent bailout bought us some time but little else.

[I_luv_saber]

I think this has to do mostly with regulatory issues. It seems to me that in most things, the private sector can take care of things just fine - providing checks and balances are put in place to ensure there's no (or very little) foul play. The problem seems to be that after a certain number of years with no problems, we get lax and seem to think we no longer need these checks and balances and throw them out the window.

This is of course a highly simplified breakdown.

[Hauptman]

I think this has to do mostly with regulatory issues. It seems to me that in most things, the private sector can take care of things just fine - providing checks and balances are put in place to ensure there's no (or very little) foul play. The problem seems to be that after a certain number of years with no problems, we get lax and seem to think we no longer need these checks and balances and throw them out the window.

This is of course a highly simplified breakdown.

I completely agree with this, but would add one more major factor; the entire concept of the stock and commodity markets has been perverted.

The markets were intended as a way facilitate business financing, but instead have become the biggest casinos the world has ever seen. And just like the casinos we are so familiar with, the markets as stacked in favor of the "house". The established players, the insiders, have a huge advantage which allows the money to pool in the hands of very few people. And now those very few people/organizations rely on computer models that move money around faster than any human could keep up with and we end up seeing huge and dangerous swings in the markets that are devastating in their effects.

I think that the markets as they exist now need to be radically changed, although I'll be honest and say that I'm not sure yet what those changes need to be. I would certainly start by eliminating the derivatives markets, put a set limit on company/fund size to eliminate this "too big to fail" situation, and do something to get the speculators out of the commodities markets.

[lindajdunn]

Here's an example of what's wrong with insurance companies denying coverage for "pre-existing conditions".

http://www.nbc11news.com/localnews/h.../63813127.html

Because of his size, Baby Alex was turned down for health insurance, his height and weight put him in the 99th percentile according to CDC guidelines.

He eats well, he's growing fast, he has no pre–existing conditions. But his mom Kelli says their insurance company says he's just too big. “Insurance standards say if he's above 95 percent he's uninsurable."

Now in response to the comment about finances:

http://www.dailyfinance.com/2009/10/...-and-social-t/

[Inquartata]

I'm coming to agree with you upon this point. Much as I love my employer-provided health insurance and much as I'd scream if deprived of it, I must concede that providing health insurance for employees is one of many factors that drags down companies and encourages them to outsource jobs to countries where they don't incure this expenditure. It also encourages them to subcontract since those non-employees also don't receive insurance.

Wait...I thought that the rising price of health care was ( somehow ) "taking care" of the problem?

Despite that, Medicare total overhead is in the range of 3-5%, while private insurance companies total overhead is 18-20%

One question I would ask is: Are all parties using the same definitions of "overhead"?

the Swiss model, with private but not-for-profit insurance that cannot reject individuals based on "preexisting conditions".

"Private but not-for-profit" in the business of producing a good or service?!

Is that some sort of composite beast, like a jackalope?

Personally, I believe that mandating that people with preexisting conditions are covered is thievery.

Let's face it, the only problem some people have with the cost of health care in this country is that they see it as private thievery. If it's the government doing it, that's perfectly OK with them...

Isn't it possible that she couldn't afford to pay the cost of an MRI, and that it wasn't a choice?

Depends on your definition of "afford".

Yours seems to involve only discretionary monies...and maybe not even all of those.

To me, "afford" means "Can I cut back on enough discretionary spending to free up the funds for this expenditure"? Not "Well, is there enough left over after I've paid my phone bill, my cable bill, my cell bill, my internet service bill, my car payment, my gym membership, my morning Starbucks, my Friday night out with the girls, my kid's camp fees, etc."

Remember, Linda is a competitive fencer. She has made a decision to spend X amount of her wealth on traveling to tournaments, on equipment, on lessons, on club fees, on entry fees, and so on. One suspects that there are other expenses she voluntarily incurs which do not involve basic survival and/or the ability to make a living. If these could be foregone in order to pay for an MRI, then she could, indeed, "afford" it.

( Whether she values that MRI more than fencing or whatever is another question, one of individual preferences and priorities. I am only pointing out that it is not the same as the ability to "afford" it. )

The idea of insurance is that all are covered,

Wait, wait...since when?

I have not been able to find that it ANY definition of "insurance" that I have been able to find.

France, which has regulated insurers and private providers. They also pay much less than us and live longer and better, I know I've mentioned that a few times...

And it still doesn't follow that "if only we do the same, we'll have the same"...

there's rationing on that level today, if you want to call it that, since your HMO doesn't let you walk up and demand an MRI either.

But you CAN still get one if you are willing to pay for it yourself. That's not the case everywhere.

