I've been trying to write up a post to Kainen to try and convince him that it may be desirable for the market to play a larger role in allocating health care resources. But it's hard to make that argument unless you know what the audience already thinks is wrong with health care. So rather than bury the discussion in an unrelated thread, and wanting to get a wide range of opinions, I thought I would create a new one.

What is wrong with Health Care in America, Today?

I think a lot of people would say that the biggest problem is that a lot of people don't have medical insurance. But that only pushes the question back a step. Why don't they have insurance? Is that a bad thing? If so, is it something the government should force people to purchase (not everyone has Life Insurance, either)?

8/27/2008 9:42:44 AM

Hillary talks like she knows.

8/27/2008 9:44:52 AM

medicare and medicaid account for ~ 55% of all healthcare (edit based on link below)

when they are only paying pennies on the dollar, the money has to come from somewhere to make up the difference

malpractice insurance rapes doctors but how can you quantify pain?

if we would start treating health insurance like car insurance and removed government involvement, prices would fall drastically

basically, under my plan, you would pay for your own upkeep, just like you do with your car

you have insurance when you have an oh shit moment, analogous to an auto collision

[Edited on August 27, 2008 at 9:58 AM. Reason : 

8/27/2008 9:46:16 AM

^ I never heard that stat before, that medicare/medicaid account for 75% of health care expenditures. Can you point me toward the source?

8/27/2008 9:47:56 AM

i caught "The People's Pharmacy" last week on NPR (i usually hate that show - i want to kick Joe and Terry Graedon in the teeth - but this one was pretty good) talking about over-treatment and medication. About how, somewhat ironically, people now are being over-treated and medicated, most often when they go to the hospital. Often, many tests and treatments don't do anything (apparently CT scans, for example, are used way too much, often when there is no actual benefit from this). But doctors and hospitals do this because they are paid by the insurance company on a per-treatment basis, not a per-time or effectiveness basis. Hospitals don't care how many tests they throw at a patient because they will just get paid more for each test, and patients don't care because insurance pays for it, and they really don't know any better anyway (i.e. how often does a patient really know what tests/treatments he needs?).
http://www.peoplespharmacy.com/archives/radio_shows/655_overtreated_archive.php
http://www.peoplespharmacy.com/archives/editorial/are_we_overtreated_and_underinformed.php

that's just one example

8/27/2008 9:49:28 AM

^^ I was about to ask the same thing

8/27/2008 9:49:53 AM

the 75% number is an anecdotal from the hospital where my mom works...i hear a lot of bitching

there are still underpayments

http://www.aha.org/aha/content/2007/pdf/07-medicare-shortfall.pdf

american hospital association

Quote :

"Also, Medicare and Medicaid account for 55 percent of all care provided by hospitals"

so more than half

[Edited on August 27, 2008 at 9:53 AM. Reason : 

8/27/2008 9:52:13 AM

Here is a great article I suggest everyone read

http://www.dcexaminer.com/opinion/columns/guestcolumnists/Is_the_grass_greener_with_socialized_medicine.html


In my opinion, the problem isnt people not having insurance, or insurance not being affordable. Its responsiblity and govt intervention. Some of the most wreckless people I see with thier healthcare get everything handed to them. they have to pay nothing for their care or medicine, yet no show for appointments, post ops, and may or may not take thier medicine. Its proof, in my mind, that NOTHING shoudl be free. Once soemthing is given for free, it usually gets abused and taken for granted.

Our govt has taken the market out of healthcare. We need more free market and competition and less third party ins./govt regulations. Allow HSA and catastrophic insurance plans to become the norm. People will have the coverage for the big stuff, yet pay for thier routine care. This will encourage docs to charge less as people now will be cost aware of their healthcare and have choices.

I agree mostly with Aficionado.

8/27/2008 10:05:05 AM

Quote :

"Its proof, in my mind, that NOTHING shoudl be free."

I agree.

This idea that health-care is a right is ridiculous. A true "right" doesn't require that someone else has to give up their labor or property in order for you to exercise it.

You have the right of free speech, but that doesn't mean the N&O has to give you free space in their paper.

It was never intended that the gov't be responsible for keeping you alive.

Politicians need to stop using "health-care is a right" as a tool to increase their power over us.

