News The US has the best health care in the world?

[wildman]

I finally found a answer on who pays for those emergency room calls by people without insurance. What apparently happens is that the hospital raises its rates on everyone. In other words it is a business cost which is expensed over its insured customers. The charity that Evo was talking about is all of us.

In other words, we already have a form of socialized medicine in the US whether we like it or not. The people with insurance and the government are paying for the poor and the uninsured. It is however a very strange and completely out of control form of socialized medicine and also VERY expensive.

In view of this, the debate about socialized medicine people are having in the US takes on a Twilight Zone kind of air. It is almost like people were debating whether automobiles should be allowed in American cities and almost half the people thought that there were no automobiles in our cities at the present time...

 

[Al68]

I finally found a answer on who pays for those emergency room calls by people without insurance. What apparently happens is that the hospital raises its rates on everyone. In other words it is a business cost which is expensed over its insured customers. The charity that Evo was talking about is all of us.

In other words, we already have a form of socialized medicine in the US whether we like it or not. The people with insurance and the government are paying for the poor and the uninsured. It is however a very strange and completely out of control form of socialized medicine and also VERY expensive.

In view of this, the debate about socialized medicine people are having in the US takes on a Twilight Zone kind of air. It is almost like people were debating whether automobiles should be allowed in American cities and almost half the people thought that there were no automobiles in our cities at the present time...

Good point, kind of. But the issue is whether to greatly expand socialist policy, not whether socialist policy currently exists at all.

More like debating about whether or not to drastically increase the number of cars in our cities, to use your analogy.

 

[Al68]

There are certain things that should not have been or be privatised or for profit.
Health, Water, Power (to the home) all are necessities and should be available to all at a cost which covers running costs and a percentage for future required investments, not excess amounts to pay shareholders.

The fact that these are necessities is more reason, not less, that there should be competition from multiple providers, instead of provided by government.

When private companies compete for consumers, the total price, including profits to shareholders, is much less than the total price if controlled by government, or any monopoly, even with zero profit. This is just basic economics, which some politicians count on people not understanding.

Treating private profit as if the same service would be cheaper without it is just faulty. The opposite is true. This is why the same politicians who want to take control of a private industry have no interest in competing with it instead.

 

[WhoWee]

That is more or less my understanding of his statement as well as my perspective. For example, there is no doubt that advanced FMRI, Spiral CT, PET, and diagnostic imaging technologies generally are second to none. Heck, it is impossible to even keep up at times. But the problem that I saw personally with these technolgies was the cost. Back in the bad old days of CT, I can remember circuit boards covered with perhaps 20 or 30 chips - all TTL and early CMOS - costing $100,000 each. Then, the additional cost of the support contracts was absurd. Like so much of technology, the development costs, and more importantly I think, the cost of continued advances is put on the user [patient].

While a non-invasive scan beats exploratory surgery every time, the continual cost burden of purchasing and maintaining state-of-the-art technologies plays a large role in driving the cost of health care. In the meantime, the essentials of medicine take a back seat and it becomes a money game. That is why in part we see things as ridiculous as a pianist playing a grand piano in the lobby of a major hospital; or a woman vomiting blood until she dies in the ER waiting room, unassisted.

Another minor absurdity that comes to mind is the tendency for hospitals to remodel and install carpeting in areas where hospital workers have to push gurneys. Not only does this present problems when body fluids hit the floor, but it also puts a burden on the workers who have to push the gurney. The reason for the carpeting is that it looks nice for investors, as does a fine grand piano. But perhaps my favorite example was the ER entry [internal access] that was too narrow for a gurney! Talk about missing the mark!

Some hospitals now require medical workers to wear nice clothes instead of scrubs. Why? Is it better or more practical? Heck no, but it looks nice.

The point: Decisions driving the industry are improperly motivated.

Ivan has hit upon something important. Hospitals compete for business - and capital, and talent. The beautiful new buildings and hi-def TV's and open balcony dining areas are all part of the marketing. However, the cost of amenities compared to the cost of the latest hi-tech machine is insignificant.

This is where one of my previous posts was headed. The Government has the wherewithal to fund capital equipment and real estate on a grand scale. The hospital networks can operate the facilities and equipment, and the insurance companies are well equipped to do their part. Government involvement doesn't have to be an expense to taxpayers. Healthcare is a profitable business model.

