Nebula815 said:
(these next ones I might have some details wrong):
Indeed!
6) From what I have read, the American Medical Association artificially limits the supply of doctors into the medical profession, which drives up the cost (some say the AMA is a cartel, not sure though; I have read lawyers rant that they wished the law profession did this, so that lawyers could make more $$$).
And where did you read this? There is no artificial limit. There are real limits to how many can enter the profession every year. Those stem from available seats in medical schools (trust me, our med school would LOVE to double the class size and tuition dollars, but who would teach those courses, and where would they put all the students when we are maxed out on classroom and lab space already?) And, because these people have other people's lives in their hands, literally, we tend to think it's a good idea that there be added post-graduate training (residencies) and comprehensive exams (board exams) before we hand them a license to practice. This is no different than most other professions where you need to work in the profession for several years under some form of supervision before you can take and pass a test that allows you to practice independently and sign off on official stuff (i.e., FE vs PE exams for engineers). The law profession is a bit odd, because you only need to pass the bar exam, which can be taken right away, and with zero days of actual work experience, you can hang up a shingle and go into private practice unsupervised. That's usually what lawyers complain about in terms of it lowering the quality of those practicing and giving the whole profession a bad rap.
7) Pharmaceuticals - the pharmaceuticals industry I believe is dominated by very large, very powerful Big Pharma companies because the industry is incredibly regulated, so there is a lack of competition. I'm not saying to unregulate them, but the lack of competition has to drive up prescription drug costs as well. for example, it can take up to 10 to 15 years just for a new drug to go through FDA testing.
More competition won't speed up the approval process. It takes that long because that's how long it takes to do adequate trials to ensure the drugs you are getting are safe and effective before they get distributed to the general public. More competition is more likely to drive up costs rather than drive them down, because now you'll have even more companies scrambling to produce drugs for a limited set of conditions, and if they happen to get beaten out by a matter of months by a competitor, they've just lost 15 to 20 years of investment into product development, so will have to make up the difference on their other products.
8) Medicare and Medicaid don't pay hospitals or doctors enough money always, so they have to make up for the lost $$$ by raising prices in the private sector.
That's true, though people who do not have any health insurance at all cost hospitals and doctors more than those whose insurance only pays a little.
I think a major problem, though, with pretty much every debate and discussion I've heard on health care or health insurance is that the two concepts are conflated together rather than being recognized as two distinctly different issues. And, that's mostly because that's what health insurers have been selling for some time now...expensive, all-inclusive packages that go beyond the intent of "insurance." Of course it's going to cost more for a routine check-up if you have to pay through a middle man who takes a cut for their own profit rather than paying directly to the provider. It really does not matter if that middle man is a private insurance company or the government, other than the government might take slightly less of a cut since they aren't trying to make a profit, just trying to pay the staff who process the paperwork and maintain all the office space and equipment and storage etc. for that to happen.
For the vast majority of the population, this is unnecessary. There is no reason that most people could not pay for the routine check-up and the occasional office visit for minor illnesses out-of-pocket. These are all predictable expenses that you can budget for, the same way that anyone who buys a car knows they are going to have to pay annual registration fees, get the oil changed every few months, sometimes have some minor service done like replacing brake pads or tail lights, etc. Or, when you buy a house, you expect that you're going to have to do things like replace shingles, repair leaky faucets every so often, replace a hot water heater or major appliance every 10 or 20 years, etc. You can save for those things, and they aren't covered by insurance. But, you can't anticipate when you'll be hit by a tornado that demolishes the entire house, or takes off all the siding in a storm, or when a tree is going to fall on the garage, etc. That's what you buy insurance for, things that are major expenses that don't really happen to everyone, or only rarely, and you can't predict WHEN they'll happen to save appropriately and consider it as part of your budget when buying the house.
Then, there are the things that are the reason people really do need insurance. The serious injury from a fall, or a major illness or disease that requires hospitalization or surgical intervention. These are things that don't happen often in one's life, and you kind of hope don't happen at all, or wait until you've reached an old age where you could have saved up a nest egg to cover such expenses. But, these are things you can't be sure won't hit when you're only 19 or 20 years old, just starting out on your own, not much money saved yet, and something that would cost a lot of money long before you could save up to pay out of pocket. If that is the ONLY type of thing insurance covered, it would likely be considerably cheaper than when it's paying for every routine office visit and minor treatment.
Now, there are two groups of people who need help with health CARE coverage. First are those who are too poor to even afford routine office visits, such as the chronically unemployed or underemployed. We have clinics in our state that serve those populations, and are funded by the state. They don't automatically get free healthcare, though. They get cost-reduced healthcare. They are charged on a sliding scale based on their income. So, they are still responsible for some of the costs of their care, even if they are only charged $10 for an office visit (that's the minimum). I think this is a good model. It works well, it minimizes the burden to the taxpayer by basically expecting the patients to pay what they can, and it has less of a stigma for the patient that they feel they are taking hand-outs, so they are more likely to see a doctor (we have a population that is very resistant to the idea of taking a free government handout...they prefer to feel independent).
Then, there is another group of people who can afford their routine office visits, but doesn't get that healthcare because there aren't any providers locally. Again, some of this is addressed by the state-funded clinics that are trying to get physicians into these more rural areas. Our university also addresses this problem through outreach programs that basically equip a mobile clinic in an RV that goes out to the patients. There are still problems with this arrangement. There is a lack of continuity of care (whichever provider is on the bus is the one they get, not the same doc all the time who knows them well), and since they rely on when the mobile clinics come around, these patients may let minor problems go unchecked for a longer time until they become more major problems since it's a big hassle to drive an hour to a clinic over what they think is probably just something minor that can wait.
This latter group of people are not at all helped by any form of insurance or coverage of health costs, because the costs aren't the problem, physical access is.
And, there are of course overlaps in these populations too. We have a lot of areas of poverty where one might ask why these people don't sign up for medicare or medicaid when they are eligible for it. And, that's for one of two reasons, usually. Either they are too proud to accept the assistance, or it doesn't matter if they have it or not, because they couldn't get to a clinic to use it anyway.