8/27/2008 10:24:28 AM

ok, so with underpayments, the government basically pays on average 90% of the costs of all the visits on Medicare and Medicaid.

And these costs make up 55% of all medical spending. Of which .55*.9 = 49.5% is actually funded. Which means that 5.5% of all medical costs in the country are for government programs just covered by other patients.

So, for those 45% of people, 5.5/(5.5+45) = 10.8% of your hospital bill is paying for all the people to get treated who you already paid for.

How was this supposed to be fair?

8/27/2008 10:27:21 AM

Quote :

"ok, so with underpayments, the government basically pays on average 90% of the costs of all the visits on Medicare and Medicaid."

Is this any different from the way insurance companies negotiate down the cost of medical care? (ie: the little statement you get at the end of the month showing three categories: your copay, amount paid by (insert health insurance conglomerate here), amount not paid by you)

The "amount not paid by you" being the portion of the fee that the insurance company negotiates down the cost of the procedure.

8/27/2008 10:35:02 AM

pretty much all of health care is paid for by a combination of insurance+copay or by the government.
People don't often go to the hospital and pay for the entire visit out of pocket.

The amount spent on all visits can not mathematically exceed the amount being paid.

8/27/2008 10:38:48 AM

What's wrong with health care is that people are under the impression that they are entitled to it.

8/27/2008 11:09:41 AM

Quote :

"What's wrong with health care America is that people are under the impression that they are entitled to it everything."

8/27/2008 11:16:09 AM

No, what's wrong with healthcare in America is that our system run by greedy, selfish fools and programmed thinkers who buy the lie that one's level of health should be commensurate with one's ability to pay. That's a philosophical difference between I and many posts already in this thread. The healthcare "system" we have in the US functions like exactly what it is: a corporation that puts the goal of making the highest possible profits above the quality of care--it happens at the doctor's office, at the pharmacy, and especially with the medical insurance providers.

Despite the growing pains, I agree 110% with Single Protective Pool (single payer). Hell, I think it's very apparent that our country would save loads of money and years of hassle if we just went to single-payer even just on drugs alone. Although I will admit Obama or Hillary argue for mandates and more convoluted BS...at least they get this issue on the radar, However, they're a HELL of a lot more correct than what John McCain proposes.

Last year California nearly passed single player as it got through the houses only to see it vetoed by Ahnold. That's too bad, they would have been a great model of the system.

8/27/2008 11:51:38 AM

EMTALA, JCAHO, Press-Gainey scores, Medicare, and Medicaid.

Quote :

"The real power in medicine today and the ability to effect meaningful change is not vested in practicing physicians. It is vested in the clipboard carriers... the makers and enforcers of policy and procedure, and the 'owners' of the 'business'."

Give doctors back SOME power and quit making them your whipping boy.

I read blogs written by real physicians a lot, they have some interesting ideas about how to fix our medical system.

http://www.docsontheweb.blogspot.com/

8/27/2008 12:17:06 PM

Quote :

"No, what's wrong with healthcare in America is that our system run by greedy, selfish fools and programmed thinkers who buy the lie that one's level of health should be commensurate with one's ability to pay."

Why shouldn't it be? Just out of curiosity. What right does any person have to the services of another except what they agree to exchange for those services?

8/27/2008 12:19:40 PM

Quote :

"EMTALA has killed the best medical system in the world, and why? Because some douchebag legislators thought that it would buy them votes (and they were right). I also know how to fix our mess, but, since I major in plain-talk, I will never be elected nor will anyone who says this and here it is."

This.

8/27/2008 12:21:16 PM

Quote :

"Why shouldn't it be? Just out of curiosity. What right does any person have to the services of another except what they agree to exchange for those services?"

Because I don't think health care is a material item or service, and I don't believe we should put our head in the sand. The whole damn world understands that you cannot go buy a TV or car without the finances to afford them. Health care is totally different though - namely, most people DON'T WANT to receive it, but they are ill and need to receive it. Second, we are not some 3rd world soceity that should be allowing our poor to just rot and die. Would you like to see uninsured people left on the side of the road after a car accident to die? Any 911 call has to be responded to regardless of insurance, and anyone who presents to an ER has to receive care regardless of insurance.

