Armed Polite Society
Main Forums => The Roundtable => Topic started by: Chris189 on November 16, 2008, 01:11:17 PM
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If you oppose Universal Health Care what other altenatives are there? I think most would agree the state of health care is the US in bad shape.
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Be more specific as to what u mean healthcare is in a bad shape.
The main reason insurance/costs are so high is due to the stupid lawyers . Tort reform would fix most of the problem and eliminate the need for testing to cover the doctors ass.
Healthcare here is better than anywhere in the world. Universla healthcare will not work on this large of a population(it barley works in smaller populated countries). In some socialist countries you have to wait years before you can have things done.. it is no solution.
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In bad shape? Are you taking about how fat everyone is?
If we are in "bad shape" why are people from other countries coming here? The solution to any "problems" is to remove socialism and let doctors practice medicine and make money (instead of filling out forms).
Look at cosmetic surgery or laser eye correction. Make all of medicine exactly like these procedures.
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I think most would agree the state of health care is the US in bad shape.
Au Contraire. I've recently gone through two fairly serious health scares, and the one thing that sticks in my memory is the exhaustive batteries of tests that led up to favorable diagnoses in both cases. None of the tests cost me a nickel, beyond the $379 per month I pay for group health insurance. This was at a smallish suburban hospital complex in NoVA.
TC
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If you've ever been sick with no insurance, you might agree that something needs to be done, otherwise, yeah, not much is wrong, as long as you either have a lot of money, or good insurance through your job.
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Not politics.
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I think most would agree the state of health care is the US in bad shape
We may not have the best but to say that it is in bad shape is just not true. We are in much better shape than most countries with universal health care. My sister in New Zealand was asked to wait 2 months to have a biopsy. Here in the US, whether you have insurance or not, the biopsy will be done in days as soon as the doctors suspect cancerous tissue. What's driving up the cost of health care are:
- excessive litigation / unreasonable jury awards
- non-paying / uninsured patients (a good portion if not a majority are illegal immigrants)
- govt. regulations - Some states require coverage for alcohol/substance abuse on all policies. Some require that all health insurance carriers are from within the state (limiting competition and market efficiencies).
- to some extent, the profit margin of health care companies and excessive CEO compensation.
Some of the things that can be done are:
- tort reform - limit the jury awards for pain and suffering. Have an automatic "losers pay" system so that ambulance chasers stand to lose something when they fail to get a guilty verdict. But at the same time, have a strict policy on doctors who have a history of malpractice. Have a 3 or 5 strike rule so that once a doctor has reached his limit, his license is suspended for n years.
- enforce immigration laws. If people insist that they be free to not buy health insurance, then allow the hospitals to be free to turn patients away when they have reasonable suspicion that the bills will not be paid. Otherwise, require all to have minimum coverage (at least for emergency cases).
- deregulate - allow patients to buy the coverage they need and remove those that they can do without. Allow inter-state competition.
- and my favorite - put a cap on CEO pay for publicly traded companies. The cap however, should not be an arbitrary number but it should be a ratio between the average rank-and-file salary and the CEO's total compensation.
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- and my favorite - put a cap on CEO pay for publicly traded companies. The cap however, should not be an arbitrary number but it should be a ratio between the average rank-and-file salary and the CEO's total compensation.
Ah yes, the solution to all our problems is to stop paying CEO's so much money!!!!
Please, PLEASE come save us, government! Those greedy corporate executives are stealing my money by force!
Oh wait, only one entity in this country has a monopoly on force...
So, MAYBE those executives get paid so much because they are worth it.
If they aren't, why doesn't some other, private company just cut costs and beat them out?
Here's a clue, it's never the fault of the market. It's the fault of government interference and seperates costs from benefits.
Instead of MORE government involvement (as they are involved in over 40% of medical care now), let's try less and see if that solves it.
NOW, can someone tell me why government interference is the only problem where the solution is more of it?
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Is healthcare in the US perfect? Of course not. However the answer is not to make it worse by putting the .Gov in charge.
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IMO, I think most of the problems are either caused by government regulation or over-reliance on 3rd party payers where patients never see the bill.
If 3rd party payers were eliminated tomorrow, doctors and hospitals would do just like the lasik eye surgery guys and have all sorts of financing options for people. It wouldn't do them any good to kick out patients since few people could write checks for some of the testing done these days.
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Ah yes, the solution to all our problems is to stop paying CEO's so much money!!!!
Please, PLEASE come save us, government! Those greedy corporate executives are stealing my money by force!
Oh wait, only one entity in this country has a monopoly on force...
So, MAYBE those executives get paid so much because they are worth it.
If they aren't, why doesn't some other, private company just cut costs and beat them out?
Here's a clue, it's never the fault of the market. It's the fault of government interference and seperates costs from benefits.
Instead of MORE government involvement (as they are involved in over 40% of medical care now), let's try less and see if that solves it.
NOW, can someone tell me why government interference is the only problem where the solution is more of it?
You mean like all those CEOs of failed banks which still stand to receive their bonuses? The US has developed a culture of paying CEOs far more than they really are worth even when the company is spiralling towards the ground.
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"The US has developed a culture of paying CEOs far more than they really are worth even when the company is spiralling towards the ground."
So you're perfectly fine with the concept of the government stepping into determine exactly what an individual's services are worth?
Interesting.
Tell me, where should it end?
If CEOs, why not attorneys and doctors?
If attorneys and doctors, why not teachers and system administrators?
If teachers and administrators, why not simply make EVERYONE subject to the same sort of worth analysis?
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I think most would agree the state of health care is the US in bad shape.
Where did you get that idea? besides having been told it so much you just believe it.
I recently went thru major surgery. Couldn't ask for better health care, PERIOD. They did an amazingly good job, both medically and bureaucratically. Out-of-pocket cost was about 2% of 6-digit total. Paperwork was easy. Processing was fast & efficient. Recovery was rapid and nearly flawless.
Most people DO have good health insurance. I mean seriously: most people have little to complain about.
Of the relatively few who allegedly don't have good health insurance:
- many choose not to. The young and healthy often choose to go without, take the risk, and apply the money elsewhere. Ya makes yer choices and takes yer lumps.
- some can afford it but don't. This gets into the very fuzzy area of what constitutes "can't afford", as in "if you have cable TV and eat out often, get your priorities straight". Plan ahead; stuff happens, be ready.
- a few can't afford ideal coverage. Face it: ideal medical care is VERY VERY EXPENSIVE. I hate to be cold-hearted, yet have to say "cope" when it comes to many conditions (and you know what I mean, don't twist this sentence). You may very well have to choose some of the less desirable (but still very acceptable) options.
- a few simply can't afford it. This is actually a very small number relative to the overall population. You want the government to help them? Fine - but don't lump in the 99% who can take care of their own medical issues & costs.
You want free care? Walk into the ER. There's a sign by the entrance saying "you will be treated without regard to ability to pay." Yes they'll hand you a bill, which you can work out with them. Most people can pay SOMETHING, even if it's $10/month for life. Extremely few truly can't pay, so stop with the "but what if they can't pay" BS - the system eats those costs anyway.
The health care itself is top-notch. If anything, it's over-the-top because doctors are persuaded to make sure NOTHING gets by them - which, very understandably, gets rather expensive real fast. Face it: the USA has the best health care system in the world, easily accessed by most people WITHOUT a "universal health care" beaurocracy. Yes, there are a few horror stories, many of which are bogus (ex.: can't afford $50/month for meds but can afford $50/month for TV), some of which are inevitable screwups (of 300,000,000 people, SOMEONE will have a problem), and some of which are valid (sure, let's make a safety net for the truly needy).
We have Medicare, Medicaid, walk-in no-questions ER, and a host of other programs in place to catch the few who truly can't swing their own health care costs. We have a fantastically advanced and efficient medical infrastructure. Expensive? heck yeah, that's reality - and yet an incredible amount is done to make it accessible to all.
NOW... explain to me again why you think the state of health care is the US in bad shape. Don't just regurgitate the talking points, address what I just wrote.
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You mean like all those CEOs of failed banks which still stand to receive their bonuses? The US has developed a culture of paying CEOs far more than they really are worth even when the company is spiralling towards the ground.
Well, yeah - what do you expect when a large corporation can fail and the government will pour gobs of money into it? The money is there, they'll take it. Bank fails? oh, FDIC will make sure all the accounts are covered - ergo the top managers dip into the non-depositor-account coffers and take their legally-mandated bonuses. When a bank "fails", it really doesn't - the money & paperwork just gets shuffled around differently. Remember all those banks that "failed" recently? They're still up & running, just under different names & managers. Nothing "failed".
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Isn't it strange that a lot of the so called "poor" can afford cell phones but cannot afford health insurance? Recent articles attribute the growth of iPhone sales to those with income between 25K - 50K. Sales to those with income of 100K and above show a modest growth of 16% but 48% growth from those in the said lower income bracket.
http://www.edibleapple.com/lower-income-consumers-drive-iphone-growth/ (http://www.edibleapple.com/lower-income-consumers-drive-iphone-growth/)
http://ipod.about.com/b/2008/04/15/teens-drive-iphone-sales.htm (http://ipod.about.com/b/2008/04/15/teens-drive-iphone-sales.htm)
(https://armedpolitesociety.com/proxy.php?request=http%3A%2F%2Fedibleapple.com%2Fwp-content%2Fuploads%2F2008%2F10%2Fchart2.gif&hash=b338bafed6dd1d2f46aaa5c2c18cb840cd83e72d)
So they have the money to plunk down on toys but they want everyone else to pay for their healthcare.
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You mean like all those CEOs of failed banks which still stand to receive their bonuses? The US has developed a culture of paying CEOs far more than they really are worth even when the company is spiralling towards the ground.
To quote from another thread, only whinny little bitches care how much money other people make.
As for the state of health care in the US, what's so wrong about it? The best health care anywhere in the world is available here. Yeah, sure, that health care is expensive. Good services of any sort are costly. TANSTAAFL.
If you want those services, then go out and earn the money and buy them. If you don't want those services, then don't bother. It's you're choice. This is a free country, after all. Sort of.
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If you oppose Universal Health Care what other altenatives are there? I think most would agree the state of health care is the US in bad shape.
Most?
MOST?
What's the number of uninsured in the US? 30 Million out of 300 Million? That's only 10%. I suspect that's what your worried about - the uninsured.
But the uninsured really don't have to worry much. All they have to do is walk into any emergency room, complain and they get treated. My scumbag of a brother is on welfare and is being treated with interferon for Hep C over a 9 month period. The worthless teat is costing the taxpayers thousands and thousands of dollars, maybe 100's of thousands for all I know and he's never earned an honest dollar in his life. It's no different for any other worthless teat. All they have to do is ask.
With insurance you can get what ever health care you need or want. What you can't get insurance to pay you probably don't really need anyway. In and out of the doctor's office on the same day you call in for an appointment for important stuff in my and my family's experience. And the care you get you get from competent well trained doctors (yeah - yeah there's some boobs out there but I don't imagine they last too long as Doctors). For the less important stuff like having a wart removed off your backside you might have to wait a week or so but so what. That's instantaneous compared to some places like Canada or Britain where you might have to wait 6 months or a year for a heart operation to save your life. In the US you'd get that same day if necessary.
The only people that think the state of healthcare in this country is BAD are the sheep and bleeding hearts who believe the crap politicians (who know it's not true) feed to them.
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The only people that think the state of healthcare in this country is BAD are the sheep and bleeding hearts who believe the crap politicians (who know it's not true) feed to them.
"I'm smart and everyone who disagrees with me is dumb!" ;/
You want free care? Walk into the ER. There's a sign by the entrance saying "you will be treated without regard to ability to pay."
One of the main areas I think our system has problems is in preventative care. Universal health care seems to do a better job of treating small problems before they become large (expensive) problems. Letting everyone get coverage through the emergency room, the most expensive and probably least effective way possible, is not at all efficient.
While I'd rather not pay for some bum to get free check-ups, it's better than paying for his trips to the emergency room that will cost 10 times more.
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Healthcare is 90% on you. What causes most disease? Lifestyle. If you don't exercise regularly or eat healthy, why should I have to pay for your healthcare? This is my only problem with universal healthcare. I don't mind taking care of people who are taking care of themselves, everyone needs a little help occasionally. However, I think the people who don't help themselves do not deserve to receive help from anyone else. Same way I feel about "spreading the wealth", why the hell should I be helping people who don't/won't help themselves.
Other factors that I think play a role:
-insurance companies need some kind of oversight. People shouldn't have to worry if their insurance is going to cover their illness.
-alternative medicine needs more attention. Drugs don't solve everything. Drug companies also have way too much power over the FDA.
-illegal immigration
-malpractice lawsuits (but at the same time, doctors must be held to a high standard)
I think the major question here is: Is healthcare a right? Do we have the right to healthcare, or the priviledge? I remain torn on this matter. Not everyone that works hard has access to affordable healthcare.
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I think the major question here is: Is healthcare a right? Do we have the right to healthcare, or the priviledge? I remain torn on this matter. Not everyone that works hard has access to affordable healthcare.
In a socialist hell-hole - healthcare is a right.
In a free society health care is a personal responsibility.
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While I'd rather not pay for some bum to get free check-ups, it's better than paying for his trips to the emergency room that will cost 10 times more.
All you'll end up with is paying for the ER trips along with the "free" check ups. The ER trips are usually due to lifestyle choices, which the check up won't fix . . . unless you want to begin mandating how people live their lives down to the least detail. Perhaps along with universal health care we can have prison sentences for making socially unacceptable food choices.
Socialized medicine is great, until you run into the problem that you can't pay for more than a basic level of care for everyone so the system starts deciding who is more valuable. That's why people who can afford quality care go elsewhere. It's not just that they can afford to do so; it's that they want to need to get treatment that the socialized medical system cannot provide in time (waiting time for CAT scans can be in months, which is a death sentence for many conditions) or won't.
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In a socialist hell-hole - healthcare is a right.
In a free society health care is a personal responsibility.
I agree for the most part, but not always. What about kids with cancer? What about my buddy who is working on his physics bachelors while working 2 restaurant jobs and has diabetes (not many restaurants offer healthcare)? Once he has his degree and a good job he'll have insurance again, but for now he's rather screwed, he pays for everything out of pocket.
Like I said, I think that ~90% of healthcare is your responsibility. Lifestyle is very obviously a major contributing factor for disease, but so is environment. I guess what I'm saying is that it's not so cut and dry as you are suggesting.
Obviously there are people in this country who work hard, and if they get very sick, they are in deep trouble. Is that right? I'm not talking about the bums, I really don't care about most of them. I'm specifically talking about the people who work hard at jobs that do not offer healthcare to employees. What about them?
