The case for socialized medicine (1 Viewer)

[Black Box]

Or, less radically (and therefore less effectively, but at least it’s a start) we could restructure medical insurance to look more like car insurance—where nobody asks how you spend your claim check. If you’re diagnosed with colon cancer, then instead of paying $X million to doctors and hospitals, the insurance company would pay $X million directly to you. That way, at least some of us would shop around for better prices and forgo treatments we don’t think we need—lowering demand and making medical resources easier for everyone else to afford.

If I am diagnosed with colon cancer, I'm not sure my first, or second, or tenth inkling is to go searching for better prices and/or forgo treatments that may or may not be necessary (I am not a doctor, like most people, and would have a very difficult time determining the difference between the two).Health care is not similar to auto body repair shops. One can't go out and buy a clunker if they total their 40,000 dollar sedan.

I think his point is that you should have an inkling of price/treatments if you are sick.

 

[StrikeS2k]

For those in a big hurry to get all medical records online, take a look at this story about a hospital server getting hacked

This is pretty irrelevant. There is no doubt in my mind that I want my records available to any medical provider I go to see. Pretty much all of the medical systems cited by Obama as more efficient and higher quality (see my sig) have embraced medical records and their availability to all doctors you might see. If we truly want to have high quality health care at reasonable cost we NEED to embrace electronic records and their availability to appropriate medical personnel. Certainly we need to take all precautions to minimize the risk of their exposure to non-appropriate people but we shouldn't be opposed to this important reform out of fear.

 

[Maurile Tremblay]

I've edited this down just a bit.

KILL THIS BILL

November 6, 2009

Kurt G. Harris MD

Imagine the following. You are a thoughtful person. You find life challenging in a positive sense. You may or may not be college educated, but you read a lot, and you feel like the internet and the availability of books is a godsend. You can access primary sources of information that were opaque to almost everyone outside of privileged or highly specialized positions until the last decade of the 20th century.

You realize that "science" is not a privileged sphere of inquiry. It is not special. You see that scientists are not priests, and doctors are not demi-gods.

At some point you start to learn about medical science and nutrition. You are amazed at the lack of consensus. You are amazed that expert advice can differ so much. If you went to medical school, maybe you are amazed at how much of what you were taught proves to be useless or dangerous.

It starts to become obvious to you that there are diseases that serve as the substrate for the biological analogue to Dwight Eisenhower's military-industrial complex. Diseases that, were they to disappear, whole portions of the world’s largest economy would have to be mothballed like the USS Iowa. There are whole systems of modern iron lungs ready to become future curiosities. They exist for today's dietary polio.

Cancer. Diabetes. Obesity. A suite of degenerative diseases.

You realize that there is very good, if sometimes obscure, evidence from both modern medical science and the study of non-neolithic human cultures that most of what is being spent on health care in the world's largest economy is going to treat these diseases of civilization. When you learn of how ineffective these efforts are, and then how cheaply and simply they could simply be avoided, you are dismayed.

You may start to educate your family and friends about how absurdly simple it might be to reduce your risk of diabetes, Alzheimer dementia, the most common cancers, osteoporosis and autoimmune disorders. You may have luck educating your own physician and stimulating her curiosity.

Eventually, you realize that entrenched interests are a powerful impediment to changing things at a societal level.

The uneasy and opportunistic partners of our government, privileged rent-seeking corporations that don't need to flout the law because it is created solely to benefit them in the first place: the agriculture lobby, the manufacturers of artificial commodity "foods" like Archer-Daniels Midland, the subsidized ethanol makers, the big pharmaceutical companies -- economic tapeworms that never profit more than when the host is not killed but kept just sick enough to continuously need the juice.

Massive "insurance" companies that ostensibly hate a patchwork of regulation and oversight, but would be competed into oblivion if there were no regulations against selling across state lines, the way computers or bicycles or electric guitars are. Companies who, if they were not protected by the gross asymmetry of the tax deductibility of employer provided insurance and ever-expanding mandates and government micromanagement, would not stand a chance in hell of selling a single policy for $20,000 per year.

Having every dollar of health care spending run through government or a private company between you and your doctor and calling it "insurance" is not insurance. It is already an insane sort of privatized socialism. Can you imagine sending $600 per month to your "grocery insurer" and having to get pre-authorization for your pastured butter and grass-fed beef?

You encounter these things. They soon become obvious to you. They become facts.

You see that a bloated 16% of the American economy is essentially a fascist partnership between privileged and entrenched commercial interests and the overweening government that pretends to discipline them.

You reckon that the freedom of individuals to make their own decisions offers some hope. You know that, despite entrenched interests, the urge among some to create and take risks in hope of profit are a spontaneous force that could challenge the current health care system.

You decide to wait. You wait for a new system to arise.

A system where the physicians and scientists who think like you do combine with the entrepreneurs who always exist, and use their certainty that a new system can work to begin to create it.

A system that recognizes the diseases of civilization for being the nearly optional scourge that they are.

A system that has the morality, enforced by the logic and self interest of both buyers and sellers, to say that your 80 year old grandmother's new knee is not as worthy as your daughter's chemotherapy for easily curable Hodgkin lymphoma.