With that....we have already decided the question of whether health care is a right or not being that the fundamental quality that any of these benefits bestowed are the benefited more or less 'rights' of living in an established society - and we can move on to the question of whether we deliver the care that right entails adequately.

8/27/2008 12:33:21 PM

Quote :

"Despite the growing pains, I agree 110% with Single Protective Pool (single payer). Hell, I think it's very apparent that our country would save loads of money and years of hassle if we just went to single-payer even just on drugs alone. Although I will admit Obama or Hillary argue for mandates and more convoluted BS...at least they get this issue on the radar, However, they're a HELL of a lot more correct than what John McCain proposes."

Please explain how a single payer plan would save loads of money.

8/27/2008 12:39:40 PM

Quote :

"and anyone who presents to an ER has to receive care regardless of insurance. "

Not if Vix has her way.

^ Obama's plan isn't single-payer is it?

[Edited on August 27, 2008 at 12:41 PM. Reason : ]

8/27/2008 12:40:30 PM

Quote :

"What right does any person have to the services of another except what they agree to exchange for those services? "

YES YES YES. Took the words out of my mouth. Health Care is a SERVICE provided by doctors. How the hell can you believe in forcing someone to provide their service to whoever the government says.

8/27/2008 12:42:36 PM

Kainen

Quote :

"No, what's wrong with healthcare in America is that our system run by greedy, selfish fools and programmed thinkers who buy the lie that one's level of health should be commensurate with one's ability to pay. That's a philosophical difference between I and many posts already in this thread. The healthcare "system" we have in the US functions like exactly what it is: a corporation that puts the goal of making the highest possible profits above the quality of care--it happens at the doctor's office, at the pharmacy, and especially with the medical insurance providers. "

But why do you believe that the profit motive is the problem? And why would a concern for profits lead to lower quality?

Let's use another example--Food. It's even more important than modern medical services. No one can live without food! Yet, the production of food is left largely to the free market. Farmers and food processors are just as concerned with their bottom line as any greedy business man you can name, yet the quality of our food products is very high by most any standard (by which I mean they are very safe and tasty, if you think people prefer too many calories in their foods, that's a different discussion).

Now certainly you can argue that the FDA helps keep an eye out for potentially dangerous products and the like. But we are far far far from the levels of government involvement we have in our current health care system.

So what gives? Why are greedy farmers and food processors so good at getting people of all income levels what they want, but greedy doctors are so bad at it?

[Edited on August 27, 2008 at 12:48 PM. Reason : ``]

8/27/2008 12:45:31 PM

Quote :

"^ Obama's plan isn't single-payer is it?"

No, but it's got elements of a single-payer plan in what it calls the "national plan", a government-based pool of insured designed to give an option to those not insured by their employers.

8/27/2008 12:46:38 PM

Well both free market and single payer have it's pros and cons, I just think the pros of the single payer far outweigh the cons.

The free market plans create a market for the providers, sure. A market that can be traded upon for services and will regulate prices that conform to the other forces in the economy in theory. The problem though, is that the current free market solution is that the insurance industry is horribly inefficient because it is for profit and thus only makes money by denying care to customers. You can't get around that.

However, in the single payer plans, you do away with the thousands of insurance companies, their 30% administrative costs, and the profit motivation for paying for care. You turn it into a highly efficient administration of the funds that does not take a profit and has very low administration costs. Furthermore, I think any national single-payer plan should offer a variety of plan choices with varying premium rates as is now done in the private sector.

8/27/2008 12:49:14 PM

Quote :

"yet the quality of our diets is very high by most any standard. "

http://www.nih.gov/news/pr/mar2005/nia-16.htm
"Obesity Threatens to Cut U.S. Life Expectancy, New Analysis Suggests"

8/27/2008 12:49:30 PM

moron

Quote :

"(by which I mean they are very safe and tasty, if you think people prefer too many calories in their foods, that's a different discussion)."

Food producers give people what they want as well as the relevant nutritional information. If people didn't want to be fat, they wouldn't be.

8/27/2008 12:51:06 PM

^ That's simply not true, but I just don't have the time right now to explain it to you.

