Health Care and Insurance

[gopman]

If the government interferes in price setting, the market can't produce at the natural efficient quantity of output. This limits the ability of new firms to enter the market and lower prices.

Here is my proposal and reasons:

Free pharmaceutical market- no government interference (other than testing for safety and quality) so that the prices will fall naturally.

Competetive insurance market: without the government taking the largest share of the market, prices will drop, and consumers will ultimately pay less. More will be insured as prices drop.

Government insurance for the most needy- I acknowledge that some need the assistance of the government. The government will pay the same, lower prices that everyone else pays.

As for implementing this plan, I'm not even going to try to lay out a strategy here. Just know that it would be gradual to avoid any price shocks.

Please post your ideas.

[gopman]

I forgot to mention that competition will improve the quality of services offered by insurers, rather than politicians dictating what is "necessary." Much like with education, the decision making should be left to professionals.

[JD3]

The government in America doesn't tell medicine or drug companies what to charge. They only deal with medicare and medicaid patients.

Private insurers deal with those who can afford private insurence.

Millions of others recieve no health care coverage at all. This is the working poor. They hold jobs, but cannot afford any insurence at all.

Canada has universial health care. The government has companies compete to give them the lowest prices. They are one customer with several companies vying for the only contract. This may be conpetition, but it isn't the market place. Insurence companies don't like it because they have no shot at making serious profits.

In America, insurence companies compete freely with those who use private insurence. Business seek the best deals. And insurence companies try their best to have more healthy people and less sick people than other insurence companies. The government has interfered to stop hospitals from refusing emergency care -- something that was practiced in the past -- limit a companies ability to terminate a policy once the consumer becomes ill. Still, an ill person must keep paying the permium no matter how ill that person is. If not, the policy will be dropped.

The government pays for medicare and medicaid patients. The pay for drugs and other equipment and services what ever the national average is. This is a problem because some areas charge more and some less. There is no garuentee that the government is getting the best deal.

The biggest problem? Millions who are uninsured. They are of little concern to the market place. They either literally can't afford the premiums, or the cost takes such a bite out of their bottom line, people choose to risk being uninsured.

The market place in medicine has many problems. We, patients and consumers pay for what the uninsured can't pay.

[JD3]

Because we have to pay for the uninsured, a bandaid when I was in the business cost $5 dollars. My company gave the bandaids to the hospital for free. It was encouragement to sell our products.

I came to understand that the more people were uninsured the more we, the insured, were going to pay. The question is no longer are we going to pay for the uninsured, but how we are going to do it.

You might also note that with the two systems in this country, we can get some insight as to which is more cost effective. Most studies I have seen, and I think people should seek more recent studies, show that more of the medicare and medicaid dollars go striaght to care than do insurence dollars in the market place. If this is still true, than I would have a hard time accepting that the market place can fix medicine.

Also, I do have a problem thinking that providing emergency care for my daughter is the same as buying a car. If the car is too much, I can easily say no. But do I really want to bargan hunt for my daughter's care? Can I say no, we'll do without? This seems to favor the seller and limits competition. At least it seems that way to me.

Medicine seems to have limitations in the market place. And I see no sign that they can reach the uninsured.

[gopman]

The government purchasing at the national average constitutes interference. It still prevents companies from producing at the efficient quantity of output.

Putting insurance companies out of business may not be the best idea economically.

Private insurance isn't for those who can afford it, it is for those who just don't qualify for government care. If insurance companies were free to compete rather than having to produce an amount of services that are less than the efficient quantity, entry to the market is limited and prices are inflated. If the government would just not interfere, the prices would drop rapidly and the quality of the services would rise. There would be less uninsured. Your five dollar bandaid is the best argument against that system. The government could still insure the most needy, but the prices would be much lower.

Another argument for free market is that it naturally rewards innovation. When was the last time government health care tried anything new? People have had the same problems for years and the government has no incentive to fix it.
You say insurance favors the seller because there is an inelastic demand. Well, the reason for that is that substitutes are so limited by the govt.
The fact is that nature works. Free markets work. It is admittedly abstract and hard to see, but the market forces are undeniable.

New Proposal:

1. privatized insurance- the quality will be better and the price will be lower, not to mention an increase in jobs.