A system that, without subsidies and mandates, doesn't insure anything that has no scientific evidence for its efficacy, unless people want to pay extra for it a la carte.

A system that sees that rare, unavoidable events are the logical and most profitable thing to insure, and avoids the mandates of central planning that increase cost.

A system that empowers people to make their own decisions about what kind of medical provider they wish to see, and recognizes the right of individuals to work with their insurer to determine what level of training should be required.

And finally, a system that recognizes that not only does it make medical insurance more affordable to allow entrepreneurs to exclude those with unhealthy behavior, it may be the most powerful weapon we have to actually make people healthier, instead of keeping them alive to feed the tapeworm.

You speculate, with good reason and perhaps a pencil and pocket calculator, that even if the removal of subsidies and mandates does nothing for medical prices, within a generation health care costs could be reduced by 1/2 or 2/3 with the focus on sophisticated care for trauma, non-dietary cancers, and infectious diseases.

Why should an insurance premium for a medical event be tax-deductible when food and your apartment are not? Do we want people to have insurance more than food?

You wait for the day, perhaps a few years off, perhaps longer, when you can buy health insurance based on your behavior – when you are rewarded for choices you know to be healthy by entreprenuers and their actuaries who are also convinced. They will offer to insure you at deeply discounted prices if you don't smoke, if you eat real food, and if you avoid gluten grains, excess vegetable oils, and fructose. You are willing to get blood tests every year to confirm that you are sticking to a diet that mimics a Paleolithic metabolism.

If the health care reform bill under consideration by the US House of Representatives is voted on Saturday and passes, you will wait forever.

THE HOUSE BILL

The Wall Street Journal calls it "the worst bill proposed by congress since the Roosevelt administration."

I agree.

The bill will create a Frankenstein’s monster of an entitlement that will likely have a real cost of over $2 trillion on top of our country's already unpayable $50 trillion in unfunded liabilities.

This new entitlement, the first in our history to force the individual purchase of a service from private corporations, will eliminate the only surviving competitive option to the loathsome private insurance system, which is the option to purchase nothing at all.

The ban on exclusion from coverage sounds fair, but will permanently eliminate the possibility of ever buying insurance that rewards you for healthy behavior. Even without new taxes and income transfers through subsidies to buy insurance, you will be forced to be in the same risk pool as your obese neighbor on Avandia who eats chips and bread all day and his kids who are already nearsighted from hyperinsulinemia, themselves just two decades away from insulin injections.

Mandates will eliminate the possibility of choosing not to be insured for things you don't wish to pay for, and minimum benefit packages will force even those who prefer high deductibles to pay for first-dollar coverage they don't want. Premiums for the self-employed will triple based on this alone.

The possibility of anything as radical as choosing to pool yourself with individuals with lower risk of disease based on your diet will disappear and likely never return. A few years after this passes, it will become another part of the "third rail" - no one will touch the idea as it will be considered unfair, and the insurance companies need the healthy in the risk pool in order to be profitable. All these efforts to keep the prudent and or healthy in the pool with the unhealthy will be done under the rubric of "fairness."

So now you have my argument. You can see, I hope, that it is anything but support for the status quo. "Health care reform" as proposed is nothing but a permanent and unrepealable entrenchment of the status quo you are disgusted with.

 

[ODoyleRules]

I've edited this down just a bit.

KILL THIS BILL

November 6, 2009

Kurt G. Harris MD

The uneasy and opportunistic partners of our government, privileged rent-seeking corporations that don't need to flout the law because it is created solely to benefit them in the first place: the agriculture lobby, the manufacturers of artificial commodity "foods" like Archer-Daniels Midland, the subsidized ethanol makers, the big pharmaceutical companies -- economic tapeworms that never profit more than when the host is not killed but kept just sick enough to continuously need the juice.

Please don't tell me you believe this.

 

[Tau837]

Or, less radically (and therefore less effectively, but at least it’s a start) we could restructure medical insurance to look more like car insurance—where nobody asks how you spend your claim check. If you’re diagnosed with colon cancer, then instead of paying $X million to doctors and hospitals, the insurance company would pay $X million directly to you. That way, at least some of us would shop around for better prices and forgo treatments we don’t think we need—lowering demand and making medical resources easier for everyone else to afford.

If I am diagnosed with colon cancer, I'm not sure my first, or second, or tenth inkling is to go searching for better prices and/or forgo treatments that may or may not be necessary (I am not a doctor, like most people, and would have a very difficult time determining the difference between the two). Health care is not similar to auto body repair shops. One can't go out and buy a clunker if they total their 40,000 dollar sedan.

I've experienced this just from a medical opinion point of view, without the associated cost pressure implied here.

My wife is disabled and has had more than 10 major spinal surgeries since 1987. Major, complex, life threatening surgeries, not more typical spinal issues. She had 4 surgeries between 1987 and 1991, and then was reasonably okay until 1998. At that point, we went to see four orthopaedic surgeons (in some cases accompanied by neurosurgeons) for recommendations on how to proceed. Two advocated major surgery and two advocated waiting due to the risks.