First, if Government were to make an investment in the buildings and equipment necessary to provide adequate care to everyone in the country, the health care system could lease the packages at a significant ROI to taxpayers. Each new hospital facility could include a preventative care/wellness clinic. By reducing the need to obtain capital, the health care networks would be more competitive - that is smaller players would have an equal opportunity to compete.

Second, if doctors were provided tax credits in exchange for services rendered in the new preventative care/wellness clinics the doors would open for everyone with minor health care issues - and remove the cost and burden from the emergency rooms.

Last, if the Government would guarantee high risk insurance pools, the doors would swing open and include everyone with pre-existing conditions. Managed properly, and with shared costs, this could reduce long term costs currently absorbed by Government plans.

This is of course over-simplified, but would address specific problems. In areas with well developed hospital networks, perhaps the Government could engage in sale/leaseback transactions to free capital for re-investment into research and add stand-alone preventative care/wellness clinics - even incorporate them into new school properties?

If everyone has the same building and equipment package, the networks will need to compete on the basis of quality and service - then we win as both consumers and investors.

 

[Al68]

Last, if the Government would guarantee high risk insurance pools, the doors would swing open and include everyone with pre-existing conditions.

Assuming you mean that government would cover the cost of the pre-existing conditions, why would anyone ever buy medical insurance until after they're sick or injured? Then they can buy "insurance" at the discounted (subsidized) rate after they're sick/injured.

Of course, using the term "insurance" to refer to something that covers something pre-existing is a logical contradiction, so it might be more accurate to use the phrase "health care plan".

Obviously the cost of "insurance" for someone that's not already sick/injured is a fraction of the cost of a "health care plan" for someone already sick/injured. Are you suggesting that government cover the difference? If so, health "insurance" would no longer exist, because nobody would buy it.

If government covered the cost of car "insurance" paying for "pre-existing" damage, there would be no reason to buy car insurance until after the damage. (Actually this is exactly what some people have done, anyway).

 

[Count Iblis]

...why would anyone ever buy medical insurance until after they're sick or injured? Then they can buy "insurance" at the discounted (subsidized) rate after they're sick/injured.

And that's why in most Western countries health insurance is compulsory. If foreign tourists from third world countries visit a Western Euopean country, they won't even be let in unless they have proof that they have adequate health insurance.

 

[WhoWee]

Assuming you mean that government would cover the cost of the pre-existing conditions, why would anyone ever buy medical insurance until after they're sick or injured? Then they can buy "insurance" at the discounted (subsidized) rate after they're sick/injured.

Of course, using the term "insurance" to refer to something that covers something pre-existing is a logical contradiction, so it might be more accurate to use the phrase "health care plan".

Obviously the cost of "insurance" for someone that's not already sick/injured is a fraction of the cost of a "health care plan" for someone already sick/injured. Are you suggesting that government cover the difference? If so, health "insurance" would no longer exist, because nobody would buy it.

If government covered the cost of car "insurance" paying for "pre-existing" damage, there would be no reason to buy car insurance until after the damage. (Actually this is exactly what some people have done, anyway).

I posted earlier in greater detail.

However, what I'm addressing is the need to create high risk insurance pools co-funded/guaranteed by the Government - similar in concept to what is done after an emergency is declared after a national disaster. Insurance companies pay their claims and the Government helps the under-insured and uninsured.

 

[Al68]

And that's why in most Western countries health insurance is compulsory.

Yeah, I know. And that's why the proposed bill in the U.S. makes it compulsory (or charges a stiff tax penalty). And it makes it compulsory to buy a (much more expensive) health care plan that covers all pre-existing conditions, even if they have none. And it forces people to buy insurance to cover the kinds of things a lot of people would never voluntarily buy insurance for. Most Americans don't realize what this bill contains, or its true purpose. Obviously, if the purpose were to just help poor people get insurance, they would just propose expanding Medicare.

And if the goal were just to make insurance cheaper, they would just propose establishing a public insurance company to compete with the private ones.

They aren't even considering those two options, yet they claim those are their purposes.

 

[Al68]

I posted earlier in greater detail.

However, what I'm addressing is the need to create high risk insurance pools co-funded/guaranteed by the Government - similar in concept to what is done after an emergency is declared after a national disaster. Insurance companies pay their claims and the Government helps the under-insured and uninsured.