8/27/2008 12:52:30 PM

Quote :

"But doctors and hospitals do this because they are paid by the insurance company on a per-treatment basis"

Also out of fear of malpractice suit from what I understand. Even if there is a 99% chance the tests run will turn up inconclusive, the potential liability of that 1%, combined with the fact that the opportunity cost is negligible (in the short term) to your patient and yourself leads to this situation.

Quote :

"A true "right" doesn't require that someone else has to give up their labor or property in order for you to exercise it."

well put. But I also see what Kainen is saying. Collectively good health benefits more than just those provided with health care.

On the other hand, from a purely utilitarian standpoint (one which I'm not particularly endorsing, but should be considered), we're building a system that encourages free riders and will essentially keep alive people who should . . . in a cold calculating world . . . simply be cut out of the gene pool. It is something of a puzzle if you think about it. From an individual standpoint, free riders are a negative, but free health care can be viewed as a near term positive. From a societal standpoint, a healthy population benefits us all, but also provides for the continued existence of people who exert a negative net loss on society.


Good thread.

8/27/2008 12:53:42 PM

Quote :

"From a societal standpoint, a healthy population benefits us all, but also provides for the continued existence of people who exert a negative net loss on society. "

Most of these people are old.

it could also give poor people a psychological safety net so that they are more ambitious in their endeavors.

The safety net from rich parents often help rich kids do more ambitious things, there's no reason a similar mechanism wouldn't work for poor people.

8/27/2008 12:56:53 PM

Quote :

"The free market plans create a market for the providers, sure. A market that can be traded upon for services and will regulate prices that conform to the other forces in the economy in theory. The problem though, is that the current free market solution is that the insurance industry is horribly inefficient because it is for profit and thus only makes money by denying care to customers. You can't get around that. "

The flaw in this argument is that we don't have a free-market system. There are so many regulations, barriers to entry in the insurance market and restrictions in switching care that, combined with our government covering 50% of health care costs already, there is no way to see our hodge-podge system as free market. If consumers are informed, there are multiple competing companies in a market, and they have the option of switching providers, companies that make their money based on denying coverage would quickly get a bad name and go out of business.

Quote :

"However, in the single payer plans, you do away with the thousands of insurance companies, their 30% administrative costs, and the profit motivation for paying for care. You turn it into a highly efficient administration of the funds that does not take a profit and has very low administration costs. Furthermore, I think any national single-payer plan should offer a variety of plan choices with varying premium rates as is now done in the private sector. "

I see you are now consulting wikipedia and backing off your claim about prescription drug costs.

Tell me, have you ever seen a highly efficient government program that is responsible for allocating billions of dollars in government money to private practices and hospitals? It would be naive to blindly assume that administrative costs would go down substantially given the complexity of the tasks involved.

[Edited on August 27, 2008 at 1:09 PM. Reason : 2]

8/27/2008 1:01:59 PM

Well I was also referring to the chronically obese, those who chose to engage in habits which lead to an early death, etc. Not that you shouldn't have the freedom to smoke 20 packs a day, you should, but I don't want to pay for your mesothelomemphasimapanretesticular cancer that shows up when you're 28.


Playing devil's advocate, one with the market is that the market relies on transparency on the part of the supplier and perfect knowledge on the part of the consumer. For a number of reasons, neither of these is realistically possible in the health care industry. Neither are the barriers to entry particularly low, and the repercussions from poor decisions in health care providers sometimes cannot be easily rectified.

I'm not saying that government could do any better, but these are issues I'd be interested in hearing responses on.

8/27/2008 1:05:14 PM

The cost of health care would be greatly reduced if people would be responsible enough to take care of their health.

8/27/2008 1:06:15 PM

Quote :

"So what gives? Why are greedy farmers and food processors so good at getting people of all income levels what they want, but greedy doctors are so bad at it?"

Well jesus christ man, there's a difference between what it takes to buy a box of crackers vs. affording a trauma surgery despite both equating to the sustenance of a human life. I can't put them mentally on the same playing field socks.

8/27/2008 1:08:56 PM

Quote :

"the production of food is left largely to the free market."

not remotely. If you believe that the worldwide market for food is remotely free, you are not paying attention.

8/27/2008 1:13:06 PM

Quote :

"It would be naive to blindly assume that administrative costs would go down substantially given the complexity of the tasks involved."

