The U.S. Health Care Debate

[Marshal Murat]

Meanwhile, those most affected, with genuine concerns/fears for what's really in the fine print are having a very difficult time figuring out who is lying to me/cheating me/holding back on me/selling me out the least.

This debate (as I've realized) isn't so much about better healthcare but how much we trust our representatives to do "what is best".

[Lemur]

This debate (as I've realized) isn't so much about better healthcare but how much we trust our representatives to do "what is best".

Well, at the moment we trust insurance companies to do "what is best." Whether you want to look at statistics, national costs or hair-raising anecdotes, the results ain't pretty.

I would really, truly like to hear about some real-world examples of the kinds of plans being put forward by Paul Ryan. In other words, we can examine the French model or the British model or the Japanese model or the Korean model of single-payer healthcare, and we can examine what works and what does not.

But the purely free-market model of healthcare? I would be much more comfortable putting everything into HSAs and private insurance if we could look at another country that has already done this.

Frankly, this should be the essence of conservatism: Show me how it works in the real world. Ditch the ideology and the theory, and show me how it functions when the rubber meets the road. (And in my private world inside my head, this is the real distinction, not between "left" and "right," but between pragmatic "conservatism" and ideology-driven "idealism." Results are what matter, not abstract political/economic theory.)

So can anyone cite an example of a first-world, industrialized nation that has gone with a (more or less) free-market healthcare system on all levels? I'm not asking this as a rhetorical question—there must be some first-world nation somewhere that has tried this. What were the results? Were costs contained? How broad did coverage wind up being? Were the common indexes (operation survival, birth survival, etc.) improved?

[Crazed Rabbit]

Some Union thugs practice their own special brand of health care. And of course I mean hitting and assaulting.

I'll say I don't know of any completely free-market health care plans. But 'radical' free market ideas have worked before. And limiting ourselves to what's been done in the past seems like quite an onerous restriction, given the nature of politicians.

CR

[Hosakawa Tito]

Here's an article on the system in France. Perhaps some of our French members could elaborate?

France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.

[Lemur]

I'll say I don't know of any completely free-market health care plans. But 'radical' free market ideas have worked before.

So ... we're to adopt a purely free-market healthcare system based on faith? Surely there must be some testing, some evidence, someplace where a more-or-less pure pay-for-play heathcare system has been tried. If not, then I'm kind of shocked. We're to adopt an untested, untried experiment at a national level because we have faith?

Say what you like about single-payer, at least it's been road-tested in the real world by just about every industrialized nation. Its drawbacks, problems and benefits are at least understood.

I wish we could do a 50-state test bed, allowing every state to adopt whatever system they think best, then circling back and checking the results in, say, five years. That would be rocking. Not politically doable, and there's no doubt a lot of people would suffer and die in the "failed" experiments, but at least we'd be dealing with actual results and reality instead of theory, ideology and faith.

[Ariovistus Maximus]

Long waiting lists are a problem, but all systems have flaws. Your currently one is rather the opposite of an exception, as you rank low on many indirect measurements for health care quality (child mortality, life expectancy etc). Never heard about that ambulance thingy (not from Canada or UK though)

True; so I guess it's about whether we want a flawed governmental system or a flawed private system.

Besides, healthcare is oddly enough something healthy people don't usually abuse.

Yes, that makes sense. Mooching meds is perhaps not so lucrative as wellfare.

Well, except from if media would even hint about something like this, the scandal would be bad enough to bring down a political party (as it's the equvivalent to murder of political opponents), unless you know for certain your doctor's political alignment the doctor could do it today.

Besides, anybody important enough for it to be viable are usually rich and/or gotten media attention.

True enough, but keep in mind that we're talking about a permanent system.

Thus, the health care plan might work under one administration, but could be easily turned around by the next.

Tricky one. By taxes probably yes, by the total money in your wallet probably no, unless it a huge failure. You got the most expensive health care in the world atm. And it doesn't pay the bang for the buck.

And the problem is, not only might the ideal Socialised Medicine program be rather expensive, but who knows what kind of madness we'll actually get???

I don't think anyone (in a healthy state of mind) is under the illusion that our legislative body is composed of saints by any means.