Well, if all you meant was the equivalent of expanding Medicaid eligibility, it would have been simpler just to say so.

I must have misinterpreted your post, my bad.

 

[WhoWee]

Well, if all you meant was the equivalent of expanding Medicaid eligibility, it would have been simpler just to say so.

I must have misinterpreted your post, my bad.

That's not exactly what I'm saying. The Government doesn't have to carry the bulk of the burden.

 

[drankin]

I found this article today. According to Dr Ann Doig, "the incoming president of the Canadian Medical Association", the current system is "unsustainable".
http://www.foxnews.com/story/0,2933,539943,00.html"

Of course it's from fox news. So we can discount what the Dr says outright.

 

[WhoWee]

I watched a panel style discussion with Kent Conrad over the weekend.

I think he's going to be a key player in shaping the final healthcare legislation. Here's a link to his website.

http://conrad.senate.gov/issues/healthcare.cfm

 

[Count Iblis]

I found this article today. According to Dr Ann Doig, "the incoming president of the Canadian Medical Association", the current system is "unsustainable".
http://www.foxnews.com/story/0,2933,539943,00.html"

Of course it's from fox news. So we can discount what the Dr says outright.

The question is if this is a systematic problem in all of the Government regulated health care systems that exist in the Western World.

 

[drankin]

The question is if this is a systematic problem in all of the Government regulated health care systems that exist in the Western World.

I agree. But, if Dr Ann Doig is correct, the current Canadian model will not work for us.

 

[BoomBoom]

I finally found a answer on who pays for those emergency room calls by people without insurance. What apparently happens is that the hospital raises its rates on everyone. In other words it is a business cost which is expensed over its insured customers. The charity that Evo was talking about is all of us.

Correct, in addition, I believe we all are also paying for everyone's insurance that is provided by employers to employees in just about every product you buy and the (reduced) wages you earn. If anyone thinks these high healthcare costs aren't already passed on to all of us, then I suggest they are naive.

 

[turbo]

Correct, in addition, I believe we all are also paying for everyone's insurance that is provided by employers to employees in just about every product you buy and the (reduced) wages you earn. If anyone thinks these high healthcare costs aren't already passed on to all of us, then I suggest they are naive.

Ding! Ding! Ding! Where do I sent the Cuban Cigar?Health insurance is not a zero-sum game. It is a system through which many US citizens are denied health care, yet are forced to pay for other peoples' coverage. Probably the worst offenses are against people who have to buy private coverage, and whose hospital bills and charges for doctor's visits are jacked up by the business-model that pushes the costs of the uninsured onto the insured.

 

[wildman]

Good point, kind of. But the issue is whether to greatly expand socialist policy, not whether socialist policy currently exists at all.

More like debating about whether or not to drastically increase the number of cars in our cities, to use your analogy.

I don't see any expansion of socialist medicine? Could you explain? Under the proposed plan, the people who have private insurance will keep it so no expansion there (or am I mistaken?) and the other people are simply moved from a very expensive model (emergency room visits) to a (hopefully) less expensive model (early visits to the doctor's office) of socialized medicine. So socialism would not increase at all. Or am I missing something?

 

[Al68]

I don't see any expansion of socialist medicine? Could you explain? Under the proposed plan, the people who have private insurance will keep it so no expansion there (or am I mistaken?) and the other people are simply moved from a very expensive model (emergency room visits) to a (hopefully) less expensive model (early visits to the doctor's office) of socialized medicine. So socialism would not increase at all. Or am I missing something?

Yes, you're missing a lot. The current proposal outlaws private insurance that is not part of the new "system" and meets its requirements (most normal private insurance. There is a grandfather clause, and employer based plans are legal for 5 years, but that's just relevant in the short term. The claim that an individual can just keep what he has is misleading, to say the least.

And anyone who doesn't buy the "new and improved" type of overly comprehensive health coverage will be charged a stiff income tax penalty.

The advocates have talked a lot about the goals of the proposal, but very little about the substance of it.

 

[mheslep]

I don't see any expansion of socialist medicine? Could you explain? Under the proposed plan, the people who have private insurance will keep it so no expansion there (or am I mistaken?) and the other people are simply moved from a very expensive model (emergency room visits) to a (hopefully) less expensive model (early visits to the doctor's office) of socialized medicine. So socialism would not increase at all. Or am I missing something?