We are both educated and (we'd like to think) reasonably intelligent, and her family had been dealing with this health issue for 11 years and through multiple surgeries. (We met in 1990 and were married in 1992, so I wasn't around for the first 3 surgeries.) Yet we had an extremely difficult time figuring out which surgeon to trust. And that was while we were covered by insurance... sure, we had out of pocket costs, and they weren't trivial, but the situation being described in this post here would add more cost pressure to the decision, when in truth we needed to make the decision based upon what was right for her health, not for dollar-based reasons.

 

[Maurile Tremblay]

It's Just Common Sense, Really.

November 10th, 2009

by Radley Balko

So if I understand the Democrats' logic correctly, health insurance companies are evil profit mongers who do everything they can to avoid paying for their customers' needed procedures.

Therefore, the government will now at the point of a gun force every American to give said health insurance companies a portion of their money, whether they want to or not.

I don’t doubt that there are people in Washington who honestly believe this makes sense.

 

[Maurile Tremblay]

I've edited this down just a bit.

KILL THIS BILL

November 6, 2009

Kurt G. Harris MD

The uneasy and opportunistic partners of our government, privileged rent-seeking corporations that don't need to flout the law because it is created solely to benefit them in the first place: the agriculture lobby, the manufacturers of artificial commodity "foods" like Archer-Daniels Midland, the subsidized ethanol makers, the big pharmaceutical companies -- economic tapeworms that never profit more than when the host is not killed but kept just sick enough to continuously need the juice.

Please don't tell me you believe this.

Sure I do. Archer Daniels Midland et al. are parasites, sucking wealth out of the country via government subsidies (and other policies crafted by their lobbyists). The more they suck out, the worse for us and the better for them -- up to a point. They do have to keep the host alive.Is that point controversial? How so?

 

[ODoyleRules]

I've edited this down just a bit.

KILL THIS BILL

November 6, 2009

Kurt G. Harris MD

The uneasy and opportunistic partners of our government, privileged rent-seeking corporations that don't need to flout the law because it is created solely to benefit them in the first place: the agriculture lobby, the manufacturers of artificial commodity "foods" like Archer-Daniels Midland, the subsidized ethanol makers, the big pharmaceutical companies -- economic tapeworms that never profit more than when the host is not killed but kept just sick enough to continuously need the juice.

Please don't tell me you believe this.

Sure I do. Archer Daniels Midland et al. are parasites, sucking wealth out of the country via government subsidies (and other policies crafted by their lobbyists). The more they suck out, the worse for us and the better for them -- up to a point. They do have to keep the host alive.Is that point controversial? How so?

The bolded part is suggestive of pharma companies suppressing cures for diseases because they profit more from years of chronic treatment than they would a single treatment to cure someone. That's the fallacy I was attacking. If that wasn't your belief, then we'll move along, nothing to see here.

 

[the moops]

The bolded part is suggestive of pharma companies suppressing cures for diseases because they profit more from years of chronic treatment than they would a single treatment to cure someone. That's the fallacy I was attacking.

While we can't be sure that this is true, haven't we seen enough instances of corporate greed in the past to make it likely that at least one pharma company would behave this way?

 

[Maurile Tremblay]

I've edited this down just a bit.

KILL THIS BILL

November 6, 2009

Kurt G. Harris MD

The uneasy and opportunistic partners of our government, privileged rent-seeking corporations that don't need to flout the law because it is created solely to benefit them in the first place: the agriculture lobby, the manufacturers of artificial commodity "foods" like Archer-Daniels Midland, the subsidized ethanol makers, the big pharmaceutical companies -- economic tapeworms that never profit more than when the host is not killed but kept just sick enough to continuously need the juice.

Please don't tell me you believe this.

Sure I do. Archer Daniels Midland et al. are parasites, sucking wealth out of the country via government subsidies (and other policies crafted by their lobbyists). The more they suck out, the worse for us and the better for them -- up to a point. They do have to keep the host alive.Is that point controversial? How so?

The bolded part is suggestive of pharma companies suppressing cures for diseases because they profit more from years of chronic treatment than they would a single treatment to cure someone. That's the fallacy I was attacking. If that wasn't your belief, then we'll move along, nothing to see here.

I don't think that's what the author was getting at, although upon rereading it I can see how it might be interpreted that way. (Since he's lumping pharmaceutical companies in with grain-growers and fossil fuel producers, I think he's talking about the country's economic health rather than its physical health. While policies favored by all three types of companies adversely affect our physical health, the grain-growers and fossil fuel companies don't profit from our illnesses. They profit from sucking money out of the economy. Making us sick is just an unintended side-effect.)

 

[Maurile Tremblay]

The bolded part is suggestive of pharma companies suppressing cures for diseases because they profit more from years of chronic treatment than they would a single treatment to cure someone. That's the fallacy I was attacking.

While we can't be sure that this is true, haven't we seen enough instances of corporate greed in the past to make it likely that at least one pharma company would behave this way?

I do think that pharmaceutical companies will downplay unpatentable cures in order to promote patentable ones. (The example that comes immediately to mind is getting doctors to prescribe vitamin D2 supplements even though over-the-counter D3 supplements are more effective.)But if they have a patentable cure for something, there's no way they'd suppress it. They're too greedy. They can charge more for an actual cure (as long as it's patentable) than they can for chronic treatment. After all, given the choice, which would you be willing to pay more for?