2. tax refunds for health care proportional to income- (you should note that this is a progressive tax that I usually would oppose) by giving power back to the market, quantities will be efficient and prices will be lower. The poorest will always be able to afford insurance. Now that everyone can pay, there is no need for the 5 dollar bandaid.

[JD3]

Insurence is privatived here.

Medicare is a benefit for the elderly.

Medicaid helps the very poor.

Everyone else is in the market. It is separate and free. There is little government interference. Ask the insurence companies, they will tell you the same.

The only interference is where you suggest. The government has tried to stop insurence companies from dropping patients. But that is about it.

And none of this has anything to do with hospital prices exept that the uninsured, who the market is free to reach, push up prices. You seem to suggest that becuase their is a separate group of people that the rest can't possibly function in a market. I wasn't aware that market depended on size. If the market is superior in medicine, show me how supply and demand has lowered prices for those not covered by medicare or medicaid. The mrket should be working for them. The government is setting the prices, they are meerly paying the average. Show me the market place at work among the those in the market.

[JD3]

I was just listening to 6 of the democratic canidates discussing health care in Iowa. Most were in favor of a one payor system. They argued that it would be cheaper and cover everyone.

[NetxMan]

Do you know how long someone has to wait in Canada just to get a cat scan?

[JD3]

yes I do. That is why I haven't claimed to be a fan of their system. But that doesn't mean have it right yet either. It is probably beyond this type of forum, but I'd love to hear a new idea and some frank discussion about the problem. I am hesitent to completely let the government run eveything. But the market place hasn't proven to me that every concern can be met that way.

Perhaps a universal insurer? Say we choose Red cross/ Blue Shield. They've been in the business as long or longer than anyone. And we say they have to insure everyone. No other insurance companies. We keep physician choice. We stay reluctant to set pysician prices or care costs. But we do establish a board so that costs can be challeneged, to avoid gouging. Varies experts in the health care industry could be a part of this board along with people experienced in the cost and maintance of the program.

I am not convinced yet that this would be better, but I am certain the system we have now doesn't work.

[JD3]

On another post someone said that it wasn't the job of the government to provide perscription drugs for the elderly. This I think hits the core of the problem. They are not likely to have insurence. Poorer to middle working class people aren't likely to have insurence or large cash reserves. So, how should we handle this?

I submit that no matter how much we stress personal responsiblity and planning, or how much freedom we give the market place, there will be people too poor, too febble, or too foolish to have enough. So, what are our options?

[stjohn]

This boils down to whether or not you believe healthcare is a right provided by your society or whether it is a privilege for those who can afford it.

[steve_in_mich]

This isn't necessarily a solution, but a possible step towards more affordable health care:

I believe that one of the reasons that health care is so expensive is that the majority of people who do have insurance have no idea how much the insurance company is paying and really don't care.

This doesn't make anyone out to be the bad guy, but the current system isn't really a free market system. For the most part I can't pick and choose which health plan that I would like to participate in. I also have no say in how much the doctors/hospitals get paid.

I think we need to get closer to a consumer driven market where we would have to pay many of the minor medical costs out of pocket, even if we are reimbursed partially or wholly. It would make us more responsible for the health care costs that we incur as well - do I really need to go to the doctor and get an antibiotic because this cold/flu has lasted 4 days.

While there are a lot of reasons why health care is in the state that it is in, I think a lot of it has to do with personal responsibility. There seems to be a whole lot of folks who feel that it is a right to have affordable health care that covers everything. And that they should be able to live any type of lifestyle that they please and be made whole later.

Tort reform is sorely needed as well.

[gopman]

In response to JD3, if someone is too foolish to provide for himself, then I'm sure as hell not going to do it. Please show me where in the Constitution it says that the government must provide health care. I'll save you some time; it doesn't. A reformed system that emphasizes free market will give access to health care for almost everyone, and still allow for some govt tax refunds or some other way to help the poorest.

[JD3]

Gopman: Never said there was a consititional right. You are correct; there isn't.

However, that wasn't my point. If you want to argue don't treat or take care of these folks, I'll listen and at least agree that you are consistent. Or if you have a plan as to how this can be done, I'd love to hear it.

But, we are going to have people who didn't take care of it. The question is what should be done.