By the way, this is a really weird conversation for me, I'm usually debating democrats on how much I hate universal healthcare.
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I agree for the most part, but not always. What about kids with cancer? What about my buddy who is working on his physics bachelors while working 2 restaurant jobs and has diabetes (not many restaurants offer healthcare)? Once he has his degree and a good job he'll have insurance again, but for now he's rather screwed, he pays for everything out of pocket.
Like I said, I think that ~90% of healthcare is your responsibility. Lifestyle is very obviously a major contributing factor for disease, but so is environment. I guess what I'm saying is that it's not so cut and dry as you are suggesting.
Obviously there are people in this country who work hard, and if they get very sick, they are in deep trouble. Is that right? I'm not talking about the bums, I really don't care about most of them. I'm specifically talking about the people who work hard at jobs that do not offer healthcare to employees. What about them?
By the way, this is a really weird conversation for me, I'm usually debating democrats on how much I hate universal healthcare.
Don't we have CHARITIES for such things?
Why is it, when people see suffering, they think- I need to force other people to pay for that!
How about asking people to pay for it. You'd be surpised, the U.S. is the most charitable place on earth.
Why is it everyone thinks the government MUST BE the solution?
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Obviously there are people in this country who work hard, and if they get very sick, they are in deep trouble. Is that right? I'm not talking about the bums, I really don't care about most of them. I'm specifically talking about the people who work hard at jobs that do not offer healthcare to employees. What about them?
It's sad. Really, I mean it. It is sad and even tragic that some deserving folk, through no fault of their own other than bad genes or just rotten luck, cannot afford the healthcare they need. Some would say it isn't fair.
But - well - that's life. It ain't fair. GOD doesn't hand out certificates of fairness when one is born guaranteeing that life will always be fair.
SUCKS!
But what ya gonna do?
OH WAIT! I know. The socialists want to steal our money and spread it around so that everyone gets access to healthcare. Yeah that's the ticket. Spread it around. AND Pay government doctors diddly squat so the smart ones go where they aren't paid diddly squat and those who aren't doctors but want to be except they don't want to work for diddly squat don't become doctors and what you're left with are incompetent boobs and too few of them to treat real problems so everyone gets to suffer.
YEAH! THAT'S FAIR. THAT'S FAIR...
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Don't we have CHARITIES for such things?
Why is it, when people see suffering, they think- I need to force other people to pay for that!
How about asking people to pay for it. You'd be surpised, the U.S. is the most charitable place on earth.
Why is it everyone thinks the government MUST BE the solution?
Of course we have charities for that sort of thing. But we're going to ignore the roll of charities, because that let's government take over the health care industry and control everyone's lives.
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It's sad. Really, I mean it. It is sad and even tragic that some deserving folk, through no fault of their own other than bad genes or just rotten luck, cannot afford the healthcare they need. Some would say it isn't fair.
But - well - that's life. It ain't fair. GOD doesn't hand out certificates of fairness when one is born guaranteeing that life will always be fair.
SUCKS!
But what ya gonna do?
As mak says, private, voluntary charities are the correct answer for that situation.
That won't stop the power hungry big government types from using unfortunate circumstances as an excuse to grab more power.
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There is one things that bugs the crap out of me when it comes to insurance: The variety of ways they will cover a given procedure.
Procedure A should be covered at the agreed upon rate period. Not 80% because it was diagnostic vs 100% because it was preventative. I had such a procedure done last year. Guess how the doctor submitted it to the insurance...
Not that I have a problem paying, it's just that I dislike that much of it is at the whim of doctors and insurance companies.
Chris
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I am not for universal healthcare, nor socialism. Just thought I'd clear that up. I am just saying that yes, there IS a problem, for some people. I completely agree that universal healthcare is not the solution. Let me say it again, I completely agree that universal healthcare is not the solution.
I don't know what the solution is.
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the insurance companies play that game in all arenas 8 years ago i did a fire restoration over your way the insurance company would only pay 12 bucks a sheet for drywall hung and finished rate was closer to 20 but the adjuster advised/allowed me to pad the number of dumpsters they paid for to make it up
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http://www.medscape.com/viewarticle/567737 (http://www.medscape.com/viewarticle/567737)
For the sixth consecutive year, the number of Americans living without health insurance has risen, according to new U.S. Census Bureau data. Approximately 2.2 million people were added to the uninsurance rolls in 2006 — the largest one-year increase in the number of uninsured Americans since 2002.
Annual Census Bureau estimates released in August show 47 million people, or 15.8 percent of the U.S. population, were without health insurance during 2006 — a 4.9 percent increase. In 2005, census figures showed that 44.8 million people, or about 15.3 percent of the population, lacked health insurance coverage.
The whole problem will not be solved if we just deny those 47 million care until they hit the emergency room, at which point they'll get a bill for $10,000 to cover the cost of a CT scan and a checkup after an automobile accident.
Whatever attachments you have to the U.S. healthcare system, dollar for dollar, it is less efficient at delivering services than any other system in the industrialized world. This is something you can measure by comparing availability and provision of services per capita to the price paid per capita-when you get similar levels of service for half the price somewhere else, the light bulb that beams "inefficiency!" should be going off.
Take a look at the cost for individual medical insurance (which, many of you are forgetting, will exclude all pre-existing conditions)....then show me a cable service or a cell phone service that charges nearly that much on average.
It's tough to afford individual medical insurance because it's usually nearly the same price as the rent, and because it does not cover everything, and most of all because.....you can't keep up the premiums if you can't work due to a major illness.
It is simply not possible, at U.S. prices, for an easy 90 percent of the population to pay outright for treatment of a life-threatening illness like cancer or some other problem that requires intensive therapies.
Lose a job while sick, get sick while in a job that doesn't give insurance, or try to keep up private health cover while sick, and suddenly the beauty of the system isn't so apparent. I saw it over and over when I worked on insurance coverage disputes.
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The whole problem will not be solved if we just deny those 47 million care until they hit the emergency room, at which point they'll get a bill for $10,000 to cover the cost of a CT scan and a checkup after an automobile accident.
This, right here, is the fundamental problem with the universal health care argument. "We" aren't "denying" anyone health care. It isn't "our" job to give anyone their health care, and it never has been. It's their job to give it to themselves, if they want it.
What the hell happened to personal responsibility? How has such an important concept been so universally forgotten in our society?
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This, right here, is the fundamental problem with the universal health care argument. "We" aren't "denying" anyone health care. It isn't "our" job to give anyone their health care. It's their job to give it to themselves, if they want it.
What the hell happened to personal responsibility? How has that been so universally forgotten in our society?
And that is the crux of the debate: The argument in favor of keeping this system has nothing to do with efficiency or providing care; it is strictly ideological. "Yeah, maybe we would spend less overall and more people would get care...but that's unfair! That would require me to believe that people have a right to receive medical treatment!"
Personal responsibility, ie, that you have no rights to anything other than what you can snag out of the marketplace, has not been forgotten...it is largely a 20th century creation. Even feudal landlords believed their peasants had a minimal right to sustenance. But again, that is another debate, about whether what you happen to believe is fair or not.
The factual question of whether or not this healthcare system is efficient doesn't turn on your belief that nobody has a right to receive medical care.
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If you think that more government would make the health care industry more efficient, then you're living in a dream world.
Maximum efficiency (which will never be achieved by government anyway) isn't even the proper goal. Maximum opportunity is the goal. Give everyone free opportunity to acquire as much health care as they can, and in whatever form they want, to the best of their ability.
Many people in our country don't have health insurance because they don't want it. I deliberately did without it for years, myself, and for good reason. My resources, like anyone's, were limited. There were better things I could do with those resources to improve my life. Under a universal health care system, I'd be forced to waste some of my limited resources to buy something I didn't want, thereby depriving me of even more important things. That isn't right.
It comes down to basic economics. Arbitrarily forcing people to spend resources on health care means stealing resources away from other places where they'd be better utilized. That doesn't benefit people individually on in total. Instead, give people the opportunity to choose to buy health care, if they want it and in whatever fashion they want it. That is the way to maximum benefit for all.
I haven't yet seen a good reason to force anyone to provide health coverage for themselves if they don't want it. And there is NO good reason to force anyone to provide health care for other people who aren't willing to provide it for themselves.
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If you think that more government would make the health care industry more efficient, then you're living in a dream world.
There's no need to imagine-you can see for yourself that per capita expenditures are much lower, and per capita provision of services equivalent, in many countries where there is more government in the healthcare industry. http://assets.opencrs.com/rpts/RL34175_20070917.pdf (http://assets.opencrs.com/rpts/RL34175_20070917.pdf)
That's pretty much the definition of efficiency: same service/amount with lower cost. And the numbers are clear.
Note that most of your argument isn't about efficiency, and deals with none of the numbers, it's about what you think is fair. But we'll consider that too.
This idea that you have: Under a universal health care system, I'd be forced to waste some of my limited resources to buy something I didn't want, thereby depriving me of even more important things. That isn't right.
is a convenient fiction. You gambled on not getting ill, which is fine...knowing that if you collapsed in a hallway somewhere, you'd be taken to an emergency room and treated. And guess what would happen to the medical bill in that case?
Written off by the hospital, or paid in small increments forever by you, until the remainder becomes uncollectable for whatever reason. In other words, someone else bears the cost, because you couldn't possibly have paid for it without insurance (virtually no one can-the prices are too high.) And to top it off, you end up in debt for life, possibly completely financially destroyed, and other people still have to pay your bill because the inefficient system generates outrageous prices.
It's the worst of both worlds: other people are still forced to bear the costs, and the individual is completely ruined by massive debts that he/she won't ever pay off and couldn't if he/she wanted to.
The only way to ensure that other people don't end up paying for your treatment is to deny emergency care to the seriously ill and unconscious, which is barbaric and never going to happen.
The good reason for making everyone pay in is that everyone may end up imposing costs on others, substantial costs, for medical care. Refusing to contribute to the system that takes care of everyone is gambling with other people's money.
This of course assumes that you can't deny people lifesaving emergency care without first obtaining payment, which is a reality and a good one, imho, but in any case, however unfair you think that reality is will not change it.
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In fact, part of the problem is the existence of health insurance. Yeah, I know that's heresy.
Back before 'health insurance', doctors and hospitals had to deal directly with customers. If the patient-customer could not pay, they didn't get health care; however, if too few people got health care, doctors and hospitals didn't get paid. So doctors and hospitals negotiated prices and made deals with the patient-customer.
With the spread of 'health insurance' which is actually 'pay the doctor and hospital' insurance, doctors and hospitals realized they would get paid after all. And their rates went up. For those who didn't have insurance, too bad.
The government at various levels got in the act. However the government influence was two fold.
One, the governments passed all sorts of 'regulations' to make patients safer. Like a legislator knows jack about 'safety'. What this really boils down to is lots of intricate legalities about this and that, and reams of reports to be filed to assure the legislature the doctors and hospitals are following the letter of the ignorant laws. (Consider all the laws passed by governments to make sure you are safe from your own firearms - get the picture?)
Two, governments at various levels instituted 'programs' to help those poor unfortunates who can't afford medical (make sure the doctor and hospital gets paid) insurance. This of course was funded by mostly the poor unfortunates who could almost afford medical (make sure the doctor and hospital gets paid) insurance. Regular working people.
Now, the same pack of loonies who screwed up the health care system in the first place want to socialize it. Just take away all private choices and issue doctors to patients.
I'd like to see a free market approach, myself. Get government completely out of providing health care, and leaving regulation of health care to independent agencies. Trouble is, no one has the sand to seriously suggest such a thing, and most of the populace has been brainwashed into thinking the government has to do it.
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There's no need to imagine-you can see for yourself that per capita expenditures are much lower, and per capita provision of services equivalent, in many countries where there is more government in the healthcare industry. http://assets.opencrs.com/rpts/RL34175_20070917.pdf (http://assets.opencrs.com/rpts/RL34175_20070917.pdf)
That's pretty much the definition of efficiency: same service/amount with lower cost. And the numbers are clear.
Note that most of your argument isn't about efficiency, and deals with none of the numbers, it's about what you think is fair. But we'll consider that too.
As I said, maximum efficiency isn't the goal. I don't recall anywhere in the constitution that delegates authority to FedGov to maximize the efficiency of health care.
This idea that you have:
is a convenient fiction. You gambled on not getting ill, which is fine...knowing that if you collapsed in a hallway somewhere, you'd be taken to an emergency room and treated. And guess what would happen to the medical bill in that case?
Written off by the hospital, or paid in small increments forever by you, until the remainder becomes uncollectable for whatever reason. In other words, someone else bears the cost, because you couldn't possibly have paid for it without insurance (virtually no one can-the prices are too high.) And to top it off, you end up in debt for life, possibly completely financially destroyed, and other people still have to pay your bill because the inefficient system generates outrageous prices.
Wrongo, bucko. If I had needed medical coverage during that time, I would have paid for it myself. If the cost had exceeded my means, then my parents could have and would have picked up the excess. This was a risk I/we took willingly.
Truth is, I didn't need health insurance. Statistically I was as unlikely to become ill as anyone ever can be. Any premiums I would have paid would have been wasted money from my standpoint, given the near zero chance I'd make a claim. It was far less expensive for me to simply pay for routine care out of pocket. The money I saved helped me put myself through college, which has benefited me far, far more than the health insurance would have.
Free choice allowed me to receive maximum benefit, uniquely tailored to my own individual circumstances. That's the way free choice tends to work, ya know.
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When will the august group discuss the distortions imposed by gov't heavy hand? Yeah, we have a problem but how much of that problem is a direct consequence of helpful senators trying impose their vision of utopia on the little people.
--Why is healthcare tied to employment
--Why are risk pools limited to state boundaries
--Why do I have to buy insurance from a state sanctioned company
--Why do doctor's office personnel go stupid when you tell them "I will pay my own bill. You don't have to bear the costs of filing for my insurance.
--Why is age related medical premiums not considered a form of employment discrimination.
--Why does a doctor who spent 10 years in training have to answer to an insurance clerk.
--Why are companies that are self-insured (up to a stop loss limit) permitted to fire people whose medical expenses pierce the limit.
--Why does the state retain the right to specify the kind of coverage I can buy. I don't need massage therapy so why should the insurance company be require to price the risk in.
--Why is employer offered insurance deductible from dollar one on the employer's taxes, yet a lowly individual has to jump over a 7-1/2% fence to deduct premiums and costs on personal taxes.
. . . . . just off the top of my head.