Under the draft House plan there will certainly be several million people leaving private insurance and joining the government public option. There is, however, substantial wonkish disagreement about how many millions. On the low side, the CBO [1] says some 6 million people would leave private, with 12 million total on the public option. On the high side the Lewin group [2] says 88 million will leave private, with ~100 million in total on the public option. The CBO report actually addresses the Lewin report. The President is technically right when he says the current proposal doesn't legally force people off private, but it appears it will set up a situation where its unaffordable for many of them or their employer to maintain private coverage.

If we assumed that workers at larger firms would be allowed to purchase coverage
through the exchanges, our estimate of the number of enrollees involved would
undoubtedly be greater than 6 million, but we have not estimated the magnitude. Analysts
at the Lewin Group recently estimated that if all employers were given access to the
insurance exchanges, more than 100 million people would end up enrolling in the public
plan.4 For several reasons, we anticipate that our estimate of the number of enrollees in
the public plan would be substantially smaller than the Lewin Group’s, even if we
assumed that all employers would have that option.

[1] http://www.cbo.gov/ftpdocs/104xx/doc10400/07-26-InfoOnTriCommProposal.pdf
[2] http://www.heritage.org/Research/HealthCare/upload/HouseBillHeritageRevised.pdf

 

[Al68]

The President is technically right when he says the current proposal doesn't legally force people off private, but it appears it will set up a situation where its unaffordable for many of them or their employer to maintain private coverage.

Except for some grandfathered private policies, which will only stay grandfathered under certain conditions, and a 5 year grace period on employer based policies, which are both irrelevant in the long term, the proposal will outlaw all private policies that aren't in the "system", meeting the comprehensive requirements.

Sure he's telling the truth (barely and misleadingly) that a lot of people can keep their current policies temporarily, but long term, the only way they can keep them is if they are changed to meet the requirements for the new "system", which effectively means it's a different policy.

Whether we use the words "government takeover" or not is a matter of semantics, but despite claims to the contrary, the people that Democrats claim are being "mislead" into thinking it's a takeover still grossly underestimate the increase in government power over health insurance that is actually in the bill.

What would Dems do if everyone read the bill? Never mind, they know that won't happen.

 

[WheelsRCool]

I agree that the current health system definitely needs reform, but I think the Obama administration is going about completely wrong, for reasons stated in previous posts.

 

[WhoWee]

Except for some grandfathered private policies, which will only stay grandfathered under certain conditions, and a 5 year grace period on employer based policies, which are both irrelevant in the long term, the proposal will outlaw all private policies that aren't in the "system", meeting the comprehensive requirements.

Sure he's telling the truth (barely and misleadingly) that a lot of people can keep their current policies temporarily, but long term, the only way they can keep them is if they are changed to meet the requirements for the new "system", which effectively means it's a different policy.

Whether we use the words "government takeover" or not is a matter of semantics, but despite claims to the contrary, the people that Democrats claim are being "mislead" into thinking it's a takeover still grossly underestimate the increase in government power over health insurance that is actually in the bill.

What would Dems do if everyone read the bill? Never mind, they know that won't happen.

Don't act surprised, every time we elect a lawyer - we get lawyer-speak.

Step back and look at the process and it will begin to make sense.

Think of the election campaign (say anything to get elected - like no more lobbists, save or creat x jobs, and televised healthcare discussions), the run up to the stimulus (no time to read it - shovel ready projects), now healthcare (keep your insurance/doctor) as the "opening statements" - a rosey (one-sided) picture is painted and a general strategy is outlined - the lawyer preps his audience but doesn't present any evidence.

Once the trial begins or the legislation is passed (in this discussion) the lawyer works through the details and counter-arguments. In a courtroom, this is where the lawyer (or his team - Pelosi, Frank, Reid and assoc.) begins to face opposition - after he's had an opportunity to present his case. Ultimately, the lawyer makes a deal - a plea bargain.

Obama is trained to think like a lawyer. He selects his words carefully, keeps his eye on the prize, and looks for possible areas of compromise to make a deal.

There is no reason for him to become mired in the details of healthcare. His associates in the House and Senate are presenting arguments and at the close of the "trial", he'll step in and make a deal.

 

[Count Iblis]

I agree that the current health system definitely needs reform, but I think the Obama administration is going about completely wrong, for reasons stated in previous posts.