 

[fightingduck]

Finally had some time to post about health care and ran accross a couple of items. Not sure where they fit. In one case, I started a new thread that no one saw. I thought, since this was the most theoretical of the current health care threads, I'd offer these items here. Here was my post from my other thread:

If you get a minute (or hours), this site has an excel spreadsheet with dozens of comparasons of health care stats among developed countries. OECD Website

This data is often quoted and is often offered as a main driver for health care reform. The stats we've all heard before:

1. The US spends the most per person of any OECD country.

2. The US spends the most as a % of GDP that any OECD country.

3. The US public sectors picks up only 45% of total expenditures.

I've always dismissed number 1&2 out of hand. It only makes sense that a rich and aging country would spend a lot on health care if they had the freedom to do so. Also, they would spend an increasing % on health care as they aged and became wealthier. A rich old person would spend all thier income on health care if it meant living. As to the third point, I've always considered it too high.

But, here are some items that I didn't know and found interesting:

1. The U.S. population spends much less in out of pocket expenses as a % of the total than the average of the rest (12% vs. 18%).

2. The U.S. is the 2nd highest in government spending per person spending.

3. The U.S has lower growth rates in health care spending than the average of the other countries.

As to number 1 - What are we complaining about? How much lower OPP do you want?

As to number 2 - If we spend more per person than Canada (single payer), what else do you want? Don't we effectively have more than enough government spending on health care already?

As to number 3 - Governments suck at controling health care spending. They do it worse than the private sector.

 

[fightingduck]

The other point that Coburn's been pushing is that Medicare denies more line items on claims than all the other major insurers.

I checked out the source data and it does show that private insurers make more mistakes based on thier own policies, but that medicare takes 2 weeks to process a claim, while the rest take a couple of days.

My guess is that denying claims that you should be paying (as the privates do) is what really pisses people off.

 

[fightingduck]

Also, a great exchange on rationing in this thread:

Rationing thread

Just wanted to keep track of somethings (never know where to find them).

 

[Desert_Power]

Finally had some time to post about health care and ran accross a couple of items. Not sure where they fit. In one case, I started a new thread that no one saw. I thought, since this was the most theoretical of the current health care threads, I'd offer these items here. Here was my post from my other thread:

If you get a minute (or hours), this site has an excel spreadsheet with dozens of comparasons of health care stats among developed countries. OECD Website

This data is often quoted and is often offered as a main driver for health care reform. The stats we've all heard before:

1. The US spends the most per person of any OECD country.

2. The US spends the most as a % of GDP that any OECD country.

3. The US public sectors picks up only 45% of total expenditures.

I've always dismissed number 1&2 out of hand. It only makes sense that a rich and aging country would spend a lot on health care if they had the freedom to do so. Also, they would spend an increasing % on health care as they aged and became wealthier. A rich old person would spend all thier income on health care if it meant living. As to the third point, I've always considered it too high.

But, here are some items that I didn't know and found interesting:

1. The U.S. population spends much less in out of pocket expenses as a % of the total than the average of the rest (12% vs. 18%).

2. The U.S. is the 2nd highest in government spending per person spending.

3. The U.S has lower growth rates in health care spending than the average of the other countries.

As to number 1 - What are we complaining about? How much lower OPP do you want?

As to number 2 - If we spend more per person than Canada (single payer), what else do you want? Don't we effectively have more than enough government spending on health care already?

As to number 3 - Governments suck at controling health care spending. They do it worse than the private sector.

Some very interesting facts, thanks for posting.

 

[cr8f]

Another choice is neither a govt takeover or socialized medicine. I want more choices in everything.

Shlt I have directv and can't get local stations in my own state because I live 85 miles away(closest station) in Minnesota. No choice. Govt should give more choice not less.

 

[Maurile Tremblay]

Drugs Don’t Help

By Robin Hanson

May 30, 2010

In 2003, Bush had the US govt start to pay for drugs for seniors. This induced seniors to use lots more drugs, but they were not any healthier.

We find that gaining prescription drug insurance through Medicare Part D was associated with an 63% increase in the number of annual prescriptions, but that obtaining prescription drug insurance is not significantly related to use of other health care services or health, as measured by functional status and self-reported health. Among those in poorer health, we find that gaining prescription drug insurance was associated with a 56% increase in the number of annual prescriptions, and is not significantly related to health. (more)

 

[Maurile Tremblay]

Good read here, relevant to the needlessly high costs of medical care near the end of life.

How Doctors Die

 

[StrikeS2k]

Good read here, relevant to the needlessly high costs of medical care near the end of life.

How Doctors Die

Great read. Thanks.

 

[scoobygang]

Good read here, relevant to the needlessly high costs of medical care near the end of life.

How Doctors Die

I really wish my wife had seen this a few months ago. My father-in-law died last week after a six month hospitalization. He was 85. And I know my wife is haunted by the thought that all the care she agreed for him to have just prolonged his pain.

 

[Maurile Tremblay]

Some more examples of situations where more medicine —> worse health.