MedicalCareHealthInsurance is really screwed up. The answer is not to give the ship of fools who created the mess even more power to fix the mess.
<breathes deeply, focuses on a distant object>
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As I said, maximum efficiency isn't the goal. I don't recall anywhere in the constitution that delegates authority to FedGov to maximize the efficiency of health care.
Wrongo, bucko. If I had needed medical coverage during that time, I would have paid for it myself. If the cost had exceeded my means, then my parents could have and would have picked up the excess. This was a risk I/we took willingly.
So much for personal responsibility-but in any case, at current prices, it's entirely possible for you and your parents to have been unable to pay. And the important thing is that many who don't buy insurance to "invest in other resources" or whatever you were doing with the cash will not be able to pay-just like uninsured drivers.
The truth about your needs is simply a statement about how you viewed the gamble-but it was still a gamble, and it still involved imposing costs on others because you realized that you would be taken to a hospital in the event of a collapse.
Now your "efficiency" and "maximum benefit" arguments turn on the fact that you personally didn't get sick when you didn't buy insurance. I don't see how that:
1) Has anything to do with the efficiency of the medical system
or
2) Addresses the problem of imposing costs on others, which is still a real concern, even if your gamble paid off and you didn't need mommy and daddy to either rescue you from bankruptcy or to become bankrupt themselves attempting to pay off a massive debt. Plenty of uninsured drivers make it home without a wreck too, but there's still a gamble with other people's money involved.
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So much for personal responsibility-but in any case, at current prices, it's entirely possible for you and your parents to have been unable to pay. And the important thing is that many who don't buy insurance to "invest in other resources" or whatever you were doing with the cash will not be able to pay-just like uninsured drivers.
A voluntary arrangement for all concerned, personal responsibility at its finest, people taking care of themselves. At current prices it isn't possible for me and mine to be unable to pay. Not in any realistic scenario.
Yup, it was a risk, but it was a risk we took ourselves, willingly. We know that it's impossible to eliminate risk completely, that to try is folly, and that it's smart to choose your risks carefully. Thankfully we had choice, and I benefited from it.
Anyway, enough of that stupid argument. You seem to be obsessed with efficiency, so let's talk about that.
Read Archie's post. It strikes to the heart of the matter with regard to costs and efficiencies. Whenever you remove the incentives to economize, costs naturally tend to rise. The way to reduce costs is to strengthen the incentives to economize, not weaken them. Once again, we're back to basic economics.
Government health care would eliminate those incentives completely. People have zero, zilch, nada incentive to use less care when someone else is paying for it. Rationing is the inevitable result. Whether it comes in the form of direct usage limits, or in the form of price controls, or in the form of reduced quality of care, it all amounts to the same thing.
At least under the current system of private insurance, the piper must always be paid in the form of premiums. Insurers and people buying insurance must agree to a mutually beneficial balance between the cost of premiums and the sorts of medical costs the insurer will cover. People now have the option of buying the coverage that best suits their unique needs and circumstances. Or like me, they can do without when that's best.
The best way to reduce costs would be to increase patients' incentive to economize. Give the patient a range of treatment options, and let him decide which is the best blend of cost and benefit for himself. Make sure the patient receives the economic benefit from choosing a less expensive option. Doctors and patients will naturally turn to less expensive alternatives whenever they exist.
That is the road to maximum efficiency and reduced costs. Obviously it's too much of a market-based solution, so you'll never go for it.
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Real quick... I need to head to work, but I wanted to add my thoughts before they escape.
I haven't read the whole thread, so I apologize if this has been said.
Heath care is not a right, neither is health insurance. There are services that are purchased by the user, much like paying a person or company to mow your lawn. The largest "problem" effecting the health care/health insurance industry is that there are too many believe that HC/HI should be given to them outright without any fees or consequences.
If a person can afford to pay for his own HC/HI or can get his company to pay for it as part of his employee benefits package, then that is great. But under no circumstances should one person expect another person to pay for his HC/HI. No way. no how.
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But under no circumstances should one person expect another person to pay for his HC/HI. No way. no how.
I don't know about that. If you give your life over to another entity completely, you should expect them to take care of you. That's the ultimate goal of the left, isn't it? Of course, you lose control over what you eat and do, but that's coming anyway with the lawsuits against the food industry and suggestions for "fat" taxes.
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If you oppose Universal Health Care what other altenatives are there? I think most would agree the state of health care is the US in bad shape.
Instead, I pose you this question:
Do you think that the government does a good job at anything? Have you ever been a part of a government bureaucracy?
I have been, twice. The military, and the FAA. Trust me, if you turn over health care to our government, it will cost more than they said it will cost, be half as efficient, and take twice as long.
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Instead, I pose you this question:
Do you think that the government does a good job at anything? Have you ever been a part of a government bureaucracy?
I have been, twice. The military, and the FAA. Trust me, if you turn over health care to our government, it will cost more than they said it will cost, be half as efficient, and take twice as long.
I am also a part of the government bureaucracy.
You REALLY do NOT want them to have ANYTHING to do with your life. The government does not help, it merely hinders.
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Give the patient a range of treatment options, and let him decide which is the best blend of cost and benefit for himself. Make sure the patient receives the economic benefit from choosing a less expensive option. Doctors and patients will naturally turn to less expensive alternatives whenever they exist.
Could you be more specific about how what you're suggesting is different than what we currently have? I mean, what is preventing a patient from choosing the other less expensive options under our current system? What specifically are you saying needs to be changed so that these options are available?
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Could you be more specific about how what you're suggesting is different than what we currently have? I mean, what is preventing a patient from choosing the other less expensive options under our current system? What specifically are you saying needs to be changed so that these options are available?
Allow me to illustrate for you:
Make sure the patient receives the economic benefit from choosing a less expensive option.
Noting is STOPPING him from doing that. Nothing is BENEFITTING him when he does that either.
Let's say I come to you and tell you you can have steak or McDonald's. It will cost you the same whichever you choose.
What are you going to choose?
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Isn't it strange that a lot of the so called "poor" can afford cell phones but cannot afford health insurance? Recent articles attribute the growth of iPhone sales to those with income between 25K - 50K. Sales to those with income of 100K and above show a modest growth of 16% but 48% growth from those in the said lower income bracket.
http://www.edibleapple.com/lower-income-consumers-drive-iphone-growth/ (http://www.edibleapple.com/lower-income-consumers-drive-iphone-growth/)
http://ipod.about.com/b/2008/04/15/teens-drive-iphone-sales.htm (http://ipod.about.com/b/2008/04/15/teens-drive-iphone-sales.htm)
(https://armedpolitesociety.com/proxy.php?request=http%3A%2F%2Fedibleapple.com%2Fwp-content%2Fuploads%2F2008%2F10%2Fchart2.gif&hash=b338bafed6dd1d2f46aaa5c2c18cb840cd83e72d)
So they have the money to plunk down on toys but they want everyone else to pay for their healthcare.
an Iphone costs about 1,200/year.
Insurance costs about 12,000 a year.
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I am also a part of the government bureaucracy.
You REALLY do NOT want them to have ANYTHING to do with your life. The government does not help, it merely hinders.
Another fed gov't worker here. You do NOT want the gov't involved. My agency is better than most, and we get fed (no pun intended) up with the crap the rest of the gov't piles on us.
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Something I have not seen mentioned in this debate...
If we declare healthcare a right at what point does the government then have to force the healthcare providers to perform these services? If we socialize healthcare will Medical professionals like doctors and nurses be allowed to quit and change proffessions if they decide thre is not enough money in it for them?
Would you spend 8-10 years learning a skill that the government controls how much you can earn while practicing? I wouldn't
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an Iphone costs about 1,200/year.
Insurance costs about 12,000 a year.
How about the phone in addition to satellite TV, along with eating out regularly? How much do vacations add to that total? The people I grew up with who used the ER for the checkups, and who were very happy to continue doing so even when the state began picking up the tab for their healthcare, generally had the amenities my family never had (cellphones, cable or satellite TV, a couple of cars, eating out all the time, vacations). I guess paying for one's own healthcare does tend to take a chunk of of disposable income.
Maybe it's just me, but growing up around the individuals for whom the hearts of the left bleed, I get a bit disgusted with all these efforts. If you knew the level of contempt to which taxpayers (i.e. suckers) are held by them, maybe you would be too.
There are a lot of good people that need help. There are far more people who are in trouble because of decisions that they made and continue to make. So many get disgusted with bailouts for corporations, yet are all over the idea of bailing out individuals.
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Something I have not seen mentioned in this debate...
If we declare healthcare a right at what point does the government then have to force the healthcare providers to perform these services? If we socialize healthcare will Medical professionals like doctors and nurses be allowed to quit and change proffessions if they decide thre is not enough money in it for them?
Would you spend 8-10 years learning a skill that the government controls how much you can earn while practicing? I wouldn't
That's helped drive many out of the field. I know of some who will not practice in the areas where socialized medicine is taking hold.
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Allow me to illustrate for you:
Noting is STOPPING him from doing that. Nothing is BENEFITTING him when he does that either.
Let's say I come to you and tell you you can have steak or McDonald's. It will cost you the same whichever you choose.
What are you going to choose?
Steak is an easy choice...
but my question is what is causing that, and how specifically do we address that? What incentive do you have for giving me two choices with different costs to you for the same price?
I'm guessing it's a health insurance thing (probably complicated), but why aren't health insurance companies providing choices with some costing more and some less according to what it will cost them? I'm trying to get an understanding of what is causing our system to be so inefficient, and what the proposed fix would change, as specifically as possible.
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That's helped drive many out of the field. I know of some who will not practice in the areas where socialized medicine is taking hold.
This right here is one of the biggest problems with any government mandated healthcare scheme. If we do go down this road, we still need to make sure it's worth doctors' effort to practice. I forsee some type of government school loan forgiveness for practicing for a certain number of years, or other tax break to practicioners.
This only makes the price of any program go up, too.
The interesting part of this, as I can see a program like this being pushed as an economic bailout. I wonder how many companies' bottom lines would do better if they don't have to provide healthcare, or their costs decrease?
Of course, its only robbing peter to pay paul.
I'm all for the idea of some kind of universal health care, but I'll be damned if I know how to pay for it without causing many other problems, like the one above; which is why I think it won't happen anytime soon.
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I forsee some type of government school loan forgiveness for practicing for a certain number of years
That's what they do for public school teachers in this state.
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Kennedy Announces Plan to Submit Bill For Universal Care
By Shailagh Murray
Washington Post Staff Writer
Tuesday, November 18, 2008; A03
Sen. Edward M. Kennedy (D-Mass.), making his second appearance on Capitol Hill since he began treatment for a malignant brain tumor in June, told reporters yesterday that he would advance a bill early next year calling for universal health care.
Some Democrats, including members of President-elect Barack Obama's circle, have begun to view expanded coverage as a longer-term goal.
The brief appearance by Kennedy, who made a surprise return in July to vote on a Medicare bill, represented an opportunity for him to show colleagues that he remains energetic and engaged, and that he intends to reclaim his committee post in January and take charge of the Obama health-care agenda. Some Democrats had speculated that Sen. Hillary Rodham Clinton (D-N.Y.) would attempt to assume the chairmanship of the Senate Health, Education, Labor and Pensions Committee.
Senate Finance Committee Chairman Max Baucus (D-Mont.) rolled out his own health-care bill days after Obama was elected, and Sen. Ron Wyden (D-Ore.) also expects to be a leading participant in the effort to establish universal health care.
Kennedy has a head start on them all. Despite his illness, he directed his staff months ago to begin work on legislation that would vastly expand health coverage, a career-long goal of his.
But as the economy has worsened, attention has shifted to measures aimed at creating jobs and stabilizing the housing market. Obama is particularly eager to advance his alternative energy agenda.
Kennedy acknowledged the competition. "There's some major issues, obviously, the economy and also environmental issues," Kennedy said on his way to a staff meeting, where he was greeted with cheers.
"But the president-elect has indicated that this is going to be a priority, and I certainly hope it will."
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Why don't they go ahead and announce how much of a tax increase this will take?
Between Obama's other social plans and this, we should see the tax rates for those who pay taxes up to around, say, 110-120%. But what do we expect from people who once seriously advocating seizing everything over a certain amount (I believe it was $1 million at the time) that people made, and expected to rake in billions as a result.
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Great, we get to fight against the Edward Kennedy Memorial Bill, aka "Swimmer's Legacy."
I won't see a doctor that accepts only Medicare or some Universal Coverage. I want some control whether the guy does good work, and if he doesn't... I can tell my insurance carrier about it. The guy will get dropped if he gets enough complaints, and have fewer contracts under which he can do business.
I imagine there might even be a bit of a black market for good doctors, even if it's Universal Coverage doctors who do work on their own time for cash.
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If you oppose Universal Health Care what other altenatives are there? I think most would agree the state of health care is the US in bad shape.
The state of healthcare is in bad shape if one doesn't have decent health insurance, as it puts treatment out of one's financial reach.
There are a number of alternatives to Universal Health Care, however our lawmakers put their noses in it, and things get screwed all to hell.
Those alternatives would include:
1. Euro-rize part of the market, offering a low cost, private health care plan to everyone, to upgrade to a better plan at their own expense. Take the better parts of Medicare part D, and apply them to this type of program, adjusting as needed.
2. Make capitations illegal and require licensed providers to allocate a formulated percentage of their practice/business/time to the poor.
3. Enable IDSs to compete effectively with HMOs and traditional indemnity insurance. Competition in industry is good.
4. Actively encourage disease prevention through tax breaks, as opposed to curative measures in health care. Right now, only a percentage of one's adjusted gross income can be written off to medical measures.
5. Emphasize American citizenship as an admission criteria for medical school admission, as well as remove the caps of admissions.
The industry as a whole better shape up, or it will be governmental bureaucrats calling the shots as who will receive what treatment and when.
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The state of healthcare is in bad shape if one doesn't have decent health insurance, as it puts treatment out of one's financial reach.
There are a number of alternatives to Universal Health Care, however our lawmakers put their noses in it, and things get screwed all to hell.
Those alternatives would include:
1. Euro-rize part of the market, offering a low cost, private health care plan to everyone, to upgrade to a better plan at their own expense. Take the better parts of Medicare part D, and apply them to this type of program, adjusting as needed.
2. Make capitations illegal and require licensed providers to allocate a formulated percentage of their practice/business/time to the poor.
3. Enable IDSs to compete effectively with HMOs and traditional indemnity insurance. Competition in industry is good.
4. Actively encourage disease prevention through tax breaks, as opposed to curative measures in health care. Right now, only a percentage of one's adjusted gross income can be written off to medical measures.