Hmmmm, any reform will have to include the government stepping in in one way or another. The problem is that some people a priori assume that any government intervention is a pretext to implement "bad socialist policies". So, these people can always raise the same type of objections against any proposed health care system that would work.

 

[WhoWee]

Hmmmm, any reform will have to include the government stepping in in one way or another. The problem is that some people a priori assume that any government intervention is a pretext to implement "bad socialist policies". So, these people can always raise the same type of objections against any proposed health care system that would work.

You can't even call this a debate until someone presents a list of specific problems, objectives, and solutions.

Starting with 1,000 pages of legislation that nobody understands tells me the "reform" is not real.

 

[Astronuc]

The Truth About Record-Setting U.S. Life Expectancy
http://news.yahoo.com/s/livescience/20090819/sc_livescience/thetruthaboutrecordsettinguslifeexpectancy

Life expectancy in the United States rose to an all-time high, the U.S. Centers for Disease Control and Prevention said today. But that's only half the story.

The country is behind about 30 others on this measure.

Though the United States has by far the highest level of health care spending per capita in the world, we have one of the lowest life expectancies among developed nations - lower than Italy, Spain and Cuba and just a smidgeon ahead of Chile, Costa Rica and Slovenia, according to the United Nations. China does almost as well as we do. Japan tops the list at 83 years.

Interesting.

 

[BoomBoom]

You can't even call this a debate until someone presents a list of specific problems, objectives, and solutions.

Starting with 1,000 pages of legislation that nobody understands tells me the "reform" is not real.

Maybe they should put it in the form of a pop-up book?

 

[Ivan Seeking]

You can't even call this a debate until someone presents a list of specific problems, objectives, and solutions.

Starting with 1,000 pages of legislation that nobody understands tells me the "reform" is not real.

The sausage making has been going on in Congress for many weeks, but unless you happen to make a living debating and negotiating in congressional committees, you would really have no way to know what is being argued. As of right now there is no single plan. There are about five plans. Apparently you haven't been paying attention.

Specific problems:

1). Lifetime limits on coverage that are exhausted in the event of a serious illness
2). Dropped coverage when illness strikes
3). Denial of coverage due to preexisting conditions
4). 50 million people who can't afford health insurance
5). Increasing costs that will certainly overwhelm the country as the baby boomers retire and the cost of medicine skyrockets
6). We pay far more per capita for medical care than do than other nations, for less in terms of results.

 

[turbo]

Ivan's #1 is a nasty one. The rates that hospitals and large practices keep rising - when is the last time your insurance company informed you that they had raised your life-time cap to keep current with these increased costs? Get out your policy and find the lifetime cap (it's buried in there somewhere) and then consider how soon you might hit it if a serious infection caused your kidneys to fail. How many years would the insurance company pay for dialysis to keep you alive while you wait for a donor? Would they pay the screenings or for the surgeries for you and the donor if you were already near your cap? There are the REAL "death panels".

 

[mheslep]

The Truth About Record-Setting U.S. Life Expectancy
http://news.yahoo.com/s/livescience/20090819/sc_livescience/thetruthaboutrecordsettinguslifeexpectancy Interesting.

Many of those life expectancy factors have little to do with medical practice or insurance.
http://repository.upenn.edu/cgi/viewcontent.cgi?article=1012&context=psc_working_papers

...a country could still have poor measured health if personal health care practices were unusually deleterious. This is not a remote possibility in the United States, which had the highest level of cigarette consumption per capita in the developed world over a 50-year period ending in the mid-80’s (Forey et al. 2002). Smoking in early life has left an imprint on mortality patterns that remains visible as cohorts age (Preston and Wang 2006; Haldorsen and Grimsrud 1999). One recent study estimated that, if deaths attributable to smoking were eliminated, the ranking of US men in life expectancy at age 50 among 20 OECD countries would improve from 14th to 9th, while US women would move from 18th to 7th (Preston, Glei, and Wilmoth 2009). Recent trends in obesity are also more adverse in the United States than in other developed countries (OECD 2008; Cutler, Glaeser, and Shapiro 2003).

If the deaths from homicides and accidents and the like are also corrected for the US moves to or near the highest in life expectancy.

 

[WhoWee]

Maybe they should put it in the form of a pop-up book?

Are you suggesting they have approached the problem in a methodical way? Or perhaps you mean Barney and co will have an easier time with a pop-up illustration?