[Ironside]

Yes, that makes sense. Mooching meds is perhaps not so lucrative as wellfare.

Mooching meds would require that you got a doctor who's very generous with his prescriptions and an actual selling market. If medical drugs are fairly cheap, why buy them black?

True enough, but keep in mind that we're talking about a permanent system.

Thus, the health care plan might work under one administration, but could be easily turned around by the next.

Considering how stiff the resistance is for this one, I would hardly call it easy to turn around.

And the problem is, not only might the ideal Socialised Medicine program be rather expensive, but who knows what kind of madness we'll actually get???

I don't think anyone (in a healthy state of mind) is under the illusion that our legislative body is composed of saints by any means.

Comparing what the US pays in health care costs (about 15% of the GDP) compared what the rest of the western world pays (about 10%), you have a pretty good shot of firing them all on grounds of incompetence if they fail to get it cheaper. They do have a considerble margin to play around with.

[Centurion1]

But our current health care bill includes social security which is possibly the worst run organization in the history of mankind

[Seamus Fermanagh]

But our current health care bill includes social security which is possibly the worst run organization in the history of mankind

But you gotta LOVE the rate of return on Social Security....not.

Advocates of privatization point out - correctly - that Logue's analysis compares theoretical stock returns with what the Social Security Trust Fund earned - not what he himself would get from the system.

From that perspective, the investment approach looks better, they argue. Over the long run, a typical worker can expect to earn 4.6 percent a year (after administrative costs) on a diversified portfolio of stocks and bonds and only about 2 percent or less from Social Security, according to federal estimates reported by Michael Tanner of the Cato Institute, long a proponent of privatization. Hypothetically, someone earning $30,000 annually would at the end of a 40-year career receive nearly twice as much under the investment approach ($344,000) than with Social Security ($185,000).

[Lemur]

An insightful piece by David Frum today. Excerpt:

What would it mean to “win” the healthcare fight?

For some, the answer is obvious: beat back the president’s proposals, defeat the House bill, stand back and wait for 1994 to repeat itself.

The problem is that if we do that… we’ll still have the present healthcare system. Meaning that we’ll have (1) flat-lining wages, (2) exploding Medicaid and Medicare costs and thus immense pressure for future tax increases, (3) small businesses and self-employed individuals priced out of the insurance market, and (4) a lot of uninsured or underinsured people imposing costs on hospitals and local governments.

We’ll have entrenched and perpetuated some of the most irrational features of a hugely costly and under-performing system, at the expense of entrepreneurs and risk-takers, exactly the people the Republican party exists to champion.

Not a good outcome.

[Ariovistus Maximus]

Considering how stiff the resistance is for this one, I would hardly call it easy to turn around.

Which is why we resist so stiffly.

[Tribesman]

Stupidity knows no limits
http://www.kansascity.com/news/polit...y/1373035.html
What sort of idiot goes protesting about the percieved threat to his private health insurance when he hasn't even got any private health insurance.
Could this be the new Joe the not the plumber who was protesting about taxes when he didn't pay them anyway?

[rvg]

The kind of idiot that does not expect to remain unemployed perpetually.

[Lemur]

My personal favorite: "Keep your government hands off my Medicare!"

-edit-

This testimony makes complete sense to me. I didn't avoid the doctor for my cut-up hand because I couldn't afford it; I stayed away because you never freaking know what it's going to cost.

I'm a bankruptcy lawyer, so I'm in one of the two groups that will be hurt by real health care reform (insurance companies being the other). About a third of my clients are in bankruptcy due to medical bills (another third have some medical bills, but it's not what pushed them over the edge). Almost all of them thought their health insurance would cover the problems they had. Many had gone to great lengths ahead of time to make sure their treatment would be covered, only to find out after the fact that their insurance company wouldn't pay. They've heard every excuse in the book (or in the fine print of the policy): experimental treatment, lifetime cap, high deductible, missed deadlines, lack of notification, pre-existing condition and so on. To me, the worst part of the American health care financing system is that you can't tell what your treatment will cost. I know folks who have flown to Pakistan to have operations they couldn't get in the US because nobody in the US (unlike Pakistan!) would agree in writing ahead of time what it would cost them.