You call that naive...but I flip the charge and call it a lack of courage that we don't strive for it.

Quote :

"“There’s little disagreement among economists today that a single-payer system would lead to lower administrative costs,” said Len Nichols, a health economist with the New America Foundation... But...he said that estimates varied widely over how big the savings could be.... ...One of the first major studies to quantify administrative costs in the United States was published in August 2003 in The New England Journal of Medicine... It concluded that such costs accounted for 31 percent of all health care expenditures in the United States. More recently, in 2005, a study by the Lewin Group, a health care consulting firm ... estimated that administrative costs consumed 20 percent of total health care expenditures nationwide. ..."

[Edited on August 27, 2008 at 1:18 PM. Reason : -]

8/27/2008 1:18:06 PM

^^ yep.
ever hear of a little thing called the Farm Bill?
only one aspect of a highly regulated and incentivized industry

[Edited on August 27, 2008 at 1:20 PM. Reason : .]

8/27/2008 1:19:58 PM

Quote :

"You call that naive...but I flip the charge and call it a lack of courage that we don't strive for it."

I also think it naive that we don't have the courage to jump off a building and see if we can't survive. Why let an overwhelming and largely universal trend get in the way of hope? I mean, not to be a jerk, but there are practically no efficient government run agencies.


On the other hand, I'd be interested to hear what people would think of something like the fed existing to run health care? Semi-autonomous but with government appointees? Again, playing devils advocate because I don't really have any good ideas of my own.

8/27/2008 1:23:49 PM

If you want govt involvement, mandate that people carry catastrophic ins. plans and make HSA tax deductible. Other than that, they should get out of all the rest.

Hospitals should be allowed to triage patients and turn them away if non life threatening.

Allow ins companies to compete over state lines and have tort reform.

People would be paying cash for thier routine care, yet be protected in the event of an accident.

The US system, even in its current state, is still one of the best in the world. I do feel we need to make some changes, but more govt sure as hell isnt the answer.

8/27/2008 1:25:57 PM

Quote :

"If you believe that the worldwide market for food is remotely free, you are not paying attention."

You're wrong about this one. Sure, there are a lot of agribusiness subsidies out there, but fundamentally the market for food is much more open than other markets. In the global food market, there is an extremely low barrier to entry, little regulation and a highly developed trade system in place. Contrast this with our health care system, where you've got high barriers to entry, over-regulation and restrictions on health-care across state lines, resulting in very few choices for consumers.

[Edited on August 27, 2008 at 1:28 PM. Reason : 2]

8/27/2008 1:26:47 PM

Quote :

"You're wrong about this one. Sure, there are a lot of agribusiness subsidies out there, but fundamentally the market for food is much more open than other markets. In the global food market, there is an extremely low barrier to entry, little regulation and a highly developed trade system in place. Contrast this with our health care system, where you've got high barriers to entry, over-regulation and restrictions on health-care across state lines, resulting in very few choices for consumers."

I strongly agree with this view. We'll put in subsidies and pay people for not planting fields (you could debate how necessary this is) but the very fact that you can buy coffee futures shows that there is some free market system out there, and that said market already adjusts to fix the fluctuations that we often say can't be fixed without government. The truth is, there's a huge and extremely well developed free market system for this (from small to global). And any one of y'all could start up your own local farm and sell your cabbage at a farmer's market.

I would still maintain that health care is different. Food doesn't need government. Neither does health care, but that misses the argument. We want standardized health care due to human arguments. On a societal level we tend to change the rules when something deals people's lives. Doctors already take the oath to treat anyone needing treatment - this institution has been around for a long time and you're not going to change it. So there's already something different in the system from a market.

But as much as we'd like to save little jimmy, the rules change again... when we run out of money completely



If we, as a society, can't pay for this then your humanitarian arguments are out the window. The money itself can save as many lives by being distributed somewhere else than being used on health care when it's comprising 20% of GDP.

But both sides of this are going to argue that cost to benefit will DRASTICALLY increase with their plans. If doctors can just be doctors they'll prescribe the most appropriate thing. If the market could just be a market, people will only pay for treatments that make sense.