5. Emphasize American citizenship as an admission criteria for medical school admission, as well as remove the caps of admissions.
The industry as a whole better shape up, or it will be governmental bureaucrats calling the shots as who will receive what treatment and when.
Highlighted the communist parts in red for you. ;/
Let's say you're an auto mechanic. You have someone roll up their beat-up car after getting in an accident with no insurance. You have 10 cars in the shop with insurance, but this schmuck needs his car to drive 50 miles to his job every day. He gets the state to pass a law that you have to dedicate 10% of your time to serving the needs of the poor with no insurance.
Hooray for you and your auto shop, right? :rolleyes:
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Highlighted the communist parts in red for you. ;/
Let's say you're an auto mechanic. You have someone roll up their beat-up car after getting in an accident with no insurance. You have 10 cars in the shop with insurance, but this schmuck needs his car to drive 50 miles to his job every day. He gets the state to pass a law that you have to dedicate 10% of your time to serving the needs of the poor with no insurance.
Hooray for you and your auto shop, right? :rolleyes:
1. If one doesn't have decent health insurance, it certainly does put treatment out of financial reach. How is that a communist statement?
2. There are a number of professions that require the individual to provide for the indigent. Why should physicians be any different?
3. Encouraging disease prevention through tax breaks is communist? Right now, if you spend money to be energy conscious, you get a tax break.
As for the mechanic story, I don't see the relationship. The OP is about health care, as well as the ability to effectively deliver same. However, I also stated that a formulated percentage should be the standard, not just an overly simple percentage that attempts to diminish my argument.
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you fellers are forgetting we already pay for health care for the poor. in the worst way possible in the er when its gotten to the point where it really costs a ton. do you think the plans for the 15 percent wuillwill cost more than the rediculous price we pay when folks use the er for a cold? or a checkup? i used to haul drunks to rehab but first we stop at the er where they get cleared medically. it could be done easily in a doctors office but the current system requires killing gnats with a shotgun. they get the full er monte
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1. If one doesn't have decent health insurance, it certainly does put treatment out of financial reach. How is that a communist statement?
Because it's against freedom. Just suffer quietly.
We did this the other day. I'm not sure if I'm boring, or if my reality just doesn't match up to the fantasies, but no-one seemed to want to address my concerns.
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Because it's against freedom. Just suffer quietly.
If health care is unaffordable to those without insurance, it's against freedom?
Huh?
If you were debating the affordability of a 50" HDTV Sony, I would agree with you.
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NEWS FLASH: Not everything the Vladimir Ilyich Lenin and Karl Marx came up with was horrible and soul crushing. Massive abuses of unchecked power usually lead to horrible things, no matter how good someone's intention is.
NEWS FLASH: Not everything Adam Smith came up with is beautiful and wonderful, either. Sometimes the invisible hand needs a little nudge, i.e. legislation to protect the environment. (yet anotehr example of unchecked power started with a good intention, btw)
cassandra and sara's daddy hits on a good point. Another point might be, how much more industry might we bring back to this country if health care costs are contained? Who knows, it might even be a good investment!
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Tom Daschle was just selected for Sec Health & Human Services.
He's for universal healthcare, of course.
Gee, for "change", he's sure picking lots of recycled Washington liberals...
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1. If one doesn't have decent health insurance, it certainly does put treatment out of financial reach. How is that a communist statement?
2. There are a number of professions that require the individual to provide for the indigent. Why should physicians be any different?
3. Encouraging disease prevention through tax breaks is communist? Right now, if you spend money to be energy conscious, you get a tax break.
As for the mechanic story, I don't see the relationship. The OP is about health care, as well as the ability to effectively deliver same. However, I also stated that a formulated percentage should be the standard, not just an overly simple percentage that attempts to diminish my argument.
3. Tax breaks. That is other tax payers subsidizing your load that you should be carrying. Good health is yours for your own benefit. Either appreciate it and work for it for your own sake, or get fat and sit on the couch and die of diabetes or heart failure quietly.
2. "Providing for the indigent." This is slavery. You are mandating that doctors must treat certain people, even against their will. Not by company policy, where they can go work elsewhere or open their own practice... they MUST treat someone. I could be a doctor in Beverly Hills, treating all the stars because I'm damn good at my job, raking in huge cash premiums because I keep those starletts happy and healthy and the studios love it. But, a presidential directive or congressional mandate comes down and WHAM! Now I have to spend my time where I used to make $500 an hour, at a homeless shelter or some other welfare gig, against my will. What civil violation did I perpetrate to deserve this punishing "community service?" I'm sure there will be some pigs that are more equal than other pigs though.
1. Health Insurance. Hey, you chose poorly. You chose poorly in school when you flunked out. You chose poorly in school when you didn't go to college. You chose poorly when you used up all the charity and good will your family was willing to give you in your twenties to get back on track. You chose poorly all the way until you got sick. Some people die. Some people are sick. I'll help take care of the ones I care about (I've already got myself one that I'm saddled with, and I'm not here asking YOU to pay for this one)... but I won't take care of the other ones.
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2. Make capitations illegal and require licensed providers to allocate a formulated percentage of their practice/business/time to the poor
If the government can force licensed healthcare providers to work a percentage of their time for free what other occupations/services can the government require (force) you to give away "free" time in? The poor might need a newe roof so do we require roofers to work for free to help the poor? How about mechanics?, Network engineers? Photographers? Poor people need these things as well.
How much of a percentage has to be given away? 5%? 10%? 50%?
How much of your time does the government own?
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If health care is unaffordable to those without insurance, it's against freedom?
Huh?
If you were debating the affordability of a 50" HDTV Sony, I would agree with you.
Why is is any different? Why do you have a RIGHT to the products produced by companies that used their own R&D money to develop them?
Why is an $8000 stent any different than a $8000 TV?
Answer? It isn't. And you don't have a "right" to either one! At all!
You want it, you PAY FOR IT. Because someone else went and used their own money to develop and sell it on the free market. Healthcare is not magically different from other stuff on the market! It's all products, just products that go in you!
You can't pay for it? You patch yourself up. Nobody is obligated to give you their medical products for free, just because they're "medical" products as opposed to entertainment or transportation or other products!
And if the government starts forcing that? Guess what happens to medical innovation in this country? It comes to a screeching halt. Who the hell would want to produce medical products or work as a doctor if they're obligated to give their products and/or time to people, instead of profiting from them? We'd be back to a standard of care like, oh, right.
Cuba.
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3. Tax breaks. That is other tax payers subsidizing your load that you should be carrying. Good health is yours for your own benefit. Either appreciate it and work for it for your own sake, or get fat and sit on the couch and die of diabetes or heart failure quietly.
2. "Providing for the indigent." This is slavery. You are mandating that doctors must treat certain people, even against their will. Not by company policy, where they can go work elsewhere or open their own practice... they MUST treat someone. I could be a doctor in Beverly Hills, treating all the stars because I'm damn good at my job, raking in huge cash premiums because I keep those starletts happy and healthy and the studios love it. But, a presidential directive or congressional mandate comes down and WHAM! Now I have to spend my time where I used to make $500 an hour, at a homeless shelter or some other welfare gig, against my will. What civil violation did I perpetrate to deserve this punishing "community service?" I'm sure there will be some pigs that are more equal than other pigs though.
1. Health Insurance. Hey, you chose poorly. You chose poorly in school when you flunked out. You chose poorly in school when you didn't go to college. You chose poorly when you used up all the charity and good will your family was willing to give you in your twenties to get back on track. You chose poorly all the way until you got sick. Some people die. Some people are sick. I'll help take care of the ones I care about (I've already got myself one that I'm saddled with, and I'm not here asking YOU to pay for this one)... but I won't take care of the other ones.
3. Tax breaks for preventative measures, is a lot cheaper than paying for curing a disease. Public policy already mandates governmental insurance to take care of the sick without means.
2. Let there no longer be any volunteer firemen either. When your house burns, as well as your loved ones needing medical attention, it's your problem. The short end is that more public service is needed in this country, to include physicians.
Licensed professionals are required a number of things to renew their licenses. Money, continuing education, et al. So a doc does a few hours of CE refresher training in public medicine. Big deal.
1. Being hit by a car isn't a choice, good or bad. How many people who work and lose their job through a disabling illness or injury, can continue to afford health insurance? Go back and read the public policy statement of taking care of people without means.
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Steak is an easy choice...
but my question is what is causing that, and how specifically do we address that? What incentive do you have for giving me two choices with different costs to you for the same price?
I'm guessing it's a health insurance thing (probably complicated), but why aren't health insurance companies providing choices with some costing more and some less according to what it will cost them? I'm trying to get an understanding of what is causing our system to be so inefficient, and what the proposed fix would change, as specifically as possible.
The insurers often try to steer the patients towards less costly alternatives. They do it through things like lists of approved procedures, having pharmacists switch patients to generic drugs, capping the amount they'll reimburse for a given operation, deciding which doctors they'll cover, and various financial arrangements with doctors and hospitals.
Usually their methods are vilified by patients. "How dare that eeevil insurance company stand between me and my doctor? They should stay out of my health care decisions." They have to do this sort of thing though, or else they face the prospects of paying ever rising medical bills.
Health care is one of the few industries where the customer always automatically demands the best possible product without regard to its cost. When we shop for cars, we don't automatically head straight to the Rolls Royce dealer and buy their most expensive model. When we need a hotel room for the night, we don't automatically head straight for the Ritz every time. But when we step into the hospital, we always, always expect no compromises. We expect the best possible cost-no-object medical care. We aren't even told the costs we're incurring, we're just presented the Rolls and Ritz level treatments and never told about the lesser alternatives.
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2. Let there no longer be any volunteer firemen either. When your house burn or your loved ones need medical attention, it's your problem. The short end is that more public service is needed in this country, to include physicians.
Oh, I'm SURE so many talented people will continue to choose that field if that happens. Why, they'd not only have to pay off their hundreds of thousands of dollars in loans for med school, not only have to pay their hundreds of thousands per year in malpractice insurance, but they'd also be slaves of the state, too! Wise career choice!
In case you hadn't noticed, good doctors are FLEEING the UK for that very reason.
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If the government can force licensed healthcare providers to work a percentage of their time for free what other occupations/services can the government require (force) you to give away "free" time in? The poor might need a newe roof so do we require roofers to work for free to help the poor? How about mechanics?, Network engineers? Photographers? Poor people need these things as well.
How much of a percentage has to be given away? 5%? 10%? 50%?
How much of your time does the government own?
No, the government owns the license to practice medicine, et al.
You choose if you wish to renew it by doing the CE that is required. I'm not saying that they do it free of charge, just take the insurance of the health plan to remove capitations from a method of payment.
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No, the government owns the license to practice medicine, et al.
You choose if you wish to renew it by doing the CE that is required.
Yeah, that's a recipe for success in a free country. Do what the government demands, or else!
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No, the government owns the license to practice medicine, et al.
You choose if you wish to renew it by doing the CE that is required.
Wow, you're a scary statist. Do you even realize what you just said?
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Wow, you're a scary statist. Do you even realize what you just said?
Yeah, I do.
What other method do you have to remove capitation?
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No, the government owns the license to practice medicine, et al.
You choose if you wish to renew it by doing the CE that is required. I'm not saying that they do it free of charge, just take the insurance of the health plan to remove capitations from a method of payment.
Yep. Black market medicine coming soon. Hooray.
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Yep. Black market medicine coming soon. Hooray.
Do you even know what a capitation is?
It drains the payer system (including public payer systems) of needed monies, all in the name of a patient to have a doctor that will see them.
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Do you even know what a capitation is?
It drains the payer system (including public payer systems) of needed monies, all in the name of a patient to have a doctor that will see them.
Yes, I used to be a DBA for a medical billing and records company. I saw the contracts spiralling higher and higher in cost each year for each common procedure code, and I saw in my clients' databases the number of uninsured that were simply "written off."
But, the practice didn't "write off" the pay of their employees or the operating overhead.
The parts that were written off were subsidized by the contracts from the private carriers. Comparatively, Medicare pays the worst out of any health care carrier. Many doctors don't even accept Medicare as a payor. Good for them. It pays about 60% of most other contracts for the CPT codes I bothered to compare against.
If you FORCE doctors to see patients that don't pay them and FORCE doctors to take a Medicare contract and FORBID them from taking private insurance in order to get their license to practice medicine, you will see a black market arise. It will be cash based, and you will have to pay for medicine, and you will have to vette (sp?) your chosen health care provider very carefully to ensure he didn't print his degree on his home PC.
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Yes, I used to be a DBA for a medical billing and records company. I saw the contracts spiralling higher and higher in cost each year for each common procedure code, and I saw in my clients' databases the number of uninsured that were simply "written off."
But, the practice didn't "write off" the pay of their employees or the operating overhead.
The parts that were written off were subsidized by the contracts from the private carriers. Comparatively, Medicare pays the worst out of any health care carrier. Many doctors don't even accept Medicare as a payor. Good for them. It pays about 60% of most other contracts for the CPT codes I bothered to compare against.
If you FORCE doctors to see patients that don't pay them and FORCE doctors to take a Medicare contract and FORBID them from taking private insurance in order to get their license to practice medicine, you will see a black market arise. It will be cash based, and you will have to pay for medicine, and you will have to vette (sp?) your chosen health care provider very carefully to ensure he didn't print his degree on his home PC.
I never said that physicians should see patients that wouldn't pay. Likewise, I never said that physicians shouldn't accept private insurance. Don't twist my words.
I merely stated that the method to getting rid of capitations, was to every Doc to accept a portion of indigent (now with basic health insurance) to treat as a CE to renewing their licenses. The fee-for-service would still be applied, without monies being given away for nothing done.
Just for the record, even private insurance doesn't pay 100% of a doc's billing. So public insurance's (Medicare and Medicaid) 60% isn't necessarily a bad thing either, as the 40% loss could be applied as a doc's corporate loss in the tax code.
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If health care is unaffordable to those without insurance
The basic premise there is faulty. The option is not black-and-white, best-care or no-care. The real fact is: you have a RANGE of care available to you, depending on what you want to spend. While it is standard practice for patients to do whatever the doctor recommends, and for the doctor to recommend the most thorough (read: expensive) options available, fact is people DO have the choice of saying "no, that's too expensive" and opting for other solutions. Yes, sometimes the choices may be hard because they are personal and painful; hard reality is that the care is not free and one does not have a right to compel others to pay for one's comfort.
If you were debating the affordability of a 50" HDTV Sony, I would agree with you.
We are. Both contribute to "quality of life", and it's up to the individual to decide how much of their labors they wish to contribute to, and how, the extension and enjoyment of their own life. If you can afford a 50" HDTV, don't come demanding I pay for your stent which cost the same.