[Tribesman]

The kind of idiot that does not expect to remain unemployed perpetually.

Yes, perhaps he can get a job with one of those firms who the taxpayer bails out because their healthcare costs are bankrupting them.
Or he could get really lucky and get a job with one of those firms who ship their workers off to the far east for medical care, together with their spouses to have a holiday and keep the ill person company..... because its cheaper than using the current US system.

[rvg]

Yes, perhaps he can get a job with one of those firms who the taxpayer bails out because their healthcare costs are bankrupting them.
Or he could get really lucky and get a job with one of those firms who ship their workers off to the far east for medical care, together with their spouses to have a holiday and keep the ill person company..... because its cheaper than using the current US system.

Or perhaps he can get a job with a normal company that provides normal benefits.

[Tribesman]

Or perhaps he can get a job with a normal company that provides normal benefits.

You should know that over the past few years companies and health care providers have been narrowing the scope of what they consider normal.

[Ironside]

Which is why we resist so stiffly.

Not sure if protecting a lousy system is worth .

Anyway does anybody know how the profit margins for the insurance companies has changed during the years (aka why they are getting skilled on insurance dodging)? Or any other nice data sets showing more exactly what's causing this slow spiral into a total collapse?

[rvg]

You should know that over the past few years companies and health care providers have been narrowing the scope of what they consider normal.

No, they've been increasing the share that the employees have to shell out. Quite different from redefining the standards of normalcy. My insurance, for example has remained unchanged of last...umm...10 years. Still covers same stuff as it used to.

[Tribesman]

No, they've been increasing the share that the employees have to shell out.

So your employer still provides for the normal cover but the employee has to pay more for the normal cover.
Yep thats not redifining the normalcy

[rvg]

So your employer still provides for the normal cover but the employee has to pay more for the normal cover.
Yep thats not redifining the normalcy

Not in my book.

[Tribesman]

Not in my book.

Perhaps you had better send your book back to the publishers with a note complaining that their proof readers were asleep on the job.

[rvg]

Perhaps you had better send your book back to the publishers with a note complaining that their proof readers were asleep on the job.

oooo I burn..... Can't believe you didn't sense being goaded. You're becoming way to predictable.

[Marshal Murat]

President talks sense

Basically Obama says that the Canadian healthcare system wouldn't work in the US.

[Xiahou]

Pelosi and Hoyer call those protesting healthcare reform "un-American".... but, I thought dissent was the highest form of patriotism.... I guess it depends on whether or not you agree with her.

The problem is that if we do that… we’ll still have the present healthcare system. Meaning that we’ll have (1) flat-lining wages, (2) exploding Medicaid and Medicare costs and thus immense pressure for future tax increases, (3) small businesses and self-employed individuals priced out of the insurance market, and (4) a lot of uninsured or underinsured people imposing costs on hospitals and local governments.

Frum must've missed the part where the CBO said that the proposed bills would accelerate cost increases. None of the proposals in Congress do anything meaningful in terms of controlling costs, so yeah, I'd consider it a win if none of them passed.

[Tribesman]

Pelosi and Hoyer call those protesting healthcare reform "un-American"....

No, they said those that just shout nonsense devoid of facts in an effort to drown out opposing voices are un-american...though I would just describe those people as incredibly stupid individuals.

[a completely inoffensive name]

Just wanting to put in my contribution. Was lurkin on Reddit and found this informative submission:
http://finance.yahoo.com/insurance/a...surance-health

In the comments section this looks to be the most favored comment:

"I've worked in health care for more then 30 years and I've been politically active for health care reform for about 10 years. I think this article is a good summary of the symptoms of health care. However, what may not be evident is the underlying disease which is causing these symptoms to occur.
The health care system didn't use to waste money this way. The waste probably began when the government started making it possible to pay health insurance premiums using pretax dollars, but kept directly paying for health care after tax (during WWII). The waste really began in the 1960's when Medicare and Medicaid were enacted and doctors and hospitals had to start coding everything they did and submitting claims for reimbursement. This coding rewarded doing more procedures and ordering more tests. Soon, private insurance followed Medicare and Medicaid, and costs went through the roof. In 1973, Nixon tried to get things under control by introducing HMOs. In the 1980s, Medicare tried to get costs under control by paying for entire hospital stays, rather than each day in the hospital separately. Nothing has worked; health care costs still go up faster than inflation while the value of care doesn't go up nearly as fast.
I think health care needs to be reformed, but I am pessimistic that the reform proposals now being discussed are going to be effective. I think we're going to have to be more radical: either have the government take over health care like the UK (not a good choice, IMHO, but better than what we've got now), or practice some tough love on the U.S. populace and explain that 60% of health care is more efficiently purchased directly and not through the government or insurance companies."

Just wanted to pitch in with this to stimulate conversation, here is the actual comments page:
http://www.reddit.com/r/Economics/co...lth_care_most/

[Lemur]

None of the proposals in Congress do anything meaningful in terms of controlling costs, so yeah, I'd consider it a win if none of them passed.

You're in excellent company:

On a private conference call, a group of top Tea Party and conservative organizers offered a surprisingly frank description of their goal, according to a source on the call: Completely blocking any kind of bipartisan compromise, and completely preventing any type of health care reform bill at all from ever becoming law.

[Xiahou]

You're in excellent company:

Thanks.... I guess.


Here's an analysis of the mandatory end of life counseling provision in the bill. It's a long post, but worth reading if you're at all interested in what's actually in the bill. Here's just a small excerpt:

Did you get all that? Of course not. It’s mostly gobblety goop and legalese, with repeated edits and references to other laws that makes it next to impossible for most anyone to comprehend. But, as the Bioethics Defense Fund has concluded, this broad and vaguely written bill is wide open to being interpreted as giving the government the power to require all Medicare recipients to receive advance care consultations and giving the government the unprecedented authority to define exactly what such counseling must include, who can deliver it, and when it must be given.

More importantly, it is clearly an effort to coerce seniors to sign such an order. There are multiple loopholes that open doors for its misuse, and abuse of the elderly, while also including no protections for these patients.

[seireikhaan]

Here's an analysis of the mandatory end of life counseling provision in the bill. It's a long post, but worth reading if you're at all interested in what's actually in the bill. Here's just a small excerpt:

Well, a couple of points I'll make before diving in:

1) Its not "the bill", per se. There's a multitude of bills that were floating around before congress went on vaca, and to label any of them as "the bill" is probably a rash judgement.

2) I am irked by their style. Yes, they list the bill, and its language. Which is good. What's not good is them trying to discourage people from reading it when they label it as incomprehensible when it is already intimidating and long.

Ok, I'm trying to figure out what the overall point is as pertaining to the actual language of this particular bill. Basically, that the state can control what medical professionals would tell seniors in these meetings, based on what this secretary proposes as "appropriate" measures that medical professionals could use. Yet what the blogger does not take note of is this bit:

The Secretary shall provide for a period of public comment on such set of measures before finalizing such proposed measures.'

So basically, the secretary has to tell everyone what these "appropriate" measures are before said person is allowed to finalize them. Meaning that they are put to the fire of public opinion before being put forth, and said secretary stakes their reputation on the line, as well as that of the current admin, when they publish these. The blogger apparently thinks this unimportant, as the entire rest of that paragraph was bolded and this was not.

Further, the blogger bold-faced lies when they claim this:

Note: It makes no provisions that the patients must consent to these orders or that the doctor writing these orders must be the patient’s own personal healthcare provider.

, as by this:

`(5)(A) For purposes of this section, the term `order regarding life sustaining treatment' means, with respect to an individual, an actionable medical order relating to the treatment of that individual that—
...

`(ii) effectively communicates the individual's preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual;

`(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items—
`(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems;
`(ii) the individual's desire regarding transfer to a hospital or remaining at the current care setting;
`(iii) the use of antibiotics; and
`(iv) the use of artificially administered nutrition and hydration.'.

So basically the requirements for patient protection the blogger so wanted are there, and the blogger decided to ignore it, and feigned bipartisanship by giving the bill only to try and intimidate people into not reading anything that wasn't bolded by said blogger.