 

[Maurile Tremblay]

From Robin Hanson today: "It's just a flesh wound."

In the US the top 5% of medical spenders spend an average of $40,682 a year each, and account for 49.5% of all spending. (The bottom half spend an average of $236.) Not too surprisingly, 60.3% of these people are age 55 or older. Perhaps more surprising, on their health self-rating, 28.9% of these folks say they are “good”, 19.9% “very good” and 7.5% “excellent”, for a total of 56.3% with self-rated health of “good” or better (source).

So, are these folks in serious denial, or is most of our medical spending on hardly sick folks?

(The source link has some pretty interesting stuff.)

 

[Wrighteous Ray]

From Robin Hanson today: "It's just a flesh wound."

In the US the top 5% of medical spenders spend an average of $40,682 a year each, and account for 49.5% of all spending. (The bottom half spend an average of $236.) Not too surprisingly, 60.3% of these people are age 55 or older. Perhaps more surprising, on their health self-rating, 28.9% of these folks say they are “good”, 19.9% “very good” and 7.5% “excellent”, for a total of 56.3% with self-rated health of “good” or better (source).

So, are these folks in serious denial, or is most of our medical spending on hardly sick folks?

Maybe they are only in good health because they spend so much.

 

[jonessed]

Good read here, relevant to the needlessly high costs of medical care near the end of life.

How Doctors Die

I really wish my wife had seen this a few months ago. My father-in-law died last week after a six month hospitalization. He was 85. And I know my wife is haunted by the thought that all the care she agreed for him to have just prolonged his pain.

My wife mentioned this to me yesterday. I'm guessing she got a briefing on Oprah or something to be honest, but it started an interseting discussion.Most people I know don't want to die in a humane manner, but I wonder if when that time comes people's fear of death changes that idea. Perhaps they cling to life out of fear.

I guess they don't have much of a choice anyway. The way our medical system operates and the way the laws are written with regard to end of life options hospitals seem obligated and incentivized to keep people alive as long as medically possible. That's one of the major hang-ups I have with socialized medicine in the US. I don't think it fits our culture. Everybody wants the best of everything for free. How do you implement socialized medicine without cost caps on individuals? At some point society has to recognize that keeping someone 90+ years old alive for three extra months is not worth 100 college educations, but we aren't anywhere near that point. If we try and implement something like a grand-scale Obamacare without the caps on immediately we are going to bankrupt ourselves. It's not something we can tack on down the road even if we get to the point where society accepts it. We're too close to the economic tipping point with regard to the deficit.

I'm not totally against socialized medicine. I just don't see how we can get to a practical implementation in the timeframe we have. Socialized medicine doesn't work without rationing and if politics prevents us from even rationing Medicare there is really no place to go. There were a few cost-cutting measures in Obamacare, but we opened ourselves to a lot mroe expenses too. Plus, we are past baby steps. There needs to be some serious cuts now.

My sister-in-law is waaaaay left and I bet we could sit down and hash out a reasonable healthcare solution, but it would be a non-starter for 90% of the population, which makes it politically dead. We can point the finger at politicians, but they are just a microcosm of the population and most of the population doesn't want a rational solution.

The whole thing is frustrating.

 

[the moops]

Most people I know don't want to die in a humane manner

What sort of self hating people do you hang with?

 

[Chadstroma]

Most people I know don't want to die in a humane manner

What sort of self hating people do you hang with?

I wanna die bloody and gory and make the pain last as long as possible please.

 

[Maurile Tremblay]

I saw a couple interesting articles on the U.S. health care system recently.From this NYT article:

We manage health care as if our needs were always urgent and unpredictable, ignoring how deeply this industry is integrated into our lives, with a vast amount of care now devoted to treating ongoing, chronic conditions. Our system takes resources from all of us, pools the cost of certainties disguised as risks, extracts enormous costs of administration and complexity and then returns — to almost all of us — a fraction of the money we’ve put in. Try to imagine what homeowners’ insurance would look like if we expected everyone’s house to burn down and then added coverage for each homeowner’s utility bills and furniture wear-and-tear. This would be insanely expensive without meaningfully reducing anyone’s risk. That, in short, is how health insurance works. ...Traditional health experts may repackage their ideas, but they are never discouraged by past failure. So the new Accountable Care Organizations are a reinvention of H.M.O.’s. The Independent Payment Advisory Board is the new Medicare Payment Advisory Commission, or MedPAC. Bundled payments are the new Prospective Payment System. We often see some early benefit from the introduction of new ideas, but over time such initiatives are always subjugated by our system’s nefarious economic incentives. Implement cost control reforms and watch providers circumvent new rules and guidelines. Reduce reimbursement rates for procedures, and witness providers expand the definition of required services. Convert fee-for-service reimbursements into bundled payments, and soon more severe diagnoses are given. Attempt to use government buying power, and see providers turn to lobbyists to keep prices up. We are approaching a half-century of fighting this losing battle ... Here’s a completely different idea, one that might actually work. Let’s give every American health insurance, but only for truly rare, major and unpredictable illnesses. In other words, let’s cover everyone but not everything. It would take a generation to transition fully to such a system, but eventually the most routine and expected medical treatments, from checkups and minor illnesses all the way to common chronic conditions and expected end-of-life care, would be funded from our individual health savings; only the most major needs — for example, cancer, stroke and trauma — would be paid out of insurance. Defining insurable events more narrowly and enabling Americans to use the premium savings to build health savings would reduce the distortions inherent in our insurance approach. Most importantly, it will also compel providers to compete on the basis of price, quality and service, as they meet the one force that creates real incentives for good performance, innovation and safety: the consumer.

