And what happens when costs run higher. Will government cut care? And if they won't then what incentive do people have to price shop? At what point is too much spending on medical care by tax payers?Originally Posted by EyeKhan
And what happens when costs run higher. Will government cut care? And if they won't then what incentive do people have to price shop? At what point is too much spending on medical care by tax payers?
Your costs are running high because of your present dumb system. If you'd fixed this system your costs would not have run this high. Your question should be answered the way my second grade teacher answered all such questions: "What if a rocket flew in through the window?"
No-one price-shops sensibly when it comes to their life and health. What they do is avoid important care until it's too late and then no-one can deny them emergency care. This is another reason why your present system sucks. You're slowly working towards a system where healthcare providers will have incentives and means to provide better and more cost-effective care (something they truly lack today). Hopefully. If not this time around then the next time.
"One day, we shall die. All the other days, we shall live."
You know, it would be nice to see some real numbers.
- how much more will the addition of workers to "the government dole" cost the government during their working years?
- how much will it save the employers, and what would be the effects of that?
- how much would you get back (or lose) in productivity from workers and employers?
"One day, we shall die. All the other days, we shall live."
Well we know the government won't do it more cheaply, and the private sector already spends trillions on health care...it's not hard to see that the amounts are potentially quite large.
And how would those wonderful employer packages be funded? Taxcuts per chance? I always love it when people argue against re-distrubution in defense of a system of reverse re-distribution. Steal from the poor and give it to the somewhat less poor.
Congratulations America
Yes but we've been going on and on about how most of the spending is in the last few years of life etc etc, so how much more will the addition of healthy people of working age cost and what would the gains be?
The private sector spends a great deal on healthcare in large part due to 1. the large number of people responsible for different aspects of a very fragmented healthcare system and 2. defensive medicine (although to the latter I suppose we can add unnecessary procedures that are driven purely by financial motives eg. fee for service models). Never mind the gains that might be had from applying good research on comparative effectiveness and best practices, or the gains that might be had from expanding and improving your primary healthcare system.
How much of a burden is healthcare coverage on small/medium employers? How does that burden compare to the one on large profitable employers?
"One day, we shall die. All the other days, we shall live."
My whole point is our employer-based system is a distortion created by government tax cuts. And now that system seems to be the target for replacement by a large government-subsidized system.
We do? How much is wasted by the insurance industry today? They have duplicated the administrative structure required many times over, they require an ever increasing profit, they each have unique and different requirements, different procedures they will cover, different drugs they will cover, different proofs to head off fraud from doctors so offices have to duplicate their own procedures and processes. You think this situation is more efficient than a single payer?
YOU have faith the government can't do it more cheaply. That's the conservative mantra that so many people embrace as the truth with or without evidence and all have concluded it MUST be true now and forever so attempting to use the government to do what it is supposed to do is hopeless and nobody should try. Do you not see something wrong with that thinking????
Does anyone know why the price of health care keeps rising so much faster than inflation?
The Rules
Copper- behave toward others to elicit treatment you would like (the manipulative rule)
Gold- treat others how you would like them to treat you (the self regard rule)
Platinum - treat others the way they would like to be treated (the PC rule)
What happens when the costs run cheaper? Will conservatives come in office and cut funding rather than expand the services or build an emergency fund for when the economy turns down? Then when there is another inevitable economic downturn will conservatives point to the system and scream "see, it doesn't work!!!" and try to outsource it to their industry buddies?
Last edited by EyeKhan; 06-09-2011 at 02:01 PM.
The Rules
Copper- behave toward others to elicit treatment you would like (the manipulative rule)
Gold- treat others how you would like them to treat you (the self regard rule)
Platinum - treat others the way they would like to be treated (the PC rule)
Your assertion that a national system is more expensive is not supported by any evidence. The experiences of countries in Europe suggest the opposite from your claims.
Congratulations America
I would like that, but I'm not at all certain that we are. I'm pretty sure legislative action over the last few years has actually been retrograde. It's only progress if one can view "making the system break down faster" as progress under the assumption that when it does collapse, something sensible will HAVE to be what arises in its place.
Last night as I lay in bed, looking up at the stars, I thought, “Where the hell is my ceiling?"
Rapid technological change.
Hope is the denial of reality
Did Medicare run cheaper?
Did medicare's performance perhaps have something to do with how totally broken the rest of your system is?
"One day, we shall die. All the other days, we shall live."
Here you go:
http://www.newyorker.com/reporting/2...a_fact_gawande
(it's in English)
"One day, we shall die. All the other days, we shall live."
From a business perspective this would be like a tax-break toward businesses. So we should expect more people being hired and higher wages.By mission accomplished you mean Obama and co wanting to make even more people/citizens dependent on the government (and hence continue to vote in his crap), then yes.