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We are. Both contribute to "quality of life",
Nonsense. One contributes to quality of life. The other means life or death to people, many of whom had absolutely no choice in the matter. Big difference.
Don't care - you're asking people to step away from fantasy and into reality. I suspect that is why no-one would address my situation directly in the other, recent thread.
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Don't care - you're asking people to step away from fantasy and into reality.
How do you figure that? He's suggested that the government have the power to control how doctors spend their professional lives. To justify this ugly idea, he uses the pseudo problem of capitation.
Seems to me you have your notions of fantasy and reality backwards.
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Nonsense. One contributes to quality of life. The other means life or death to people, many of whom had absolutely no choice in the matter. Big difference.
Don't care - you're asking people to step away from fantasy and into reality. I suspect that is why no-one would address my situation directly in the other, recent thread.
I went to see what you were talking about and I assume it was the question of how to deal with people with serious problems.
I did answer that: Aren't there charities for these sorts of things?
Perhaps you don't want to believe it, but Americans are very charitable people. Rather than using the government to steal someone else's life (money represents some portion of your life that you have spent EARNING it), why not ask people to pay for it?
Instead, it seems the ideas are to force someone else to pay for your support.
Simply because you use the government behind the gun doesn't make it any more righteous than if you club someone over the head and take their wallet.
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In what world is it that people who actually produce/provide goods and services are expected to continue providing those goods and services at the point of a gun for incentive instead of being paid for their labor? Why would any sane person spend 8-10 years of their life, invest/borrow the $100s of thousands of dollars needed to become a doctor only to become a virtual slave of the state?
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In what world is it that people who actually produce/provide goods and services are expected to continue providing those goods and services at the point of a gun for incentive instead of being paid for their labor? Why would any sane person spend 8-10 years of their life, invest/borrow the $100s of thousands of dollars needed to become a doctor only to become a virtual slave of the state?
Bah. That's just fantasy. You need to step into reality.
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In what world is it that people who actually produce/provide goods and services are expected to continue providing those goods and services at the point of a gun for incentive instead of being paid for their labor? Why would any sane person spend 8-10 years of their life, invest/borrow the $100s of thousands of dollars needed to become a doctor only to become a virtual slave of the state?
Aren't lawyers required to do a certain amount of pro-bono work?
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Iain, where is your thread you're referencing? I'm in the dark.
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Bah. That's just fantasy. You need to step into reality.
The fantasy is the trite Mel Gibson impersonation that seems to pass for serious debate on this, and other issues. Now let adults talk.
http://www.armedpolitesociety.com/index.php?topic=16044.0 - That's the previous topic. I welcome serious discussion about it, there may be answers and I'd really like to hear and understand them because it is entirely possible they are good answers. But I've raised this with people before, and aside from 'theft' 'thief' and said Mel Gibson impersonations few have ever addressed the serious underlying issues.
There are a lot of people like me in America. The only way I will ever be able to pay the full costs of my lifetime medical care needs is if I write something as successful as Harry Potter. In the next thirty years I could need three major organs transplanted. That's the downside of treating people like me with basic things like antibiotics - we live longer and cost more in the long run.
No-one seems to want to address the problem of those who have large medical needs they cannot afford, I suggested that we do on the previous page and no-one has. Could I keep going back to a specialist unit to get arguably non-absolutely-essential drugs, routine check-ups and scans - when that hospital knows that I cannot pay?
This is not about the ability to get patched up at the ER. This is about regular routine appointments, follow-ups investigations etc. I'll say this, and then I'd rather go back to generalities rather than personal issues - one consultant decided that my main condition did not adequately explain the seriousness of my state (multiple pneumonias, regular hospitalisation) So he looked, and looked and looked. And found a primary immune deficiency, or more accurately a marginal case for arguing that I had one. They treated that (at considerable expense) and the hospitalisations stopped, decline was arrested, even reversed and today I have a degree, a job and make a positive contribution to society. I'll never cover those costs though.
That's reality.
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They treated that (at considerable expense) and the hospitalisations stopped, decline was arrested, even reversed and today I have a degree, a job and make a positive contribution to society. I'll never cover those costs though.
That's reality.
And who pays the doctor who has to pay the malpractice insurance costs and their student loans? Who pays the pharmas that developed and produce the medication? Who pays the R&D labs? Who pays the medical companies that developed the best way to stabilize those medications for delivery? Who pays the hospital's operating costs? Who pays?
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Nonsense. One contributes to quality of life. The other means life or death to people
Well, life/death is a rather important quality of life issue, isn't it? A biggie, ya think? Maybe people should put that $3700 toward their health care FIRST, instead of the HDTV and cable? And let's add up those other luxuries (bigger house, newer car, dining out, etc.) and see how much people can contribute to their own survival BEFORE just reaching into the pockets of others. We ARE talking life-and-death here, so how about individuals prioritize that before marginal/tangential quality-of-life luxuries.
And most of the time health care costs aren't a life/death binary choice, they're a shade-of-gray. Much of the cost goes to "let's rule out X" (and that largely to cover the doctor's butt, not yours), treatments to smooth out what would naturally heal anyway (you know it's the flu, no $200 doctor visit needed), and treating self-destructive behavior (your cigs and daily Cokes are your choice, not mine).
So let's get back to what the actual issue is: the chronically and/or desperately ill who really truly can't afford it and didn't bring it on themselves. Yes they warrant sympathy, and yes they are a tiny fraction of the citizenry of this nation. Arguably there is a gap, which does NOT require taking over the entire health care infrastructure which is working fine for most people, including those under Medicare, Medicaid, and walk-in ER types (who aren't going to do anything else anyway, even if free).
(And for something popped up after the above was written)
No-one seems to want to address the problem of those who have large medical needs they cannot afford
We do. Problem from our angle is the pro-universal-free-care people keep spinning the few facing unaffordable needs into "the whole system is broken everybody is screwed let's socialize everything", which just derails the whole thing as the opposition rightfully sees it as theft.
Most people have the opportunity to get medical insurance - pricy, yes, but within their budget if only they would prioritize accordingly. Those who can and choose not to, well, at some point it you have to face the consequences of your own decisions. Get insured, stay insured, work hard, most conditions & illnesses will be covered. That takes care of the vast majority of individuals.
Next is the shade-of-gray scenarios. Certain treatments are desirable but not vital, so hard choices should be made - WITHOUT resorting to compelling others to pay it.
As noted above, that leaves a rather small percentage of people who truly need care and truly can't afford it. Much of that is already covered by Medicaid, Medicare, and ER - so there is really only a very small percentage that warrant charitable/taxpayer attention, like yourself. Given that gap in the system, let's see the real numbers on what closing that gap would cost - and NOT the $1T or so needed to cover everyone who currently is covered.
If we could limit the discussion to the actually needy, the discussion could progress to a viable solution.
Thing is, it keeps coming back to some form of me paying for the health costs of a cig-smoking chip-munching couch potato enjoying 40+ hours a week of an HDTV and cable TV service that frankly _I_ can't afford.
Drop the "universal" part of the argument. Most are doing fine with the system as-is.
Drop the "free" part of the argument. It's not free, it's freaking expensive.
Then we'll talk.
I'll never cover those costs though.
But you CAN contribute significantly to it. Just because you can't pay the whole bill now doesn't mean you hand the whole bill over to Joe Taxpayer, AND tack on the bills from people who CAN cover their costs. My bill was really high too - but I can manage to earn & contribute $10/day to it for life; no reason to stick Manedwolf with it.
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The fantasy is the trite Mel Gibson impersonation that seems to pass for serious debate on this, and other issues. Now let adults talk.
http://www.armedpolitesociety.com/index.php?topic=16044.0 - That's the previous topic. I welcome serious discussion about it, there may be answers and I'd really like to hear and understand them because it is entirely possible they are good answers. But I've raised this with people before, and aside from 'theft' 'thief' and said Mel Gibson impersonations few have ever addressed the serious underlying issues.
This is not about the ability to get patched up at the ER. This is about regular routine appointments, follow-ups investigations etc. I'll say this, and then I'd rather go back to generalities rather than personal issues - one consultant decided that my main condition did not adequately explain the seriousness of my state (multiple pneumonias, regular hospitalisation) So he looked, and looked and looked. And found a primary immune deficiency, or more accurately a marginal case for arguing that I had one. They treated that (at considerable expense) and the hospitalisations stopped, decline was arrested, even reversed and today I have a degree, a job and make a positive contribution to society. I'll never cover those costs though.
That's reality.
I'm sorry if you feel that we've neglected this issue in the past when you brought it up. It's just that this sort of thing is common sense, and I think most of us don't feel the need to dwell on it.
It's basic economics, Iain. It's a problem of limited resources. It simply isn't possible for everyone to consume more resources (medical or otherwise) than they've produced.
It's possible for one person to consume more than he's produced if there are other producers making up the difference. That's the situation you describe yourself in. You've consumed medical resources beyond your ability to produce. It worked because there was someone else out there who produced more than they consumed and shared their excess with you.
That solution works on a small scale, so long as there are many more excess-producers than there are excess-consumers. That's how insurance works. It's a great system whenever the odds of a major costly operation are low. But if that balance shifts, if there are more excess-consumers than excess-producers, then the system falls apart. Resources have to be produced before they can be consumed, and if there aren't enough being produced then it just isn't possible for everyone to consume them.
If it becomes probable that everyone will need major costly medical services in their lifetimes, beyond their ability to pay, then the system becomes untenable. Even if you believe that major, costly medical procedures are a fundamental right, the system just isn't possible. Making it a right doesn't magically mean there are enough doctors and hospital beds and medicines to go around. Those are all economic resources, they have to be produced in the economy, and there is a limit to our productive capacity.
That's the fundamental problem with universal health care. It promises to let everyone consume more than they produce. Obviously that isn't possible, but that doesn't stop politicians from promising it.
Politicians can promise to give these things to us all, but they can't make those things exist to be given in the first place.
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Worth repeating:
I'm sorry if you feel that we've neglected this issue in the past when you brought it up. It's just that this sort of thing is common sense, and I think most of us don't feel the need to dwell on it.
We're not heartless. We just realize there are limits in the system, and limits to our own wallets.
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I don't have time now, but I'll say quickly - I'm not arguing in favour of universal health care necessarily. I'm arguing that crying 'freedom' and saying that we don't want to pay for others costs is not a comprehensive answer to a complex issue, which I agree is not what all of you are saying. More another time.
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Aren't lawyers required to do a certain amount of pro-bono work?
A quick search on Wikipedia turns up that lawyers are reccommended to contribute 50 hours of pro-bono service per year by the American Bar Association. Some law school apparently require some pro-bono service.
If it was me, I sure as hell wouldn't do any pro-bono work. I don't get paid, I don't do any work. Simple as that.
(Oh, and the word to define requiring work without pay...that's slavery)
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I don't have time now, but I'll say quickly - I'm not arguing in favour of universal health care necessarily. I'm arguing that crying 'freedom' and saying that we don't want to pay for others costs is not a comprehensive answer to a complex issue, which I agree is not what all of you are saying. More another time.
Freedom is a comprehensive answer to this issue. And the issue is really quite simple. There two parts to the problem. One is limited resources, and the other incentives. Freedom solves both of those problems. But I agree, more another time.
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an Iphone costs about 1,200/year.
Insurance costs about 12,000 a year.
Where in the hell did you get that number from?
We just insured our family for about $312 a month, which is about $3150 a year. Family of four, I have high cholesterol and we've all had at least one surgery.
Oh, and we are paying for it ourselves. It is not a plan through an employer.
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My health insurance costs $315 a month, and it covers myself and my wife.
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To justify this ugly idea, he uses the pseudo problem of capitation.
If you believe that capitation, one among many others, is only a pseudo problem, then your idea of reality and fantasy deserve closer scrutiny.
I hope your insurance plan has a good psych rider.
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Aren't lawyers required to do a certain amount of pro-bono work?
Generally not, but their fees are more or less set in stone.
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Definition of irony: Bunch of employees of the government complaining that government doesn't work, and that no doctors will want to work for the government.
Jamis, as you well know, coverage like that at your price is the exception, not the rule. Nitro's number is accurate for the average. And then there's this problem: If the breadwinner paying the 315 goes out of work, how can the insurance remain available for any significant period of time?
The puzzling thing is this: per capita, the US spends way more on healthcare than any other country in the world. Yet, other countries manage to cover the entire population, and receive equivalent per capita levels of service and amounts of service.
So even though were we to simply copy one of the socialist medicine systems, it would cost less per person and we'd receive basically the same care, that's a horrible thing because....it's against freedom.
"Freedom" is going to be a dirty word within a generation if it's held responsible for maintaining outrageous prices for medicine, and denying treatment to millions of people.
I suggest that as a movement, pro-freedom conservative thought should take its battle elsewhere, or the 40 million voters (and increasing) with no insurance, and the roughly 30 percent of insured who can't afford decent coverage, are going to vote it out of existence.
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Definition of irony: Bunch of employees of the government complaining that government doesn't work
It's not irony...it's the truth.
You think I like working for the government? I DON'T. It's soul sucking. But, I had a unique opportunity to take a unique job that few others will see that will be one hell of a part time job when I put it on my resume.
But the people I work with...you would be an IDIOT to want them to have anything to do with your healthcare.
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If you believe that capitation, one among many others, is only a pseudo problem, then your idea of reality and fantasy deserve closer scrutiny.
I hope your insurance plan has a good psych rider.
Capitation is an attempt to make an end run around the root problem of incentives. It won't work. Like any other attempt at realigning the incentives involved, it will only lead to rising prices. It's not much of a problem, though. Eventually capitation costs will rise to the point where capitation ceases to be a viable alternative. They'll stop using it and maybe try some other ineffective scheme to ignore the misaligned incentives at play here.
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Capitation is an attempt to make an end run around the root problem of incentives. It won't work. Like any other attempt at realigning the incentives involved, it will only lead to rising prices. It's not much of a problem, though. Eventually capitation costs will rise to the point where capitation ceases to be a viable alternative. They'll stop using it and maybe try some other ineffective scheme to ignore the misaligned incentives at play here.
Question: If screwing with the incentives drives up the price, how come the exact same medical service is cheaper in many communist-health systems by several multiples of dollars for private purchasers?
How did they manage that in these state-managed healthcare systems? I mean, you'd think if the prices go up, it would be way, way more expensive to take a flight to Singapore and get back surgery done than to stay in the US....but generally it costs double digit amounts less.