And from this very long Time Magazine article:

On the second page of the bill, the markups got bolder. Recchi was charged $13,702 for “1 RITUXIMAB INJ 660 MG.” That’s an injection of 660 mg of a cancer wonder drug called Rituxan. The average price paid by all hospitals for this dose is about $4,000, but MD Anderson probably gets a volume discount that would make its cost $3,000 to $3,500. That means the nonprofit cancer center’s paid-in-advance markup on Recchi’s lifesaving shot would be about 400%.When I asked MD Anderson to comment on the charges on Recchi’s bill, the cancer center released a written statement that said in part, “The issues related to health care finance are complex for patients, health care providers, payers and government entities alike … MD Anderson’s clinical billing and collection practices are similar to those of other major hospitals and academic medical centers.”The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise....Yet those who work in the health care industry and those who argue over health care policy seem inured to the shock. When we debate health care policy, we seem to jump right to the issue of who should pay the bills, blowing past what should be the first question: Why exactly are the bills so high?...Why does simple lab work done during a few days in a hospital cost more than a car? And what is so different about the medical ecosystem that causes technology advances to drive bills up instead of down?...According to the Center for Responsive Politics, the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington....Put simply, with Obamacare we’ve changed the rules related to who pays for what, but we haven’t done much to change the prices we pay....Over the past few decades, we’ve enriched the labs, drug companies, medical device makers, hospital administrators and purveyors of CT scans, MRIs, canes and wheelchairs. Meanwhile, we’ve squeezed the doctors who don’t own their own clinics, don’t work as drug or device consultants or don’t otherwise game a system that is so gameable. And of course, we’ve squeezed everyone outside the system who gets stuck with the bills.

 

[CBusAlex]

I saw a couple interesting articles on the U.S. health care system recently.From this NYT article:

We manage health care as if our needs were always urgent and unpredictable, ignoring how deeply this industry is integrated into our lives, with a vast amount of care now devoted to treating ongoing, chronic conditions. Our system takes resources from all of us, pools the cost of certainties disguised as risks, extracts enormous costs of administration and complexity and then returns — to almost all of us — a fraction of the money we’ve put in. Try to imagine what homeowners’ insurance would look like if we expected everyone’s house to burn down and then added coverage for each homeowner’s utility bills and furniture wear-and-tear. This would be insanely expensive without meaningfully reducing anyone’s risk. That, in short, is how health insurance works. ... Here’s a completely different idea, one that might actually work. Let’s give every American health insurance, but only for truly rare, major and unpredictable illnesses. In other words, let’s cover everyone but not everything. It would take a generation to transition fully to such a system, but eventually the most routine and expected medical treatments, from checkups and minor illnesses all the way to common chronic conditions and expected end-of-life care, would be funded from our individual health savings; only the most major needs — for example, cancer, stroke and trauma — would be paid out of insurance.

As far as I can tell, insurers cover things like checkups, minor illnesses, and chronic conditions because they can develop into major health emergencies if left untreated. It may be cheaper to pay for someone's regular blood pressure medication than to pay for the ensuing heart attack if the patient can't afford treatment on their own.So in that sense, the analogy isn't really homeowner's insurance covering people's utility bills, it's that insurance paying to have smoke detectors and sprinkler systems installed.

 

[Maurile Tremblay]

As far as I can tell, insurers cover things like checkups, minor illnesses, and chronic conditions because they can develop into major health emergencies if left untreated. It may be cheaper to pay for someone's regular blood pressure medication than to pay for the ensuing heart attack if the patient can't afford treatment on their own.

For the most part, I don't think that's the reason. Most studies that I'm aware of seem to show that preventive measures increase total medical costs. (See here and here.) I believe that insurance that covered heart attacks but not blood pressure medication (if there were such a thing) would cost less than insurance that covered both heart attacks and blood pressure medication.I think the main reason (but not the only reason) that so much predictable, non-catastrophic stuff is typically covered is because of the tax code. If a checkup costs $100, a patient can either pay the doctor $100 directly or he can pay his insurer $115, who will then pay the doctor $100 and keep $15 for itself. The tax code makes the second method effectively cheaper, so that's what people do.

 

[renesauz]

As far as I can tell, insurers cover things like checkups, minor illnesses, and chronic conditions because they can develop into major health emergencies if left untreated. It may be cheaper to pay for someone's regular blood pressure medication than to pay for the ensuing heart attack if the patient can't afford treatment on their own.