I for one have always supported a national healthcare, I think if done right, it'll be a great step in efficiency for our country, and for overall health and lifespan of our populace. This is a law that benefits strongly the middle class and below, unless your upper middle class you should support this. I think it's good overall regardless, but just for yourself you should support it if you fall in where the vast majority of Americans fall.
long read, great article.
Congratulations America
I'm sure it has an influence. However the basic point remains when the government gets involved with something it runs over budget. In addition unlike a private business there is virtually no incentive for people to try to make it more efficient.
You didn't read the article did you. Admit it, you haven't actually read a single source or a single serious essay on this topic in the years we've been discussing it.
You keep forgetting that the most important thing to become more efficient at--for most private practitioners in the US, as well as for every other player in the healthcare game--seems to be the taking of as much money as possible from patients. Patients will pay that money. The more they earn, the more they will pay, regardless of whether or not they need to, whether or not they should. That doesn't increase efficiency in the sense of improving the quality of healthcare per dollar. It's a system heavily biased in favour of bad, fearmongering, inefficient medicine.
"One day, we shall die. All the other days, we shall live."
Interesting article.
This is a bit disingenuous. You don't need to be a car expert to get a good deal on a car. Business competes with each other to get consumers to go with them. You don't need to be an actuary to get a good price on insurance. You can compare rates, you can look at the reputation of the company, look at reviews and tons of other ways. Why couldn't we do this with hospitals and doctors?He gave me a quizzical look. We tried to imagine the scenario. A cardiologist tells an elderly woman that she needs bypass surgery and has Dr. Dyke see her. They discuss the blockages in her heart, the operation, the risks. And now they’re supposed to haggle over the price as if he were selling a rug in a souk? “I’ll do three vessels for thirty thousand, but if you take four I’ll throw in an extra night in the I.C.U.”—that sort of thing? Dyke shook his head. “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”
Lets look at another medical procedure that is not typically covered by private insurance or Medicare.
http://abcnews.go.com/2020/Stossel/story?id=8026098
Insurance, whether private or a government Ponzi scheme like Medicare, means third parties pay the bills. When someone else pays, costs always go up.
Imagine if you had grocery insurance. You wouldn't care how much food cost. Why shop around? If someone else were paying 80 percent, you'd buy the most expensive cuts of meat. Prices would skyrocket.
That's what health insurance does to medical care. Patients rarely even ask what anything costs. Doctors often don't know. Often nobody even gives a damn. Patients rarely ask, "Is that MRI really necessary? Is there a cheaper place?" We consume without thinking.
By contrast, in areas of medicine where most patients pay their own way, service gets better, while prices fall.
Take plastic surgery and Lasik eye surgery: Because patients shop around and compare prices, doctors work hard to win their business. They often give customers their cell-phone numbers. Service keeps increasing, but prices don't. "In every other field of medicine, the price is going up faster than consumer prices in general," says John Goodman of the National Center for Policy Analysis. "But the price of Lasik surgery, on average, has gone down by 30 percent."
This shouldn't be a surprise. What holds costs down is patients acting like consumers, looking out for themselves in a competitive market. Providers fight to win business by keeping costs down and quality up.
The timing of those two posts made me lol pretty hard just now.
I'm glad you liked the article, but you picked out among the least relevant passages in it. With that said, comparing complex life-and-death matters with relatively simple trivial procedures such as lasik and then running a "thought experiment" is, as you put it, disingenuous.
Can you reasonably be expected to shop around for every single test associated with a given emergency hospital admission and treatment? What if the competitors are far away from one another? What if they don't have compatible journal systems?
It's relatively easy to "act like a consumer" with something like lasik.
"One day, we shall die. All the other days, we shall live."
Do you know how much time and energy I put into researching a purchase of eg. a smartphone? A great deal of time. Do you think I could do that under severe time constraints, guided by untrustworthy people, fearing that my health hangs in the balance?
"One day, we shall die. All the other days, we shall live."
Most medical care isn't ER care. Obviously you aren't going to price shop as your being wheeled in from the ambulance. And just because you won't necessarily make the best decision doesn't mean someone else should make the decision for you.
There is no "perfect" solution to rising medical costs. Part of the problem is that as society grows older with medical advances costs will rise even under optimal situations. HSA and having "skin in the game" gives choice to the individual as opposed to choice to the state. It creates incentives to be aware of costs. Eventually care *must* be rationed. Not everyone can get the 'best' care. Even if the rationing is waiting lines, or the rationing is fewer new medicines in some form or fashion something has to give.