Can anyone explain that?
http://www.marketwatch.com/news/story/Medical-Tourism-Are-Major-Changes/story.aspx?guid=%7B6460049D-D037-434C-8DE0-5E87C11955E8%7D (http://www.marketwatch.com/news/story/Medical-Tourism-Are-Major-Changes/story.aspx?guid=%7B6460049D-D037-434C-8DE0-5E87C11955E8%7D)"While there are many factors to consider," states Look, "cost seems to be the biggest. It's easy to see the draw ... when a heart bypass procedure that costs $130,000 in the U.S. can be done at an accredited hospital in Singapore for $18,500 or in India for $10,000, for example."
Odd...it looks like hundreds of thousands of people are leaving the U.S. every year to obtain care, yet the rumor is that actually people are coming from all over the world because it's so great in the U.S. Apparently the socialist paradises must have some draw for people who are sick.
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The puzzling thing is this: per capita, the US spends way more on healthcare than any other country in the world. Yet, other countries manage to cover the entire population, and receive equivalent per capita levels of service and amounts of service.
So even though were we to simply copy one of the socialist medicine systems, it would cost less per person and we'd receive basically the same care, that's a horrible thing because....it's against freedom.
The congressional study you linked earlier seems to claim that other countries spend less on health care and receive comparable quality of care. But I don't buy it. Quality of care is a qualitative concept, not a quantitative concept that can be measured and tabulated.
If the quality of care in the other socialize medicine countries were really comparable, then foreigners wouldn't travel to the US to receive our care like they do.
Studies like the one you posted mighty be able to catalog the number of doctor visits per capita per year, or the number of hospital or ER visits per year, and so forth. But they can't accurately divine differences in quality of care. There are differences, surely.
An "accredited hospital in Singapore" isn't necessarily as good as a hospital in America, and it's foolish to assume they are. But in a study they'd be assumed to be equal.
Then, of course, there's the issue of people who have access to socialized medicine choosing to go outside the government system for their care. Australia's system has been held up as a model. Nevermind the long waiting times, nevermind the concerns that the system is underfunded and slowing bleeding itself dry. The fact half of Australians choose to buy private health insurance rather than use the free government coverage ought to tell us something about the desirability of government coverage. I hear similar stories from other European social medicine countries. Those who can tend buy private health care rather than use the public services.
So what's to say we don't adopt the same socialist system here, and end up with the same problems we've always had? Those with the means will still end up buying superior care out of pocket, which is exactly what we all do now. Those without the means will still end up using the free services provided to the public, just like they do now. It doesn't solve anything.
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Question: If screwing with the incentives drives up the price, how come the exact same medical service is cheaper in many communist-health systems by several multiples of dollars for private purchasers?
Because there are government mandated prices. The services are not exactly the same, either, but that's a subject I've already touched on.
It is entirely possible for government to force prices down by fiat. That's what they do in most of the industrialized world with their social medicine programs. But as any economics student knows, price caps cause shortages. That's the reason why most procedure have long wait times in foriegn countries but not here.
It goes back to the problem of limited resources. There are only so many operating rooms and surgeons and nurses in the country. Their use will be allocated in some fashion. If it isn't done inherently by means of prices, then it'll be done by some form of rationing (price caps, waiting lists, service limits, reduced quality of care, and so forth).
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Because there are government mandated prices. The services are not exactly the same, either, but that's a subject I've already touched on.
Except that those aren't government mandated prices-that's the private hospital cost for a foreigner, who has no health care rights in Singapore.
The rest of your post is centered on that, but it is inaccurate-the prices for medical tourism generally are a free for all; this is the price range for a private hospital, that solicits patients privately and can charge whatever it wants.
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Odd.
Poor people can't expect the same level of care as well-off people. No one deserves steak on a hamburger budget.
However,
We have the bestest most expensivest awesomest healthcare in the world, people with the resources come from all over to partake of our wonderful expensive healthcare, and that shouldn't change.
Ok...
So, what do the people with a hamburger budget do? For that pricey surgery, maybe they go to Singapore, if they have the resources to travel. What do they do for the minor procedures, the ones that take fifteen minutes and minimal staff/drugs/facilities, but still costs thousands in the US? What do they do about the drugs that osts double here what they do elsewhere? What do they do for emergency conditions? What do they do when there is no hamburger option available?
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So what's to say we don't adopt the same socialist system here, and end up with the same problems we've always had? Those with the means will still end up buying superior care out of pocket, which is exactly what we all do now. Those without the means will still end up using the free services provided to the public, just like they do now. It doesn't solve anything.
It doesn't solve anything except the price: Those who buy private insurance pay less, and receive the same care, and the public cost of providing healthcare to the poor is lower as well.
That is a solution: everyone gets treatment, and everyone pays a lot less.
The only sense in which it is not a solution is from the perspective of ideological commitment to a particular system, regardless of costs and benefits. I think you basically just ignore the actual numbers because that's not relevant; all that's relevant is that the system comports to your ideology.
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Except that those aren't government mandated prices-that's the private hospital cost for a foreigner, who has no health care rights in Singapore.
The rest of your post is centered on that, but it is inaccurate-the prices for medical tourism generally are a free for all; this is the price range for a private hospital, that solicits patients privately and can charge whatever it wants.
Perhaps you need to be more specific about just which country you're asking me about, then. Earlier you quoted Singapore, and all along we've been talking about industrialized Western social medicine countries. You brought up communist health systems in there somehwere, too.
So, which is it we're talking about?
I had assumed we were still talking about the industrial, Western nations with socialized medicine. Australia and the Canada and the UK and so forth. I believe that all of those countries do use government price fixing, with the inevitable results.
If we're talking about Singapore, then the answer is one of cost-of-living. Everything tends to cost less in poorer countries. Wages are lower, the public's buying power is less, local currency and exchange rates are favorable to us, and so forth. It doesn't take much for a Westerner to walk into a place like Singapore and outbid the local population for whatever services he wants.
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So, what do the people with a hamburger budget do? For that pricey surgery, maybe they go to Singapore, if they have the resources to travel. What do they do for the minor procedures, the ones that take fifteen minutes and minimal staff/drugs/facilities, but still costs thousands in the US? What do they do about the drugs that osts double here what they do elsewhere? What do they do for emergency conditions? What do they do when there is no hamburger option available?
If it were up to me there'd be hamburger budget options available here. Our system isn't set up to allow that. There isn't much demand for it, either. I feel like a broken record, but it gets back to a problem of incentives.
When someone else is footing the bill for you (and in our system, someone else is almost always footing the bill for you), then you and your doctor have no incentive to come up with a hamburger solution. You end up using the steak solution and charging it off to whoever else is paying. And why not? It costs you nothing.
These constant attempts to relieve the patient from the burden of paying for his care will ALWAYS tend to remove hamburger level solutions. Government care, the ultimate "pay it for me" system, will only exacerbate this problem. It will exacerbate the problem to the point that some sort of rationing becomes necessary, and with that come a myriad of other problems that are even worse.
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So, which is it we're talking about?
Take your pick and it's cheaper-that was sort of the point. There isn't any in the list that has higher private medical care costs than the United States. Referring to them as "communist" was simply a reaction to your ideology of "freedom"-by communist, I mean the public healthcare systems available in every industrialized country in the world besides the United States.
If we're talking about Singapore, then the answer is one of cost-of-living. Everything tends to cost less in poorer countries. Wages are lower, the public's buying power is less, local currency and exchange rates are favorable to us, and so forth. It doesn't take much for a Westerner to walk into a place like Singapore and outbid the local population for whatever services he wants.
Well, Singapore in particular is basically a giant mall with Armani/Prada stores, so I think the average westerner will have a hard time completely outbidding the local population. Rolex and Cartier are popular there too-fairly comparable to American prices, sometimes a decent deal to be had, sometimes not.
But with medical care...how is it that they provide hospitals, doctors, the same equipment and medicines, and then the service for $90,000 less??? That's a bit well outside of the exchange rate and well outside the respective differences in cost of living.
See, it looks like what you're doing is simply ignoring the facts, because they aren't important. Lower cost and higher efficiency isn't an issue, just so long as you and your parents are paying for your care and no one else.
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If it were up to me there'd be hamburger budget options available here. Our system isn't set up to allow that. There isn't much demand for it, either. I feel like a broken record, but it gets back to a problem of incentives.
40 million people with no insurance doesn't create enough demand for cheap services???
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The congressional study you linked earlier seems to claim that other countries spend less on health care and receive comparable quality of care. But I don't buy it. Quality of care is a qualitative concept, not a quantitative concept that can be measured and tabulated.
If the quality of care in the other socialize medicine countries were really comparable, then foreigners wouldn't travel to the US to receive our care like they do.
Studies like the one you posted mighty be able to catalog the number of doctor visits per capita per year, or the number of hospital or ER visits per year, and so forth. But they can't accurately divine differences in quality of care. There are differences, surely.
An "accredited hospital in Singapore" isn't necessarily as good as a hospital in America, and it's foolish to assume they are. But in a study they'd be assumed to be equal.
Then, of course, there's the issue of people who have access to socialized medicine choosing to go outside the government system for their care. Australia's system has been held up as a model. Nevermind the long waiting times, nevermind the concerns that the system is underfunded and slowing bleeding itself dry. The fact half of Australians choose to buy private health insurance rather than use the free government coverage ought to tell us something about the desirability of government coverage. I hear similar stories from other European social medicine countries. Those who can tend buy private health care rather than use the public services.
So what's to say we don't adopt the same socialist system here, and end up with the same problems we've always had? Those with the means will still end up buying superior care out of pocket, which is exactly what we all do now. Those without the means will still end up using the free services provided to the public, just like they do now. It doesn't solve anything.
as far back as late 70's folks went overseas for treatment. interestingly enough some of these treatments were pioneered/ developed in the usa but couldn't get fda approval. (read lobbyists failed)
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40 million people with no insurance doesn't create enough demand for cheap services???
You can't use the fact that someone doesn't have something as proof that they want it. If anything, assuming the opposite would make far more sense.
Fact is, a good many of those 40 million uninsured people are uninsured by their own choice. There are plenty of reasons why folks decline to make health insurance a priority.
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http://www.minatokuishikai.or.jp/eng/basic/bas_home.htm
heres how they do it in japan
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Fact is, a good many of those 40 million uninsured people are uninsured by their own choice. There are plenty of reasons why folks decline to make health insurance a priority.
Reason #1
It sucks paying $400-1000/month for a product one cannot afford to use, and which fails to serve its intended purpose.
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Reason #1
It sucks paying $400-1000/month for a product one cannot afford to use, and which fails to serve its intended purpose.
Yes... much more convenient to have the government run an insurance plan, give my employer incentive to cancel my perfectly good plan, increase my taxes and give me worse insurance with less take home money. ;/
Shootinstudent: Communist state healthcare is cheap because they don't do any research in pharmaceuticals or surgery there. They do it here.
You make here socialist in the same way and no more research will get done. There's just no incentive if people won't pay for the research to be lucrative to the innovator.
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Regarding Singapore's health care system, a quick google search turned up this link:
Singapore's Health Care System: A Free Lunch You Can Sink Your Teeth Into (http://econlog.econlib.org/archives/2008/01/singapores_heal.html)
How does Singapore do it? Singapore is no libertarian health care paradise, but it does self-consciously try to maintain good incentives by narrowly tailoring its departures from laissez-faire:
Golly, there's that 'i' word.
Singapore shows that the free lunch offered by greater government control is meager compared to the free lunch offered by old-fashioned individual incentives.
Whoa! There's that 'i' word yet again.
Now, where have I hear that 'i' word in this thread?
Oh yeah! I've been harping on the concept of incentives all a-freaking-long.
So, it seems that the reason Singapore's health care costs so much less is because they've managed to align the incentives properly.
Even for the poor, government only pays up to 80% of the charges. That gives patients a strong incentive to minimize the costs they incur.
Each hospital is required to publish their prices, to allow comparison shopping between doctors and hospitals. This gives docs and hospitals strong incentive to keep their prices down.
The government provides low-cost major medical insurance, and competes against private insurers for the same. That gives both parties incentive to keep their costs in line.
Everyone is required to save a portion of their income specifically for use in your own health care. When you buy health care, you're spending your own money. That gives you a strong incentive to economize.
It's an interesting system. It seems to have been designed by someone who had an inkling of basic economics. The results are predictable.
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Communist state healthcare is cheap because they don't do any research in pharmaceuticals or surgery there. They do it here.
true once no longer the case
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Headless,
So you'd support just copying the Singaporean system? Or is that 80 percent payment too communist despite the results?
It seems like now what you're doing is relabelling the least socialist system as a market based one, and then concluding that the U.S. must be more efficient since it's even more privatized. But obviously that's not the case. Your ideology is confusing your analysis.
AZredhawk,
Medical research is done all over the world-Australia is a major hub for it. State health care didn't kill it here, and won't elsewhere.
Indeed, a good chunk of the research in America is state funded in the first place.
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Indeed, a good chunk of the research in America is state funded in the first place.
if you consider the gov funded schools it goes on at most of it is subsidized
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Headless,
So you'd support just copying the Singaporean system? Or is that 80 percent payment too communist despite the results?
It seems like now what you're doing is relabelling the least socialist system as a market based one, and then concluding that the U.S. must be more efficient since it's even more privatized. But obviously that's not the case. Your ideology is confusing your analysis.
You're not making sense. The least socialist system (if by that you mean Singapore) employs a mostly market-based approach. There's no need to re-label it. There is plenty of government intrusion, which I don't like, but at least they intrude in minimal and sensible ways. They haven't adopted the dirt stupid universal health care systems that the rest of the industrialized world adopted, and which we in the US are desperately trying to avoid.
The Singapore government will pay 80% of your care only if you're poor. If you don't meet their strict needs test, they don't pay a dime. Even if you do qualify for government-paid care, you're still responsible for 20% of every cost you incur.
They keep costs in line by means of competition. That's the answer to BridgeWalker's question about hamburger vs steak care. In Singapore you have both options, steak-level care or hamburger-level are, with prices published publicly so that everyone can see what they're getting before they get it. It's easy to choose one over the other.
In Singapore they seem to use insurance intelligently. They use it for major medical costs, not for routine care. Insurance doesn't save anyone any money if claims are common and frequent. Insurance only works if it's used to average infrequent risks over many people.
I found another interesting link on Singapore's health care system:
The Singapore health system – achieving positive health outcomes with low expenditure (http://www.watsonwyatt.com/europe/pubs/healthcare/render2.asp?ID=13850)What can be learned from the Singapore health care system?