For the most part, I don't think that's the reason. Most studies that I'm aware of seem to show that preventive measures increase total medical costs. (See here and here.) I believe that insurance that covered heart attacks but not blood pressure medication (if there were such a thing) would cost less than insurance that covered both heart attacks and blood pressure medication.I think the main reason (but not the only reason) that so much predictable, non-catastrophic stuff is typically covered is because of the tax code. If a checkup costs $100, a patient can either pay the doctor $100 directly or he can pay his insurer $115, who will then pay the doctor $100 and keep $15 for itself. The tax code makes the second method effectively cheaper, so that's what people do.

Sorry Maurile....but preventitive medicine most certainly does save money long term. There's loads and loads of studies and data backing it up. Not EVERY preventitive measure for sure, but in general the majority of recomended measures do. A system that paid only for major illnesses would be catastrophic.

 

[Tau837]

As far as I can tell, insurers cover things like checkups, minor illnesses, and chronic conditions because they can develop into major health emergencies if left untreated. It may be cheaper to pay for someone's regular blood pressure medication than to pay for the ensuing heart attack if the patient can't afford treatment on their own.

For the most part, I don't think that's the reason. Most studies that I'm aware of seem to show that preventive measures increase total medical costs. (See here and here.) I believe that insurance that covered heart attacks but not blood pressure medication (if there were such a thing) would cost less than insurance that covered both heart attacks and blood pressure medication.I think the main reason (but not the only reason) that so much predictable, non-catastrophic stuff is typically covered is because of the tax code. If a checkup costs $100, a patient can either pay the doctor $100 directly or he can pay his insurer $115, who will then pay the doctor $100 and keep $15 for itself. The tax code makes the second method effectively cheaper, so that's what people do.

Sorry Maurile....but preventitive medicine most certainly does save money long term. There's loads and loads of studies and data backing it up. Not EVERY preventitive measure for sure, but in general the majority of recomended measures do. A system that paid only for major illnesses would be catastrophic.

No, preventive medicine generally does not save money. This is fairly well established fact, according to what I have read. I just Googled it, and clicked on several articles... not one of them supports your viewpoint.As you say, there are exceptions. But the exceptions are those preventive treatments that save money, not the opposite, as you are claiming.You say there are loads of studies and data backing your viewpoint. Can you cite some examples?Preventive medicine generally improves our health. But that's a different subject.

 

[SoBeDad]

As far as I can tell, insurers cover things like checkups, minor illnesses, and chronic conditions because they can develop into major health emergencies if left untreated. It may be cheaper to pay for someone's regular blood pressure medication than to pay for the ensuing heart attack if the patient can't afford treatment on their own.

For the most part, I don't think that's the reason. Most studies that I'm aware of seem to show that preventive measures increase total medical costs. (See here and here.) I believe that insurance that covered heart attacks but not blood pressure medication (if there were such a thing) would cost less than insurance that covered both heart attacks and blood pressure medication.I think the main reason (but not the only reason) that so much predictable, non-catastrophic stuff is typically covered is because of the tax code. If a checkup costs $100, a patient can either pay the doctor $100 directly or he can pay his insurer $115, who will then pay the doctor $100 and keep $15 for itself. The tax code makes the second method effectively cheaper, so that's what people do.

Sorry Maurile....but preventitive medicine most certainly does save money long term. There's loads and loads of studies and data backing it up. Not EVERY preventitive measure for sure, but in general the majority of recomended measures do. A system that paid only for major illnesses would be catastrophic.

No, preventive medicine generally does not save money. This is fairly well established fact, according to what I have read. I just Googled it, and clicked on several articles... not one of them supports your viewpoint.As you say, there are exceptions. But the exceptions are those preventive treatments that save money, not the opposite, as you are claiming.You say there are loads of studies and data backing your viewpoint. Can you cite some examples?Preventive medicine generally improves our health. But that's a different subject.

Socialized medicine outside the USA pays for preventive treatment, and the overall cost of healthcare is much lower in the rest of the world. So, there are some unique factors at work in the USA keeping healthcare costs higher. Even if it were cost effective to drop preventive care from health insurance to reduce premiums, I don't think any insurance company wants to be the first to offer such coverage.

 

[Maurile Tremblay]

Just came across this video.

Not perfect, but worthwhile.

http://www.upworthy.com/his-first-4-sentences-are-interesting-the-5th-blew-my-mind-and-made-me-a-little-sick-2

 

[bigbottom]

Just came across this video.

Not perfect, but worthwhile.

http://www.upworthy.com/his-first-4-sentences-are-interesting-the-5th-blew-my-mind-and-made-me-a-little-sick-2

Funny. Just posted this in another thread.

 

[Tau837]

Did you know that around 300 million Americans went without food, water and shelter at some point last year?

I am a survivor.

If you were blessed with the prodigiously creative and cunning mind of a politician, that kind of statistic — meaningless, but technically true — could be put to good use.

In the entertaining 1954 classic, "How to Lie with Statistics," Darrell Huff writes that "misinforming people by the use of statistical material might be called statistical manipulation . . . or statisticulation."

One of the most persistent examples of modern-day statisticulation is the sufficiently true claim that 46 million (it becomes 50 million when senators really get keyed up) Americans are without health insurance.

Set loose on the public's compassion, this number is a powerful tool in the hands of eloquent orators like President Barack Obama when peddling government-run health care reform. And no matter how often the figure is debunked, no matter how many studies point to its inexact nature, it's just too politically inviting not to embrace.