We both have very different systems that emphasize different types of care. Your system is more focused on primary care and regulated drug prices. Our system is more geared towards specialized care.
You also barely spend any money on your military, so you can blow money on things like national socialized healthcare.
I agree, insurance companies haven't been truly competing. They can't because of the backwards incentives and regulations they work under. But they also have very low margins. It's a highly imperfect system.We do? How much is wasted by the insurance industry today? They have duplicated the administrative structure required many times over, they require an ever increasing profit, they each have unique and different requirements, different procedures they will cover, different drugs they will cover, different proofs to head off fraud from doctors so offices have to duplicate their own procedures and processes. You think this situation is more efficient than a single payer?
YOU have faith the government can't do it more cheaply. That's the conservative mantra that so many people embrace as the truth with or without evidence and all have concluded it MUST be true now and forever so attempting to use the government to do what it is supposed to do is hopeless and nobody should try. Do you not see something wrong with that thinking????
Does anyone know why the price of health care keeps rising so much faster than inflation?
But I think it's naive to think the government will do a better job.
Do you make a distinction between less expensive and untenable?
You skipped over the part where Insurance itself increases costs of care. Stop comparing healthcare to cars just because they both have insurance products, that's just silly. And if you read the article, one main theme is that medicine shouldn't be operated as any other for-profit business, with physicians as originators of revenue.
The Government is really just our legislators and their constituents. Sure, our incentives are backward, but that's because of special interest groups/lobbyists/PACs that dominate legislators' agendas. The Regulations are tax incentives are the way they are because certain industries wanted them that way. Employers got tax cuts for offering employee insurance subsidies. As costs of care rose, employees wanted employer-based insurance instead of more taxable income. The Insurance Industry (and big pharma) love the individual mandate, in fact they helped write the legislation, because they want it that way.
But glad you mentioned military spending. We spend too much on spreading our military all over the world, protecting and building other nations, to the exclusion of our own citizens.
And its cynical, cruel, and lazy to conclude the best solution to the Medicare and Medicaid cost problem is to simply cut the amount the government will spend on it. That 'solution' doesn't even pretend to try and address the real problem which is the rising cost of healthcare for everyone. That cost is still going to rise and the myriad of resulting problems are still going to get worse, they will just get worse faster for older and poorer Americans. Whatever is driving the cost increase has to be addressed. And I don't believe for a second the driver is simply fast changing technology; as stated by Loki above, that explanation doesn't even make any sense (Loki: I am interested in a more detailed explanation, however).
The Rules
Copper- behave toward others to elicit treatment you would like (the manipulative rule)
Gold- treat others how you would like them to treat you (the self regard rule)
Platinum - treat others the way they would like to be treated (the PC rule)
Run cheaper than what? Was Medicare ever run by a myriad of companies duplicating administrative efforts that required doctors comply with a complex and inconsistent patchwork of coverage and paperwork? No, of course not. Private insurance companies would never take on a pool of only high risk, guaranteed high claims people. Which is why the government got stuck with it - nobody else would cover old people at a price they could afford. And that is also why there should be a single payer system for the entire country requiring healthy people to participate. The high risk people can't be covered at a reasonable price without the gigantic pool of low risk people paying in to balance the costs. Duh.
The Rules
Copper- behave toward others to elicit treatment you would like (the manipulative rule)
Gold- treat others how you would like them to treat you (the self regard rule)
Platinum - treat others the way they would like to be treated (the PC rule)
On Spending:
Solution: A virtual discharge nurse named Louise, software for sale.It's part of a push to reduce the 4.4 million hospital stays that are a result of potentially preventable re-admissions, which add more than $30 billion a year to the nation's health-care tab, or $1 of every $10 spent on hospital care, according to the federal Agency for Healthcare Research and Quality.
http://online.wsj.com/article/SB1000...p_mostpop_readBrian Jack, an associate professor at Boston University who developed Project RED, says in a recent study the use of the discharge plan with human nurses cut costs by about $123 per patient and took about 81 minutes of a nurse's time; the virtual discharge system automates 30 minutes of that time, for a total savings of $145 per patient. "It can be so complicated if you are sick and sleep-deprived in a noisy hospital, and you've been taking pain medications or have a fever," says Dr. Jack. "The last thing you are able to do sometimes is concentrate on these relatively complex things."
Hospitals can download the tools for Project RED from the program's website. The nonprofit Joint Commission Resources has also received funding from the Agency for Healthcare Research and Quality to help about 250 hospitals adopt Project RED tools, and Boston University has licensed the program to San Francisco-based Engineered Care, which sells a software program with a soups-to-nuts discharge-planning program to hospitals, including the Louise virtual-discharge feature.
Posting Permissions
Reply With Quote