The key to Singapore’s efficient health care system is in its emphasis on the individual to make a significant contribution towards their own healthcare costs. With this focus, the Government has been able to maintain a relatively low level of public expenditure on health for many years with the major burden put on individuals and/or their employers.
Golly, personal responsibility actually works! Not only that, it works without relying upon primarily upon the government.
I would take Singapore's health care system over Europe's in a heartbeat. There are minor details I don't like about it, but they've got the big picture right. They use price competition to force costs down. They give patients and doctors strong incentive to keep costs down and to minimize the resources consumed. They use personal savings (mandated personal savings, but still personal) to cover routine costs, and they use major medical coverage to handle the big expenses.
Singapore is definitely a step in the right direction. Universal health care a la UK or Australia is a step in the wrong direction.
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was there hidden in there an explanation of why its so much cheaper there? i missed it
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Quality of care is a qualitative concept, not a quantitative concept that can be measured and tabulated.
If the quality of care in the other socialize medicine countries were really comparable, then foreigners wouldn't travel to the US to receive our care like they do.
Studies like the one you posted mighty be able to catalog the number of doctor visits per capita per year, or the number of hospital or ER visits per year, and so forth. But they can't accurately divine differences in quality of care. There are differences, surely.
So there's no possible way to determine if one system is doing a better job than another? Life expectancy, fewer unmet needs, and lower infant mortality (which we fall behind most UHC countries in) are totally meaningless? The US spends more per person, and is less healthy by most metrics. You can't just disregard those metrics because they don't agree with you. Do you care to provide any metrics other than your gut instinct or anecdotes that that show UHC care is worse?
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Me too, cassandra and sara's daddy.
The odd thing is, you're taking a system which pays out tons of government money (80 percent for the poor, with a fund to pay for people who can't afford the 20), taxes income to pay for healthcare (that's what "mandated savings" is-a tax on income), and then pays out government regulated rates on major medical (just like medicare)....and yet a heart surgery is about $90,000 cheaper.
???
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So there's no possible way to determine if one system is doing a better job than another? Life expectancy, fewer unmet needs, and lower infant mortality (which we fall behind most UHC countries in) are totally meaningless? The US spends more per person, and is less healthy by most metrics. You can't just disregard those metrics because they don't agree with you. Do you care to provide any metrics other than your gut instinct or anecdotes that that show UHC care is worse?
Illogical argument. Correlation without causation.
The US is indeed less healthy than most UHC countries. But that isn't because we lack UHC. It's because we're less healthy.
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Indeed, a good chunk of the research in America is state funded in the first place.
if you consider the gov funded schools it goes on at most of it is subsidized
Really?
Tell me where this magic subsidizing agency is, because my company would be very interested in getting this money from the sky. We fund our own research on medical devices.
The "medical R&D is all government funding" argument is a lie.
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Me too, cassandra and sara's daddy.
The odd thing is, you're taking a system which pays out tons of government money (80 percent for the poor, with a fund to pay for people who can't afford the 20), taxes income to pay for healthcare (that's what "mandated savings" is-a tax on income), and then pays out government regulated rates on major medical (just like medicare)....and yet a heart surgery is about $90,000 cheaper.
???
But the Singapore government doesn't pay out tons of money, not relative to the other countries we've been discussing. And they get better results (so say the studies) by not doing so.
By your reasoning, wouldn't that means that paying less from the government is better, and that the Western universal health care schemes are inferior? Lower costs, higher efficiencies, and all that?
If you're going to be consistent,then you have to agree that UHC and/or massive government payouts are an inferior solution.
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Really?
Tell me where this magic subsidizing agency is, because my company would be very interested in getting this money from the sky. We fund our own research on medical devices.
The "medical R&D is all government funding" argument is a lie.
Yeah, I do believe he said "a good chunk"-just because your company doesn't get it doesn't mean it exists.
I mean, I don't get welfare-does that mean that "poor people getting tax money" is a lie?
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check the japanese system next and ask yourself why nih sends folks there when they could offer no more treatment here
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If you're going to be consistent,then you have to agree that UHC and/or massive government payouts are an inferior solution.
It is a universal healthcare scheme-if you're poor, the government pays. If you have money, the government taxes and then uses that money to pay fixed (by government) rates for major medical care.
The private system competes with that.
The reason why it spends less money is that the provision of services costs much, much less.
So that's the question: If government regulation and taxing to pay for the poor drives up the cost, how come Singapore's cost is far below what it is in the US?
It obviously has more regulation than here (basically it has medicare for everyone, and it covers 100 percent of the population with government funds...the poor get out of the government's account, the wealthy get taxed and forced to pay for their own)....yet it's much cheaper.
See the problem with your reasoning there? By your logic, the "individual cost" angle should make American healthcare the cheapest and most efficient in the world, but it's not. So what's doing it in Singapore?
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http://en.wikipedia.org/wiki/Research_funding
The US government spends more than other countries on military R&D, although the proportion has fallen from around 30% in the 1980s to under 20%[1]. Government funding for medical research amounts to approximately 36% in the U.S
more from the dems
Government-Funded Research Enhances Our Quality of Life and Promotes Economic Growth
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the U.S. It provides grants and contracts to support research in over 2,000 research institutions in the U.S. and abroad, and conducts more than 2,000 research projects in its own laboratories. NIH grants have also trained a host of scientists in its intramural programs and supported the training of hundreds of thousands of scientists at universities and medical schools around the country through research grants. The list of those scientists who have received NIH support over the years includes 106 Nobel Laureates, five of whom made their prize-winning discoveries in NIH laboratories. NIH reports a number of scientific advances supported by its research dollars, including:
* Improved understanding of heart disease. In 1948, NIH inaugurated the Framingham Heart Study, a project to identify the common factors or characteristics that contribute to cardiovascular disease (CVD). At the time, little was known about the general causes of heart disease and stroke, but the death rates for CVD had been increasing steadily since the beginning of the century and had become an American epidemic. Over the years, careful monitoring of the Framingham Study population has led to the identification of the major CVD risk factors - high blood pressure, high blood cholesterol, smoking, obesity, diabetes, and physical inactivity. Since its inception, the study has produced approximately 1,200 articles, making the concept of CVD risk factors integral to the medical curriculum. This has led to the development of effective treatment and preventive strategies in clinical practice.
* Chemotherapy as a standard treatment for cancer. Work done during the 1950's and 1960's by NIH researchers led to the development of the first successful cures for a leukemia. This played a major role in establishing chemotherapy as a standard cancer treatment.
* Cigarette - lung cancer link. In the late 1990's, researchers supported by NIH found the first direct biological link between cigarette smoking and lung cancer. Scientists had long associated cigarette smoking with lung cancer, but this discovery uncovered the molecular basis for how smoking leads to lung cancer.
* Breast cancer treatment validation. In the mid-1990's, researchers supported by NIH showed that women at high risk of developing breast cancer who took tamoxifen had 49 percent fewer cases of breast cancer than those who did not. Tamoxifen has been hailed as the first drug to prevent breast cancer in women at high-risk for the disease.
* Anti-cancer drug. In 2001, NIH funded the lion's share of the basic research that eventually led to the discovery and development by the drug company Novartis of a new drug known as Gleevec. It is the first anti-cancer drug specifically developed to target a molecular problem that causes a particular type of cancer, in this case, chronic myelogenous leukemia (CML).
* Searching for a diabetes treatment. In 2002, scientists at NIH and the University of Texas Southwestern Medical Center successfully used the hormone leptin to treat patients suffering from lipodystrophy, a rare and difficult to treat disorder that shares some of the characteristics of typical type 2 diabetes. Diabetes is the sixth leading cause of death in the U.S. and is responsible for $92 billion in direct medical costs per year.
* Epilepsy treatment. In the early 1990's, NIH scientists helped to develop a major new drug for epilepsy, felbamate, that is safe at high doses and does not have side effects commonly associated with other antiepileptic drugs.
* Decrease in Sudden Infant Death Syndrome. Between 1992 and 1996, the rate of Sudden Infant Death Syndrome (SIDS) dropped by 38 percent. Much of that drop was likely due to a 66 percent decrease during the same period in the number of U.S. infants being placed to sleep on their stomachs. The Back to Sleep Campaign, a national campaign that encourages infants to be placed to sleep on their backs, was launched by the National Institute of Child Health and Human Development (NICHD) in partnership with several other organizations in 1994.
* Advances in rubella detection and prevention. In the 1960's, NIH researchers developed the first licensed rubella vaccine and the first test for rubella antibodies that was practical for large scale testing (rubella hemagglutination inhibition test). Deaths from rubella have decreased 99 percent since the vaccine became available.
* Juvenile typhoid vaccine. In 2001, NIH researchers and others supported by NIH developed and tested the first vaccine capable of protecting children ages 2 to 5 against typhoid fever. Seemingly the most effective typhoid vaccine ever developed, it is also virtually free of side effects. About 16 million people worldwide develop typhoid each year, and 600,000 die from the disease.
* Mother-infant HIV transmission treatment. In the late 1990's, researchers supported by NIH demonstrated an affordable and practical strategy for preventing transmission of the HIV virus from mother to infant. A single oral dose of the antiretroviral drug nevirapine given to an HIV-infected woman in labor and another to her baby within three days of birth reduced the transmission of virus by half compared with a similar short course of AZT.
* Smallpox vaccine dilution trial. In 2002, an NIH-supported clinical trial demonstrated that the existing U.S. supply of smallpox vaccine - 15.4 million doses - could successfully be diluted up to five times and retain its potency, greatly expanding the number of people it could protect from the contagious disease.
* Staph bacteria vaccine. In 2002, NIH scientists and the company Nabi developed the first successful vaccine against Staphylococcus aureus, a major cause of infection and death among hospital patients. Recently, researchers have discovered strains of the bacteria that are resistant to the antibiotics used to treat them, making a preventive vaccine critical.
* Urinary incontinence treatment. In 2002, researchers supported by NIH showed that rural older women with urinary incontinence (UI) could use behavioral changes, such as bladder training, and pelvic muscle exercises with biofeedback, to reduce their UI severity by 61 percent. UI is a leading reason for people in rural areas to move to a nursing home, and controlling it leads to a better quality of life and allows people to remain in their homes longer.
The National Institutes of Health is not the only source of federally-funded advances in medical technology. A number of other federal agencies, including the National Aeronautics and Space Administration (NASA) and the National Institute of Standards and Technology (NIST), have supported research that has improved public health in the United States and around the world.
* Advances in medical laser technology. Laser technology that originated in NASA's satellite-based atmospheric studies in the mid-1980s has been applied to a variety of medical fields. NASA-developed switching technology, for instance, was used to produce a uniform controllable laser beam maintained at a low working temperature. Lasers of this type are being used to correct myopia (nearsightedness) and to perform laser angioplasty, which vaporizes blockages in coronary arteries.
Laser angioplasty is helping to prevent cardiac arrest with a success rate of 85 percent at opening blocked arteries. At the same time, this procedure positively impacts patients' recovery time, costs and productivity. The same type of technology allows medical facilities, in a one-minute procedure, to correct myopia. According to NASA there are an estimated 60 million nearsighted Americans who will not need glasses if they undergo this procedure.
* Breast biopsy system. Technology developed at NASA's Goddard Space Center for the Hubble Space Telescope in 1997 has found a new application in breast biopsies. A high technology silicon chip converts light directly into electronic or digital images that can be manipulated and enhanced by computers. Known as stereotactic core needle biopsy, the procedure is performed under local anesthesia with a needle instead of a scalpel, leaving a small puncture wound rather than a large scar.
Recent statistics from the American Cancer Society show that approximately one in nine women in the United States will develop breast cancer at some point in their lives. This new technique, which is replacing surgical biopsy as the method of choice in many cases, is saving women pain, scarring, time, and money. Compared to traditional surgery, the new procedure is just as effective and can be performed in a physician's office for about one-quarter the cost. NASA estimated in 1997 that this procedure would reduce national health care costs by about $1 billion a year.
* Advanced pacemaker. In 1969, NASA and the Applied Physics Laboratory of Johns Hopkins University began working with private industry to apply NASA-developed aerospace technology into pacemakers. Through this collaboration, technology originally designed for two-way communication with satellites has been used since 1997 as a means of communicating with and reprogramming pacemakers without the need for further surgery. Additionally, space microminiaturization technology and spacecraft electrical power system technology have been applied to produce the first single-chip pacemakers with rechargeable, long-life batteries.
Pacemakers help people with heart rhythm disorders live longer, more productive lives. According to NASA, by the late 1990's, the U.S. pacemaker market totaled over $1 billion annually and was on a trajectory to continue growing at a rate of 8 percent annually.
* New DNA biochip technology. While working on a project to develop advanced biosensors in 1994, scientists at the Department of Energy's Oak Ridge National Laboratory developed a DNA diagnostic biochip. The hand-sized device, which uses less blood than current procedures, may eventually be used to diagnose diseases such as AIDS, cancer and tuberculosis in the doctor's office without the need for a separate testing facility.
According to NASA, many drugs work on less than 50 percent of all patients and there are approximately 100,000 deaths each year in the US resulting from the adverse effects of medication. Biochip technology will support more specific diagnostics, prediction of response to drugs, and safer, individualized medication.
* Infrared Thermometer. NASA's Technology Affiliates Program seeks to improve the competitiveness of American industries by facilitating the transfer of government-developed technology to the private sector. Through this program, technology initially used to view and measure the emitted infrared radiation from planets and stars was refined in the late-1980's and early-1990's to develop the infrared thermometer. This almost instantaneous method of taking body temperatures, introduced to the commercial market in 1990, is easier and much faster (1 second as compared to 30 seconds) than previous oral or rectal methods.
According to NASA, the economic potential for the thermometer worldwide for acute care hospitals is approximately $126 million a year. A roughly similar value is predicted for sales to alternate care facilities, such as clinics, physician's offices, and nursing homes as well as to individuals. Furthermore, infrared thermometers save considerable valuable time for hospital personnel and are less intrusive to the patient.
* Advances in dental technology. In the late 1920's, laboratories at the National Institute of Standards and Technology (NIST) began what continues to be a collaboration with the American Dental Association to develop, refine, and generally improve medical practice through the invention of new dental materials, tools and methods. One of the more significant advances to come out of this collaboration was the introduction in the late 1950s of new polymeric and mineral-based materials for aesthetic tooth restoration and the development of metallic alloys for amalgams.
Over the past four decades, American dentists have made hundreds of millions of restorations with these dental polymers. It was estimated in 1987 that the increased durability of composite restorations, and thereby the reduction of replacement costs of previously used materials, saved Americans more than the combined appropriated budgets of NIST, the ADA, and the National Institute of Dental Research. The U.S. market for these products is now $163 million per year (American Dental Association, National Institute of Standards and Technology, and Strategic Dental Marketing Corp.).