A doctor once said this to me: "We could, I suppose, go back to trading medical care for furits and vegtables. But fruits and vegtables won't buy an MRI machine. If you want the best medicine in the world, you are going to have to pay for it."

How will the market place deal with this? I suggest that there would be fewer MRI machines and fewer people getting quality care. Is that what we want? Is medicine an area that we say if you can you can and if you can't you can't?

That is how I see the debate. Am I missing something?

[gopman]

My plan for health care is to free the market and provide tax credit for the poorest. The system we have now is just too restrictive and it prevents health care from being efficient.

[JD3]

You know I have doubts concerning the market place, but explain the tax credits. I get tax cresits for health care insurence and I do admit it's better than nothing, but when I a need a few hundred dollars for medical care right after I've had to enroll the kids in school, and fix the latest car problem, vaccinate the dog, repair the furance, get my tags, etc., or whatever that month's costs were, I am sometimes short. I can't have the tax credit when I need the cash. And when I was less prospous than I am now, well, I am telling you that you can talk responsibility all you want, the pressures to spend money for others things meant this took a back seat.

Many working people seldom have enough money. Maybe they spend unwisely, or maybe they just got hit with something unexpected but hadn't planned for or been able to plan for, or perhaps just too much went wrong that day, week, month. Here I am, not able to pay my share. What now?

I suspect this will continue to happen and I am curious as to how a tax credit will deal with this type of problem.

[JD3]

By the way, stjohn, I think you're right. I just keep forgetting to tell you.:)

[gopman]

You're private insurer would still pay, but at the end of the year you would receive a credit based on your tax bracket. It's not a matter of right or privelidge, its a matter of efficiency. It is a concrete fact that less government interference is more efficient, and I feel that's the best way to help everyone.

[JD3]

I am not sure what is or isn't a concrete fact. But your answer so far assumes that everyone will be insured. Am I wrong that someone will not choose to purchase insurence for whatever reasons. I suspect some of them will be because of poor choices and others because of tough choices, but pick your poison. The thing is I am pretty sure there will be people unisured. The elderly would appear to be a particular insuence risk. I have sat with poeople who didn't want them in there insurence group because they raised premimums.

I don't think the market place will just find a way to insure high risk folks. And since they are high risk, if they did, the prememums are likely to be higher and that would be a larger bruden on those with less to work with.

I still see us with unisured and uncovered people. ** you really think I am wrong about that? If not, what will happen to them?

[gopman]

Firstly, if someone chooses not to purchase medical insurance, that's their own problem. If the government stops interfering, prices will be able to drop. The tax credit would also lower premiums because it would take some of the risk away from the insurers.

If someone is at higher risk, then, since they collect more, they should pay more. I shouldn't be saddled with the cost of caring for everyone else when I have my own problems. If that means that sick people have to make sacrifices for their own health, then so be it- my time will come too.

[steve_in_mich]

gopman - I'm probably preaching to the choir, but I'm really disturbed that the health care discussion over the last 20 or so years has changed so drastically. I remember growing up that a good health plan was something that you aspired to rather than expected - if you wanted a good one you needed to find a good job.

I'm very afraid of where this is going - first it starts with "everyone is entitled to health care", next it will be "everyone is entitled to excellent health care and we can't have different levels of service". Where does it end?

I personally think that this issue is hugely blown out of proportion. There are already numerous programs in place to make sure that folks don't fall through the cracks.

I would really like to see some discourse on what people feel their responsibility is to their own health care.

This hits close to home for me because we have some very contentious teacher contract negotiations going on right now and the major sticking point is health care. Their health plan is by far the costliest in the area and they pay nothing towards the premiums. This is across the board in our county - not one public teacher pays a penny towards health care premiums.

I read an article a while back that showed that Americans paid significantly more out of pocket for health care 30-40 years ago.

[JD3]

Well, I wanted to hear you say it was their problem. Maybe it is.

I am not convinced that premiums will go down. And while you are right it was cheaper 30-40 years ago, you didn't the advancements you have now. That is why I quoted the doctor. You aren't like to see most people having access to much of this at the lower prices. The market place then had people giving fruits and vegtables for service. They won't do that now.