Somehow we need both. We desperately need a (short term) monetary benefit for exercising every day over not doing so. And we also need to make hospitals, real hospitals, not private practices, accountable mostly to the patients and the doctors who know their shit. The doctors were never the problem, it's the administration, and THAT'S where you need to attack.

[Edited on August 27, 2008 at 2:18 PM. Reason : ]

8/27/2008 2:16:59 PM

if socialized medicine ever makes it into the US the level of care will fall and medicine and services will have to be rationed. Resulting in long wait times. Its a fact of socialized care. People who tell you otherwise are very naive, not a taxpayer, or still in school.

8/27/2008 2:29:21 PM

Quote :

"People who tell you otherwise are very naive, not a taxpayer, or still in school."

or living in one of the dozens of countries with some form of socialized healthcare where this is not the case.

Please, this thread has done extremely well primarily because comments like that haven't been used yet.

8/27/2008 2:34:11 PM

^I agree with your point, I apologize. However, I do feel that the VAST majority of people calling for socialized medicine are very naive to what that means or some consequences of such a system.

Rationing will have to occur. To suggest otherwise is being dishonest.

8/27/2008 2:40:44 PM

Yeah, one misunderstanding about our healthcare is the actual quality insured people actually receive. When using WHO metrics like infant mortality rates, life expectancy and cancer statistics, it appears that we are not receiving quality care.

But the fact is that people in the US with insurance receive absolutely top-notch care, with better-trained doctors, more access to cutting-edge equipment and experimental procedures, and newer prescription drugs. We also receive our care RIGHT NOW, as opposed to waiting months to see a specialist as happens frequently in Canada and Britain. And we pay out the ass for this top quality care. It's the uninsured and fat people that really drag down our health care ratings.

8/27/2008 2:51:05 PM

I was watching the national news the other night and they were running a piece on prenatal care and how lackign it was in the US. They had a girl in memphis, 12 yrs old, who had a baby with problems bc she didnt get any prenatal care. The story was slanting towards how much better this baby would have been had they received prenatal care, but didnt even mention the mother was 12. Also, many of these stories HAVE FREE INSURANCE already, but surprise, dont do the responsible thing and actually do it.

THe OBG at the local hospital bitches about this all the time. Its usually caids that show up at the hospital for delievery, have never been seen before, and want the epidural. However, they know NOTHING about this patient and often cant give them it.

I ask those who think socialized medicine is the cure, what exactly do you think it will accomplish? I see, every day, people who are given everythign who still dont act responsibly. In fact, our biggest no show rate is among those who have free healthcare. School nurses have to bring in some of my kids bc the mother wont. Of the ones that do, they often break thier glasses very quickly, bc they pay nothing for them, or use thier "benefit" for glasses, while they buy color contacts with cash.

8/27/2008 3:04:22 PM

Fact check:

15% of people are not covered now



http://www.latimes.com/business/la-fi-census27-2008aug27,1,2743262.story

In 2007, Medicare provided health care coverage for 43 million Americans --> 14%

http://en.wikipedia.org/wiki/Medicare_(United_States)

Now, Medicaid:
It is estimated that 42.9 million Americans will be enrolled in 2004 (19.7 million of them children) at a total cost of $295 billion.

And 6 billion overlap with medicare. That means 37 million exclusive here. --> 12%

So,
Out of Americans
14% Medicare
12% Medicare
15% not even insured

So there can't be but 59% of the people in this country who are actually getting medical bills paid for by insurance that was paid for by working. And their tab pays for everyone else.

[Edited on August 27, 2008 at 3:10 PM. Reason : ]

8/27/2008 3:10:26 PM

Quote :

"Rationing will have to occur."

You mean triage?

And the analogous mechanism in a freemarket system is poor people dying of their illnesses.

8/27/2008 3:26:33 PM

seems like if we got universal health care the gov would limit what we eat so we wouldnt have so many unhealthy fat asses roaming around...which is a good thing

8/27/2008 3:46:45 PM

no, rationing. Meaning we will do X number of procedures. Or we will provide X number of medicines.

Its amazing how the human race was able to survive without govt insurance isnt it moron? Charities can provide services to the poor, and do it better than our govt. Are you suggesting there isnt poor people dying in the streets now? And, guess what moron? They probably HAVE insurance too.

8/27/2008 3:49:13 PM