Neither public nor private system lets you demand whatever you want, both systems control utilization.

No?

Let's raise the shade of Howard Hughes, and ask him about it.

The problem is that everyone is using an economic term fuzzily, without really understanding it. They really mean nonprice rationing, or queuing. ALL economies ration resources; they must, because resources are finite. But rationing by price is not what we're talking about.

The priate system lets you demand as much as you want, so long as you've got the money. This is not the case in public systems which practice nonprice rationing as an integral part of the deal. In these you can only obtain more care than you are rationed by going outside the system ( as by coming here and using ours ).

Without going back to verify, I believe I said that if I had had to pay for it myself, I would not have had the MRI.

A-HA! Just as I suspected. This is not "I couldn't afford it". This is "I would have made a rational decision based on my own utility maximization function not to prioritize that MRI above other discretionary uses of my funds".

There is nothing wrong with this. It is how all economic decisions are made in a free marketplace. It's how we all work...until distortions are introduced by making us believe that we have certain entitlements to free or reduced-price goods and services paid for by the collective resources of the society...

I don't want the government to give it to me. I want a public option available -- as it is in my state -- everywhere.

Er--- for those who choose that "option", they are the same thing.

To say nothing of the fact that it would not be "optional" for very long, the way the current reform is being shaped.

those rocks, we still wouldn't have enough to cure everyone in this country with cancer. So, we'd have to ration. Option 1 is to let people who can personally pay for it get it. That seems reasonable, they can cover their own expenses. Now th government steps in and decides they'll cure 1000 cancer patients per year (less than 1% of those who die in the US). Who are they going to save? Babies are pretty worthless, they're easily replaceable. Old people are pretty worthless, they're just going to die soon anyway. You'd probably use the Mars rocks on otherwise healthy people probably between 10 and 30.

Now maybe keeping most old people alive doesn't cost quite that much, but that's the direction it's heading. As medical technology advances (good thing) it's going to cost more and more to keep people alive as long as possible (good thing) so we can either start allocating these resources efficiently now (good thing) or we can just pull the plug on all of them once we're out of money (good thing).

This pretty much gives the lie to I Luv Saber's statement about how we've evolved past a cost-benefit analysis when it comes to health care decisions.

It's like Churchill's bon mot about "We've established what you are, now we're just haggling over price". We DO apply cost-benefit analysis, we are just arguing about where it's limits lie, or should lie.

Obviously, no one would begrudge a 10-cent dose of a drug that would save the life of a surgeon who himself saves hundreds of lies a year. Obviously, we would not spend the entire yearly GDP of the world to save the life of a 100-year-old homeless alcoholic. In between those extremes is the realm of balancing cost against benefit...

[jeff]

Really quickly as I have a plane to catch....

One question I would ask is: Are all parties using the same definitions of "overhead"?

Yup.

"Private but not-for-profit" in the business of producing a good or service?!

Is that some sort of composite beast, like a jackalope?

I dunno - but that was once a very popular, perhaps dominant model in the US: All the Blue Cross/Blue Shield companies (I worked for one), HIP in the east coast, and probably others I don't know of. So, it ain't some goshdarn weirdo furriner thing.

[Greybeard]

Oh, and why do I hate America if I don't want the same people who overspend gazillions of dollars to run my healthcare. Based on the treatment I had for my brain surgery, I think healthcare in this country is pretty darn good.

[dcmdale]

One question I would ask is: Are all parties using the same definitions of "overhead"?

Yup.

Understanding that you were rushed, I am still wondering about this. From some of the methodological articles I have read, both private and public numbers would appear to be far too low. The <21% numbers that keep getting thrown around seemed to be based on the delta between health care premiums and health care payouts without taking into account reciprocal costs incurred by health care providers. I have read less about some of the statistical issues related to Medicare, but it certainly seems like it would be easy for some of the areas where Medicare does things differently than private insurance could end up excluded from the government numbers while being included in the private calculation. It is somewhat easier to gauge the private costs than figure all of the possible government pockets that need to be looked at. For instance, private insurance companies often foot their own bill for investigating fraud, DOJ covers investigation/prosecution of medicare fraud is this being measured? How are the costs of medicare provider certification being accounted for? Etc. Not arguing, just asking.

Given the overhead at least in the private sector, I think that models that can cut down the settlement costs can be a significant part of the solution. Kaisar, while hated by a large segment of the medical community (and a fair number of patients as well), combines the insurance function with the provider function: the insurer runs the hospitals and clinics and the non-M.D. staff. The doctors are in a separate group (by law). A group of the senior doctors sets medical standards for care which is what the actuarial tables are built against. If a doctor makes a medical decision that isn't in accord with the standards, the patient gets the treatment and the doctor explains to a board of doctors which can "give feedback on future decisions The business model is based on virtually eliminating the back and forth billing and justifying that most insurance companies engage in.