We, as a country, still have to decide if we have the stones to tell some ill or injuried to go home we aren't going to do anything. If you don't do that, then someone will be paying for someone else. You can't escape it. It then becomes a matter of how. Pay more for the service, which leaves more people out, or pay with taxes which takes from your take home. I see no easy answers.

[Missouri Mule]

Sooner or later the U.S. government will take this unruly bull by the horns. It is simply too inefficient and too expensive to continue as it is.

One of the most ridiculous things is to have an HMO or insurance company negotiate with a health provider and reach an agreement for compensation. Say you (insured) go into the hospital and the hospital has agreed to $5000 for the services rendered but the "list" price is $20,000. But the uninsured is billed for the full amount which usually is written off. However, a few do attempt to pay or file bankruptcy. This system is absurd and cannot continue much longer.

[JD3]

I agree. What do you want to replace it with?

[Missouri Mule]

I would have a consortium of insurance companies who would handle the insurance claims. Think of it like this. The entire nation would have "group insurance."

No way in the world would I turn it into a government administered program. I worked in state government and there would be so much deadwood in the bureaucracy it would be both inefficient and more costly.

Right now my wife and I pay about $600 per month for health insurance. My former employeer coughs up another $700 for a total of about $1,300 a month. We pay the copays which are reasonable and we have almost no paper work to deal with. In the past we had indemnity insurance and that was a nightmare and the deductibles were constantly being scaled back. The paperwork with our current insurance is handled properly and on time. I can't knock it. And we have access to very good doctors where we live and immediate access to necessary care.

I want to retain the good of this but obviously we need to get everyone under the umbrella of some kind of system. Overloading the emergency rooms and old people doing without necessary prescription drugs is just plain stupid. It also costs more for the unnecessary medical care costs that result.

Surely there is some way to get this monster tamed before it bankrupts the entire country.

[gopman]

Once again I must take my hat off to Mr. Bush.

By essentially creating a government corporation out of medicare, it is forced to compete, creating all the benefits of a free market, but it can fall back on tax dollars if necessary. Medicaid is untouched, which is understandable, but i think it could also be partially privatized.

It's the best plan I've ever heard- so simple, why didn't I think of it?

[JD3]

Missoui Mule:

I like your plan. Some form of universial insurer. I would wanted it run by the industry. But how will premimums be paid fairly by all?

Gopman:

I hate Bush's plan. You'll see why if it is ever implimented.

[gopman]

I guess so.

[Missouri Mule]

"But how will premimums be paid fairly by all?"

Offhand I would guess through taxation. What's the difference in paying more taxes and paying more insurance? It comes out of the same pocket. Now as to those people who are going "bare" that could present a problem. As we know there is no such thing as a "free lunch." HillaryCare was supposed to have addressed this situation but she loaded up her task force with her own operatives until it was flushed out by inquisitive reporters. Then it was soundly defeated in Congress. Had it be a bi-partisan group it surely would have succeeded.

The reason I believe it must necessarily come to pass is because when Rush Limbaugh says the current system is too inefficient then I believe a convergence of views is developing. We all know the current system stinks and is too expensive. Yes, we can get good insurance and good medical care but we can't take comfort in knowing that so many do not have coverage and are living an economic Russian roulet by assuming they won't get sick or injured. Then they will almost surely be forced into bankruptcy.

We have to do something before the nation is bankrupted. That is an indisputable fact and everyone knows it.

[JD3]

I agree again, mostly (all but the Hillary thing).

Government can function to do for the whole what the whole agrees to do. If we want to build new roads, the government can collect a tax to that becasue it benefits society to do that. Medicine, I think can work that way, and I agree that it makes little difference whether I pay more for care from my own pocket or through taxes. I pay for it either way.

And since we won't as a country turn the ill or injured out on the street, this seems like a fair way to deal with the problem.

Now as for Hlllary, I think the medical estblishment lobby groups who sponsored the Harry and Louise adds played a large role. By changing public perception, they changed the debate.

[gopman]

You're avoiding the fact that rent-seeking and bureaucracy have huge negative effects on efficiency. A government corporation solves that problem, because it works as efficiently as a private firm.

[xexon]

One measure of how civilized a nation is, is how well they take care of their poor and downtrodden.

The US has along way to go in this respect.

I personally know several people who have had to sell personal property to pay for medicine. (I'm elderly)

We have no right to call ourselves the richest nation on earth as long as big business controls who lives and who dies.