Wherever we stand on health care policy, surely we can admit that it's just as important to understand why Americans are uninsured as it is to get a handle on how many Americans are uninsured.

It is true that the 46 million figure is based on unreliable Census Bureau data. But even the less unreliable Congressional Budget Office puts the number at around 31 million. And even that number, former CBO Director Douglas Holtz-Eakin claims, is an "incomplete and potentially misleading picture of the uninsured population."

For one reason, the uninsured figure counts every American (and illegal immigrant) who has been uninsured for any time frame during a year, even if they happen to be between jobs or changing insurance plans or on family visit to Guatemala.

According to the CBO, 45 percent of the uninsured are uninsured for four months or less, which seems like a pretty positive number to me.

Then, another portion of uninsured Americans already qualify for an existing government health insurance program — and government already controls 46 percent of spending on health care — for which they have not signed up.

The CBO estimates that as many as 15 percent of the chronically uninsured are already eligible for help. The Urban Institute (hardly advocates of free-market fundamentalism) found that 25 percent of the uninsured qualify for some program.

Surely, most citizens will concur that health care is too expensive (though most citizens would likely concur that everything is too expensive) and something should be done. So when Obama tells us that 46 million Americans are uninsured, he is implying that 46 million people can't afford health insurance. That, too, is absurd.

In a study for the National Bureau of Economic Research, "Is Health Insurance Affordable for the Uninsured?," Stanford economists say that "based on a plausible range of definitions and assumptions . . . health insurance is affordable for between one quarter and three quarters of adults who are not insured."

Turns out that 8.4 million uninsured Americans are making $50,000 to $74,999 and 9.1 million more are making more than $75,000. Health insurance is just incompatible with their lifestyles, I guess.

There are obviously inconveniences — children and mortgages, for instance — that can quickly make $50,000 seem like a pittance. Then again, 27 percent of all adults in their 20s (many, I presume, without offspring) choose not to have health insurance. Many of them surely have the means to purchase insurance, but after meticulously considering the tradeoffs (imbibing or insuring?) say no thanks.

These facts do not undermine the argument for nationalized health care (history and common sense do that already). They do, however, point out that many statistics, to quote Huff again, get by "only because the magic of numbers brings about a suspension of common sense."

http://www.denverpost.com/opinion/ci_12691196

Interesting. Let's do a little math, based on the article:31M Americans and illegal immigrants were uninsured at some point during the year prior to the data collection.

17.5M of those uninsured Americans make $50K or more... so they are uninsured by choice IMO and thus should not be used to justify the need for nationalized healthcare. I realize this probably includes a small number of cases where people would pay but cannot qualify. I'm comfortable that it is a negligible amount unless someone can show otherwise, so I'm excluding them.

So we're down to 13.5M.

45% of the original 31M are uninsured for 4 months or less - not a major problem IMO... there will be hardship cases as a result, but in general the number of such cases should be relatively small. If there is some reform to implement to specifically address this type of gap (besides COBRA), that would be fine, but again this does not seem to be a justification for nationalized healthcare. I'll assume this cuts equally across the 31M and apply this percentage to the 13.5M.

So we are down to 7.4M.

15-25% of the "chronically uninsured" qualify for assistance do not sign up for whatever reason... I'll assume the 45% number represents people who are not "chronically" uninsured, since they were only uninsured for 4 months or less, so this group logically comes from our remaining 7.4M. However, it isn't clear what the base of this 15-25% number is in the article (i.e., was it the 15-25% of the full 31M or from some the subset that is the "chronically uninsured")? I'll take the conservative route and apply this percentage just to to the 7.4M.

So we are down to a range of 5.6M to 6.3M... I'll split the difference for convenience and call it 6M.

But we're still including illegal immigrants, who should be excluded from this exercise IMO, since our government shouldn't be providing them benefits... but I'm not sure what number to use in excluding them. I've seen estimates of 10M to 12M illegal immigrants in the country. It stands to reason that a large number of them would not have insurance coverage. I think it is reasonably conservative to assume that 2M of our remaining range are illegal immigrants, and thus can be excluded.

That would bring us down to roughly 4M American citizens who cannot afford or qualify for healthcare. Less than 10% of the number being thrown around by the Democrats.

The United States currently has a population of around 306M. (I assume that number only includes American citizens.) So we're talking about roughly 1.3% of the population.

There are a lot of assumptions in there, but I think the margin of error could go either way, so I'm comfortable with that number, though it assumes the facts in the article are correct, so that is really where the number could be off. Still, the Denver Post is a respectable source, so I'll assume the source data is valid.

So in theory that is the critical population that would truly be served by this plan. And in theory this plan *could* improve healthcare for others if it works well... but I have little confidence that it will. I think it is much more likely to negatively affect the healthcare the other 98.7% of the population is receiving. And none of this even addresses the tremendous cost burden it will place on the nation, and, thus, on the taxpayers.

It's an absolute nobrainer that we have no business even considering doing this as a nation.

Ran across this when searching for another old post. 6 years later, this post looks pretty good IMO.