[jessicasimpson]

Oh, and why do I hate America if I don't want the same people who overspend gazillions of dollars to run my healthcare. Based on the treatment I had for my brain surgery, I think healthcare in this country is pretty darn good.

You hate America because you do not want American healthcare that is at least on a par with most 1st world countries. You should be horrified that our kids are dumber and our citizens not as healthy as the French, Germans, Swiss, and a dozen of other countries.

[keith]

You should be horrified that our kids are dumber and our citizens not as healthy as the French, Germans, Swiss, and a dozen of other countries.

Well perhaps that is not the only model. Brazil & China are doing pretty well these days, proof that all that matters is who you ask.

[Slim]

Oh, and why do I hate America if I don't want the same people who overspend gazillions of dollars to run my healthcare. Based on the treatment I had for my brain surgery, I think healthcare in this country is pretty darn good.

You're selfish and mean spirited.

[lindajdunn]

Oh, and why do I hate America if I don't want the same people who overspend gazillions of dollars to run my healthcare. Based on the treatment I had for my brain surgery, I think healthcare in this country is pretty darn good.

Because you're reserving that level of care for a select few rather than making it available to the great unwashed masses of humanity. And... of course... illegal aliens.

[I_luv_saber]

"Private but not-for-profit" in the business of producing a good or service?!

Is that some sort of composite beast, like a jackalope?

We've discussed this before, and it's not super odd...

Let's face it, the only problem some people have with the cost of health care in this country is that they see it as private thievery. If it's the government doing it, that's perfectly OK with them...

That's a cop out blanket statement, nothing more. You can do better.

My problem with it is not that people are making money off of this, it's that people are making a killing on this (here's the important part) at the expense of not only the health of the individuals involved, but the health of our society as a whole. This would be just as bad if the government were behind it (although as it stands now, at least the government has some amount of oversight).

Yes, I do find it unacceptable that insurance companies are entering into agreements in bad faith with little to no consequences (but if you'd like to continue to ignore that elephant in the room, by all means).

Yes, I do find it unacceptable that people can't have a speedy resolutions to hiccups in the system, and instead get stalled to death (sometimes literally).

Yes, I do find it unacceptable that people are not getting basic health care from somebody at a reasonable rate, turning cheap and preventable conditions into conditions that are much more costly both to the individual and society.

To me, "afford" means "Can I cut back on enough discretionary spending to free up the funds for this expenditure"?

If it's reasonable, yes. But I think you are tossing an awful lot of things in the discretionary pile that are for all practical purposes, necessary.

Sure, I could go sell my car and cut out my landline phone to get medical help. Sure, I'm making a decision to not do that. But that does NOT mean that the situation which exists now that I must make that sort of decision is a good one.

And it still doesn't follow that "if only we do the same, we'll have the same"...

However, it's a good hint that maybe there could be other ways to go about this whole thing and come out spending less and gaining more.

Er--- for those who choose that "option", they are the same thing.

No. With a public option (at least if we are discussing the same proposal) it is essentially insurance run by the government. It's not a handout. You're still paying into the system.

This pretty much gives the lie to I Luv Saber's statement about how we've evolved past a cost-benefit analysis when it comes to health care decisions.

Actually, I said we have evolved past pure cost-benefit analysis. Cost-benefit is necessary and good - to a point. In a civilized society, it should not be the end all and be all. I do not want to be Borg .

It's like Churchill's bon mot about "We've established what you are, now we're just haggling over price". We DO apply cost-benefit analysis, we are just arguing about where it's limits lie, or should lie.

Exactly. It's A factor. Not THE ONLY factor.

If that were the case, we would be eliminating anybody who has "outlived their usefulness" since they are now a drain on society. We are humans, and compassion, mercy, and similar concepts play a big role. And to me, this throw-your-hands-up attitude at the shady practices which are being done at the expense of the people's well-being and very lives, is not acceptable for an advanced society.

[prototoast]

Exactly. It's A factor. Not THE ONLY factor.

If that were the case, we would be eliminating anybody who has "outlived their usefulness" since they are now a drain on society. We are humans, and compassion, mercy, and similar concepts play a big role. And to me, this throw-your-hands-up attitude at the shady practices which are being done at the expense of people's well-being and very lives, is not acceptable for an advanced society.

It is the only factor is you account properly.

The primary inhibitor to a better functioning health care industry is current government involvement. Why would you want increased government involvement to fix this?