Its all about money. That is the first god of the United States.



x

[JD3]

Well, I certainly see a dilema when profiting on someone elses misfortune.

I know many physicians. I eat dinner with them, play racket ball, and discuss politics with them. Some are even my in-laws. Most want to good and do well. I understand. But when you are pressured to do well and you need someone to be ill, there is just a certain conflict there. It isn't like selling a car.

In all my years working in the profession, I couldn't get over this dynamic. With no real malace, if we got a new machine, it got used. If we had a new test, it was run. If we were nearly 100% sure of something we ran other tests just to rule things out. Some of this has to do with lawsuits, and some with profit.

It is just so hard to tell sometimes. And the patient is most times completely in the dark.

It is just hard for me to see this as business.

[Missouri Mule]

Originally posted by xexon
One measure of how civilized a nation is, is how well they take care of their poor and downtrodden.

The US has along way to go in this respect.

I personally know several people who have had to sell personal property to pay for medicine. (I'm elderly)

We have no right to call ourselves the richest nation on earth as long as big business controls who lives and who dies.

Its all about money. That is the first god of the United States.



x

This is why our campaign financing laws must be changed. We need to get the special interest money out of politics and the politicians should start representing the common man. It is not right that only the very wealthy should have access to the levers of power.

[Missouri Mule]

Originally posted by JD3
Well, I certainly see a dilema when profiting on someone elses misfortune.

I know many physicians. I eat dinner with them, play racket ball, and discuss politics with them. Some are even my in-laws. Most want to good and do well. I understand. But when you are pressured to do well and you need someone to be ill, there is just a certain conflict there. It isn't like selling a car.

In all my years working in the profession, I couldn't get over this dynamic. With no real malace, if we got a new machine, it got used. If we had a new test, it was run. If we were nearly 100% sure of something we ran other tests just to rule things out. Some of this has to do with lawsuits, and some with profit.

It is just so hard to tell sometimes. And the patient is most times completely in the dark.

It is just hard for me to see this as business.

Oregon has a head start on the rest of the U.S. Their governor is a physician if I am not mistaken. They are having to make choices and it will come down to this. It makes no sense at all to keep people alive on machines. It is both unnatural and offers no worthwhile life to the person who should naturally pass on. I've told my wife that when that time comes to pull the plug.

The largest expenditures of money on medical care is during the last stages of life. The irony is that our techonological advances may bankrupt us all. Tough choices have to be made but we cannot continue down the road we are traveling or we will all wind up in the ditch.

[mahayana]

I have enjoyed reading your many views on this complex subject.

Please correct if I am wrong, but doesn't the US have the most sophisticated and most expensive healthcare system in the world?

One reason it is so expensive is that so much of the money goes to people who don't actually provide care.

Another is that the A.M.A. restricts the number of doctors trained in America. Last I heard, there were 7 qualified applicants for every space in American Medical schools.

America does not have enough doctors for there to be competition in the fees charged.

I have heard the numbers 50 million and "one in five" Americans having no health insurance. Does anyone have an accurate estimate?

Are you aware that Prudential has more assets than Exxon?

[gopman]

"Are you aware that Prudential has more assets than Exxon?"

This is an interesting phenomenon in the insurance market. What is actually happening when you buy insurance is that you loan money to the firm, to be repaid in case of death, fire, etc. The company uses this money to pay out other claims, but it also invests a large portion of it because it doesn't make sense to just let all those funds sit around, and they are at risk of needing more money at any moment so they need to grow thier assets.

A problem with the cost of health insurance is risk. is this- the government requires insurance companies to accept the highest risk cases, but this requires low risk people to pay more, and many low risks leave, compounding the problem. It is a difficult problem to solve. The best way I think is to let private firms compete, and the risk will be spread through so many people via financial markets that they will be willing to insure more. The government could require that everyone have health insurance to stop low risk people from leaving insurance and footing a large part of the costs. I'm not completely sure on this issue. I support the president's plan as a good compromise and a first step toward a final solution. I think only the benefits of competition can improve the situation.

[Platypus]

Originally posted by gopman
By essentially creating a government corporation out of medicare, it is forced to compete, creating all the benefits of a free market, but it can fall back on tax dollars if necessary.

Ah yes, the incredibly successful Amtrak model.

[JD3]

Even with competetion, it isn't profitable to insure sick people. To do so means raising premiums. There is virtually no way to avoid that. Soon competeing compnyies will see that only insuring the well makes any business sense. I actually sat in a meeting where this was argued.

I agree with the notion that one insurer is the only way to spead the risk. But everyone would have to be insured.

[liberalman]

Originally posted by gopman
If the government interferes in price setting, the market can't produce at the natural efficient quantity of output. This limits the ability of new firms to enter the market and lower prices.

Here is my proposal and reasons:

Free pharmaceutical market- no government interference (other than testing for safety and quality) so that the prices will fall naturally.

Competetive insurance market: without the government taking the largest share of the market, prices will drop, and consumers will ultimately pay less. More will be insured as prices drop.

Government insurance for the most needy- I acknowledge that some need the assistance of the government. The government will pay the same, lower prices that everyone else pays.

As for implementing this plan, I'm not even going to try to lay out a strategy here. Just know that it would be gradual to avoid any price shocks.

Please post your ideas.


Now let me start out by saying that I have only skimmed this post so if i steal your thunder i apologise.


It seems that the you are for a private market becuase that will cheapen the overall cost of healthcare. However, it has already been proven that the government plans are cheaper then the HMO and private plans.

Take Medicare plus and attempt to bring to bear market forces on medicare prices. It has been shown that administrative costs increased 3% or more above teh gvt's cost so that a test that cost 100 dollars under medicare cost 103 dollars under the market driven approach.

As to the idea that we should allow the market to take care of itself this would work if we lived in Candyland or some other sugary world where people were not involved. The fact is everytime we have de-regulated we have seen corresponding jumps in prices along with jumps in CEO pay. Look at the military industry, power industry and yes teh pharmecutical industry as well.


The argument that prices will fall naturally is a farce as without GVT regulation one almost always sees collusion between "competitors" to fix prices and maximize profits. The California power dibacle which by the way was set up by Pete Wilson not Grey Davis comes to mind.

Don't get me wrong I think that capitalism works but not for the general good rather for the individual good. While this is not evil it is not going to help the poor or others not on the radar. Nor will it provide cheaper healthcare plans as without regulation there is no impetus to lower prices.


As to the free market driving inovation, per usual you do not look at the whole picture. Drugs, technology and even farming techiniques are paid for with R&D credits and outright corporate welfare payments and then once the gvt finishes research the resulting product or idea is given at below market prices to corporations who make huge profits off of this PUBLIC/GVT reseach and innovation. Everything from advanced glues to guns

[xpanda]

As a Canadian, I find it terribly disappointing that the bulk of this debate is centred around analyses that dangerously resemble a profit and loss statement. There are so many other economic implications to sick and dying people being denied treatment, never mind the saddening domino effect it ultimately has on the formation of social policies aimed strictly at creating a society which places compassion high on its list of priorities.

While I won't purport that Canada has a system without its faults (it does take a while for non-emergency tests such as MRIs and the like) at least we know that we will never be denied care because the condition was pre-existing, or I was laid off from my job and my health care had to take a backseat for a time. We take care of each other here, and are very proud of that fact.

To do otherwise would be deemed immoral and inhumane. Some things just aren't meant to be run as a business.

[gopman]

"as without GVT regulation one almost always sees collusion between "competitors" to fix prices and maximize profits"

You're fighting a strawman here. No one is advocating that the government somehow completely abandon this industry. Even the market for little plastic bugs is regulated more than that. Insuring high risk people results in higher premiums at a higher risk, which is profitable if you insure a very large number. That is known in the statistics world as the "law of large numbers." Another thing that most consumers don't realize is that this would create a market for a reinsurance company (most people don't know this because they have no reason to). It is like insurance for insurance, and it spreads the risk even further, allowing insurance companies to bypass part of the risk of insuring high risk people, thus increasing profitability for everyone, and resulting in more people being insured. Mind you, I think the government should subsidize health care for the poorest.

Of course it costs alot to insure sick people. If someone waits to get insurance until they're already sick, that's their fault and they should pay for it, not everyone else. Particularly since they would no longer be paying a substantial portion of thier income to the medicare tax.

"there is no impetus to lower prices."

The introduction of substitutes through competition increases the elasticity of demand and causes prices to drop.

"I find it terribly disappointing that the bulk of this debate is centred around analyses that dangerously resemble a profit and loss statement."

I know what you mean, but I can assure you that we all have the best interest of the public in mind, just different ideas about how to get there.

[Missouri Mule]

Much of the problem with the American medical care system has to do with redudancy, inefficiency of paperwork and a propensity to overtest patients in the interests of dodging lawsuits. The ultimate consumer (patient) is not involved with the selection and cost of services and this leads to all kinds of excesses. These excesses must be dealt with in a political way or we will bankrupt the country.

[steve_in_mich]

For those of you who have used Medicare, Medicaid as a good example of how the government provides health care cheaper than private companies - are you aware that in most cases Medicare and Medicaid only pay a percentage of the cost that health care providers charge for their services? In many cases it is a very small percentage. There is a ton of cost that is incurred by the providers (and passed on to others) as a result of accepting Medicare and Medicaid.

Those who pay for private insurance in this country are subsidizing Medicare, Medicaid, the uninsured and to a certain extent Canada's health care system.

Again, most of the debate seems to center around who's going to pay as opposed to reducing the cost.

[JD3]

I guess this is how I see the situation:

Stuart H. Altman, Uwe E. Reinhardt, and Alexandra E. Shields, eds. The Future U.S. Healthcare System: Who Will Care for the Poor and Uninsured?

Joel S. Weissman
Harvard Medical School and Massachusetts General Hospital
Email: weissman@gem.mgh.harvard.edu

Well before the Clintons advocated health system reform, universal health insurance had been seriously considered by Congress during the Truman administration. The effort failed because a strong special interest lobby campaigned against it; many if not most middle-class Americans already had insurance and were enjoying the fruits of an economic boom, and the Republican party generally opposed universal health insurance. In addition, even the proponents of universal coverage could not agree on what form it should take. Sound familiar?

Despite grand efforts at reform, this country seems destined to revisit the issue of the medically uninsured again and again. It is the problem that won't go away and lately it seems as if it may be getting worse. The central question is not whether government intervention is necessary to ameliorate the consequences of there being too many people who lack the means to pay for adequate health care. The question is rather what form that intervention should take. The solution boils down to two options---what might be called the uninsured policy dichotomy. Either one can seek to expand ways in which to insure the uninsured, thereby reducing their numbers, or one can seek to fund, at adequate levels, the institutions that are willing to treat uninsured persons at reduced rates. The rest is just a matter of updating the numbers and providing more detail about programs that might work.

# http://www.jhppl.org/review/

The Future U.S. Healthcare System: Who Will Care for the Poor and Uninsured?

[DRMIZER]

All I can offer to this thread is my personal ongoing tragedy with health care.

My wife and I have an Aetna HMO. Due to the fact I have health issues, i.e. HBP & Diabetes, our monthly insurance premium is just over $1,000.00!

I have been unable to get any other carrier whatsoever at any price. People don't purchase insurance with money, they purchase it with their health.

We are not the only ones in this position and we are fortunate we have the means to cover it. However, those who work in a company, for example, have a group plan and may pay $125 a month. Those who are contractors

When I worked for a hospital, our ins. was $125 every two weeks which was reasonable. When I left the hospital, COBRA benefits jumped immediately to $675 a month.

These are facts. Unpleasant ones.

Any sugestions? :confused:

[mahayana]

I have some suggestions, but they may not be helpful!

You can forego you present policy and pay as you go, like the millions of others who can't afford insurance. Do your actual costs of treatment exceed $1000 a month?

You can try to survive until you are old enough for Medicare.

You can declare bankrupcy when your medical expenses take all you have, then apply for Medicaid.

The government and the insurance companies don't care about you. If it's any comfort, lots of others are facing the same kind of situation.

[Missouri Mule]

DRMIZER: You have my sympathy. You have your hands full.

My wife and I pay about $550 per month and our former employer pays out another $700 or so for about $1250 per month in insurance. Our health is relatively good but as we age we get more and more chronic diseases and these are expensive to treat but they must be treated or we will get even worse.

My wife landed in the hospital this past week for observation and I dread seeing the bills coming in. Yes, most will be paid for by insurance but I'm sure the numbers will be mind blowing. This cannot continue or as I said it will bankrupt the country. We spend something like 13.5% of our national GDP on medical care and this is substantially more than any other nation on earth. The costs jump up even more from year to year. A procedure that cost $29 in 1968 cost over $5000 last year, in my case.

Here is how the problem can be fixed and I'm being serious now.

We MUST have government funded elections and take all private money out of the election process. This will require a constitutional amendment. Otherwise we will never get the special interest money out of the process and they will therefore always have their voices heard while the rest of us peons will get the shaft. We must have "citizen legislators" who will actually listen to the people and do what is required.

Specifically, we need a single payer system. No redundancy and confusing insurance claims and flim flamery that goes no now. The costs of medical procedures will be prominently displayed and everyone will participate in the costs based on their declared income (verified by tax records). The ambulance chasing lawyers must be retrained to a different profession and stop with this nonsense of suing everyone in sight. The current insurance companies will provide the mechanism to process the medical claims as they already know how to do this efficiently and for a profit. (We already have government contracts for everything else so this is not groundbreaking but very practical.)

The Surgeon General should use his or her bully pulpit to promote healthy lifestyles and really work on the obesity epidemic that is sweeping America and soon the rest of the world. The chances of getting Type II diabetes is increased dramatically with age and weight increase. We can help ourselves. We must ensure that everyone's blood pressure is kept within safe limits. This is both achievable and necessary. Physical fitness such as runs, walks, and bike rides should receive the attention they deserve. Our schools should go all out in inculcating physical fitness in our educational curriculum. Cigarettes should be illegal to produce within the U.S. You could grow your own but no manufactured cigarettes would be sold over the counter.

People who rip off the system should be vigorously prosecuted and the perp walk ought to be on nightly TV.

That's for starters. I'm sure I could think of other ideas.

[DRMIZER]

You certainly have my vote. The insurance industry and health care industry needs desperate attention. Doctors here are dissatisfied with the PC hoops to jump through just to make a living. HMO's dictate treatment. PPO's for most people are out of reach.

And the fraud that goes on and on, especially here in Florida. It drives prices up and gives everyone a bad name. Doctors who commit fraud should pay just as well.

[JD3]

Originally posted by DRMIZER
You certainly have my vote. The insurance industry and health care industry needs desperate attention. Doctors here are dissatisfied with the PC hoops to jump through just to make a living. HMO's dictate treatment. PPO's for most people are out of reach.

And the fraud that goes on and on, especially here in Florida. It drives prices up and gives everyone a bad name. Doctors who commit fraud should pay just as well.

I agree. We must address the problem.

[TheRenegade]

I agree too. This is such a horrible problem, and one with a remedy that is not beyond our reach. Let's just pray that either the current administration or the next one does something about this.

[mahayana]

I'd like to see a pie chart of where a dollar for healthcare goes.

I'll bet the doctors and nurses get less than ten cents.

If anyone has such a visual aid, please post it. Thanks.

[JD3]

Originally posted by mahayana
I'd like to see a pie chart of where a dollar for healthcare goes.

I'll bet the doctors and nurses get less than ten cents.

If anyone has such a visual aid, please post it. Thanks.

So would I. I saw one once but I can't find it. If I do, I'll post it.

[Voice Of Reason]

I am really lucky being retired military.........I only have to pay a few dollars a month for my health insurance.......Of course it was promised to me that if i made the miltary a career I would not have to pay anything.........

Clinton changed that though..........

My Prescription drugs are free........A few years ago my wife had Ovarian Cancer and had to have major surgery..She was in the hospital for 10 days with 5 in IC.........The bill was $137,000 of which I had to pay $10. a day for her stay in the hospital.........

Needless to say my medical benefit is a very important one........I don't have to be told that............

[mahayana]

VOR- do you know what percentage of the population is now covered by government? I don't. It's old people, very poor people, disabled people, kids whose parents meet the guidelines, everyone in the military and their families(active and retired), people who are employed by the government, politicians.

Would you guess 30-40%?

I'd like to see a great extension of the local Public Health departments, get an emergency room and doctor in every one of them, set it up where everything is cash , and doctors working there can't be sued.

As a start.