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was there hidden in there an explanation of why its so much cheaper there? i missed it
Let me summarize:
In Singapore, everyone pays at least a portion of the costs they incur, even the poor. Most people pay all of the costs they incur. This creates strong incentives to patients to minimize the amount of service they consume. This goes a long way to keeping costs down.
Care providers must publish their prices. This enables price shopping, which doctors and hospitals even more incentive to keep their prices down.
Routine care is paid by individuals out of pocket, from mandated personal savings accounts. Yet again, incentives to keep costs down. When it's your money, you tend to use less. They use insurance only for major medical costs, not for routine care. This means people are covered int he event of a catastrophic illness, and it also means that insurance costs stay reasonable.
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http://www.npr.org/templates/story/story.php?storyId=89626309
2008 · Japan produces cars, color TVs and computers, but it also produces the world's healthiest people. It has the longest healthy life expectancy on Earth and spends half as much on health care as the United States.
That long life expectancy is partly due to diet and lifestyle, but the country's universal health care system plays a key role, too.
Everyone in Japan is required to get a health insurance policy, either at work or through a community-based insurer. The government picks up the tab for those who are too poor.
It's a model of social insurance that is used in many wealthy countries. But it's definitely not "socialized medicine." Eighty percent of Japan's hospitals are privately owned — more than in the United States — and almost every doctor's office is a private business.
Health Care for Anyone at Anytime
Dr. Kono Hitoshi is a typical doctor. He runs a private, 19-bed hospital in the Tokyo neighborhood of Soshigaya.
"The best thing about the Japanese medical system is that all citizens are covered," Kono says. "Anyone, anywhere, anytime — and it's cheap."
Patients don't have to make appointments at his hospital, either.
The Japanese go to the doctor about three times as often as Americans. Because there are no gatekeepers, they can see any specialist they want.
Keeping Costs Low
Japanese patients also stay in the hospital much longer than Americans, on average. They love technology such as magnetic resonance imaging; they have nearly twice as many scans per capita as Americans do. A neck scan can cost $1,200 in the United States.
Professor Ikegami Naoki, Japan's top health economist, explains how Japan keeps MRIs affordable.
"Well, in 2002, the government says that the MRIs, we are paying too much. So in order to be within the total budget, we will cut them by 35 percent," Ikegami says.
This is how Japan keeps cost so low. The Japanese Health Ministry tightly controls the price of health care down to the smallest detail. Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug.
That helps keep premiums to around $280 a month for the average Japanese family, a lot less than Americans pay. And Japan's employers pick up at least half of that. If you lose your job, you keep your health insurance.
An Accommodating Insurance System
Japanese insurers are a lot more accommodating than their American counterparts. For one thing, they can't deny a claim. And they have to cover everybody.
Even an applicant with heart disease can't be turned down, says Ikegami, the professor. "That is forbidden."
Nor do health care plans covering basic health care for workers and their families make a profit.
"Anything left over is carried over to the next year," Ikegami says. If the carryover was big, "then the premium rate would go down."
Perhaps Too Cheap?
So here's a country with the longest life expectancy, excellent health results, no waiting lists and rock-bottom costs. Is anyone complaining?
Well, the doctors are. Kono says he's getting paid peanuts for all his hard work.
If somebody comes in with a cut less than 6 square inches, Kono gets 450 yen, or about $4.30, to sew it up.
"It's extremely cheap," he says.
Kono is forced to look for other ways to make a yen. He has four vending machines in the waiting room. In a part of Tokyo with free street parking, he charges $4 an hour to park at his clinic.
The upside is that virtually no one in Japan goes broke because of medical expenses.
Personal bankruptcy due to medical expenses is unheard of in Japan, says Professor Saito Hidero, president of the Nagoya Central Hospital.
Hospitals Hit Hard
But while the patients may be healthy, the hospitals are in even worse financial shape than the doctors.
"I think our system is pretty good, pretty good, but no system is perfect," he says. "But 50 percent of hospitals are in financial deficit now."
So here's the weakness: While the United States probably spends too much on health care, Japan may be spending too little. In a country with $10-a-night hospital stays, prices just aren't high enough to balance the books.
Hospital prices too low? That's a problem a lot of countries would like.
Related NPR Stories
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and the japanese system covers ganjin too
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So a heart surgery costs $90,000 less than in the US because it's covered by insurance in Singapore for residents, and regular visits are not covered by insurance, and because the government taxes your income and forces you to spend it on care (I note that you were recently championing the benefits of not having mandated savings-like how you relied on your parents to not spend money on medical care)....?
Not seeing how that's an explanation of the lower cost for each individual service, as opposed to the lower total spent.
Cost for service and amount spent are two different things. You are talking amount spent; how do you explain the staggering difference in costs?
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chirp chirp
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chirp chirp
See, like you gave an article with an obvious answer for Japan This is how Japan keeps cost so low. The Japanese Health Ministry tightly controls the price of health care down to the smallest detail. Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug.
Not seeing the same from other folks here for why the US is twenty times more expensive than anywhere else, including the supposed "free market" Singapore where everyone is covered and the government forces you to pay a tax to cover your health.
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The US is indeed less healthy than most UHC countries. But that isn't because we lack UHC. It's because we're less healthy.
So you are saying that we are less healthy than most UHC countries because... what? Not our health care system? Because we have the worst genes in human history? If you're going to say obesity, I hope you've got more than that.
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http://content.healthaffairs.org/cgi/reprint/10/3/87.pdf
long article
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It is a universal healthcare scheme-if you're poor, the government pays. If you have money, the government taxes and then uses that money to pay fixed (by government) rates for major medical care.
Not true. If you're poor, they only pay a portion of your costs, you're still on the hook for some of what you need. If you're wealthy, you're forced to set aside some of your income for medical expenses. You may choose to use some of that savings to buy government major medical insurance. Or you may choose not to.
The reason why it spends less money is that the provision of services costs much, much less.
Yup. Properly aligning the incentives will tend to do that. I assume less bureacracy is involved in Singapore, too. I doubt they have the US FDA to deal with, and devote less to new development
So that's the question: If government regulation and taxing to pay for the poor drives up the cost, how come Singapore's cost is far below what it is in the US?
If all you do is pay for the very poor, and then only for a proportion of the costs, then costs may not rise appreciably.
It obviously has more regulation than here (basically it has medicare for everyone, and it covers 100 percent of the population with government funds...the poor get out of the government's account, the wealthy get taxed and forced to pay for their own)....yet it's much cheaper.
I don't believe that's true. They fund their system differently, but I've seen no indication that it's regulated more there. If anything, given the massive FDA regulation we have here, it's almost a given that they regulate less there.
Also, My reading indicates that most of Singapore's health care is self-funded by the individuals who need care. Most people pay with private savings and personal insurance, not government funds.
See the problem with your reasoning there? By your logic, the "individual cost" angle should make American healthcare the cheapest and most efficient in the world, but it's not. So what's doing it in Singapore?
Individual cost is what they have in Singapore, not here. Here in the US most routine care is paid by insurance, which is a layer removed from individual cost.
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So you are saying that we are less healthy than most UHC countries because... what? Not our health care system? Because we have the worst genes in human history? If you're going to say obesity, I hope you've got more than that.
Americans live distinctly less healthy lifestyles compared to most other developed countries.
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The copayment
rate differential to which insured workers and their dependents are
subjected has been largely cushioned by the fact that any out-of-pocket
copayment faced by a patient in a given month over the amount of 57,000
yen ($438) [or 30,000 yen ($231) for those with low income] is reimbursed
regardless of the plan. These measures have inhibited the extensive
development of a competitive private insurance alternative. Most
private insurance offerings are for supplemental benefits, to cover amenities
during a hospital stay or other incidental expenses.
Thus, Japan has one of the most equitable single-tiered health care
systems in the world. According to a 1988 survey. conducted in Tokyo,
neither the utilization rate nor the health care expenditure per person
was affected by an individual’s income level.8 In a national survey in 1985,
of those who had experienced an illness but had not seen a physician,
only 0.4 percent gave economic reasons for not having done so.9 Out-ofpocket
expenses for copayments amount to only 12 percent of the total
health care expenditure provided under social insurance.
The key factor that allows for this level of equity under a multiple-payer
system is the government’s central role in managing and subsidizing the
plans that insure the financially disadvantaged. As shown in Exhibit 1,
in the government-managed health insurance for those employed in small
enterprises, the central government acts as the insurer and provides a
direct subsidy from the general budget amounting to 16 percent of its total
expenditure. In the national health insurance plan for the self-employed
and pensioners, local governments act as insurers, and the central govJAPANESE
SYSTEM 93
emment provides a direct subsidy amounting to half of total expenditures.
For the elderly, the central pooling mechanism is financed through
contributions from the national and local governments-the former, 20
percent, and the latter, 10 percent of expenditures-and from funds
pooled from all plans. Because those individuals who are employed by
large companies or in the government have relatively high incomes and
tend to have better health status, no public subsidies are given to the
insurance societies and the mutual aid associations, with the exception
of some modest support for administrative expenses.
Are Japanese Health Care Costs Truly Low?
Among the major industrialized nations, Japan’s personal health expenditures
are virtually the lowest, according to data collected by the
Organization for Economic Cooperation and Development (OECD). But
are Japan’s costs really that low? The first question that confounds any
international expenditure comparison is the difference in statistical compilation.
The boundaries between health care, human services, environmental
protection, and education are not clearly drawn, so that what is
aggregated under “health care” need not be, and is not, the same. The
OECD has attempted to standardize the cross-national variations; it
estimates that Japan spent 6.8 percent of its gross domestic product
(GDP) on health care in 1987, 3 percent higher than the official Japanese
government figure of 6.4 percent.10 The latter estimate is probably an
understatement, since it is based only on the social insurance expenditures
and excludes expenses for normal child delivery, direct medical
education and research expenditures, grants to public hospitals, preventive
health measures, private room charges, and private gifts to physicians
(which I discuss later). Thus, the 3 percent difference may be regarded as
too small for comparative purposes.- However, the OECD figure is the
best comparable data currently available; even if increased by as much as
10 percent, this estimate would still be well below that of the major OECD
countries, with the exception of the United Kingdom and Italy.
The second question is whether health care costs are low when
compared with the service demands placed upon the system. The problems
assailing the U.S. health care system and certainly adding to its
higher costs-such as the high prevalence of people who abuse alcohol
and drugs, engage in criminal practices that lead to death and injury, or
have acquired immunodeficiency syndrome (AIDS)-are of a significantly
lower magnitude in Japan. In particular, only 195 persons were
reported as manifesting AIDS as of August 1990, most of whom were
hemophiliacs.11 With a little more than twice Japan’s population, the
94 HEALTH AFFAIRS | Fall 1991
United States has about 180,000 AIDS patients. The Japanese may also
have a healthier diet: only 25.5 percent of total calories come from fat
(1988). 12 Another factor is the litigious nature of American society, which
has led to malpractice suits and, of more significance economically,
defensive medicine. In contrast, the number of lawyers per capita in Japan
is about one-tenth that of the United States, and malpractice suits are far
less common.
On the other hand, some negative factors in the Japanese lifestyle may
counterbalance these positive attributes. About 61 percent (1989) of men
over age twenty smoke, down from 84 percent in 1966 but still well above
the U.S. rate and that of many other countries.13 The Japanese diet has a
high salt content (daily consumption rate of 12.2 grams), which has led
to a high incidence of cerebrovascular disease. Also, the manner in which
Japan provides geriatric care to its elderly citizens is not likely to be a
factor in explaining health spending differences. The ratio of individuals
over age sixty-five is similar to that of the United States-about 12
percent. Although some 62 percent of the elderly live with their children
in Japan, the institutionalization rate is quite high (6.2 percent) and is
comparable to that of the United States. Thus, popular beliefs about the
veneration of the elderly and the willingness of children to provide care
in their homes in Japan are not borne out by available data. Moreover,
the major burden for taking care of the elderly falls on the health care
system because of the inadequate provision of social services. Of those
institutionalized, 75 percent are in hospitals and clinics.14
The third dimension to be considered is the denominator in health
costs. Since Japan’s GDP has grown rapidly, the relative cost of health
care has remained low when compared with most other countries, which
have not experienced rapid economic expansion. According to George
J. Schieber, of the seven major OECD countries, Japan had the highest
growth in real per capita health expenditure during 1960-1987, adjusted
for health care inflation and population growth.15 The increase was 8.18
times or 8.1 percent annually (the equivalent U.S. figure was 2.78 times
and 3.9 percent, respectively). However, it should be noted Japan was
still a relatively poor country in 1960 with a per capita expenditure of
only $258 (purchasing power parity), compared with $1,489 in the
United States. Thus, a more meaningful comparison is the real elasticity-
the compound annual rate of growth in real per capita health
spending relative to the compound annual rate of growth in real per capita
GDP. This figure comes to 1.46 annually during 1960-1987 for Japan,
which is well below the U.S. figure of 1.80 for the same period.
After one examines the above caveats, health care costs are definitely
low in comparison with the United States and very likely in comparison
JAPANESE SYSTEM 95
with Canada, France, and Germany as well. While the spending differential
that exists between these countries could be partly attributed to
the social systems in question, the following measures are important in
Japan’s effort to moderate the growth of its health spending.
Mechanisms For Cost Containment
The nationally uniform fee schedule has already been cited as playing
a key role in maintaining equity. It has also been the primary mechanism
for containing total health care expenditure. This is because it establishes
both the scope and standard of services that can be provided. Neither
providers nor payers can negotiate individually to expand benefits; any
such decision must be made by government. Because any benefit expansion
must apply to all insurers, the government has a strong incentive to
constrain the growth of total health expenditures. The incentive derives
from the fact that the government subsidizes the plans at a fixed rate;
when plan expenditures increase, so does the government’s subsidy.
When the Japanese government began to focus on containing overall
public expenditures in the early 1980s, one of its targets in relation to
medical care was limiting the increase in the fee schedule.16 The general
effort to constrain public expenditures came in the context of an Administrative
Reform campaign spearheaded by private business interests and
the Ministry of Finance in reaction to the huge deficit spending in the
1970s. A committee headed by Dokou, honorary chairman of the Japan
Federation of Economic Organizations, recommended in a widely publicized
report that the combined burden of taxation and Social Security
payment should remain below the level of 45 percent (recently amended
to 50 percent) of GDP. This ceiling, the committee said, should apply
even when the number of elderly reaches its maximum in the year 2020.
This report, along with support from the Ministry of Finance, was
successful in creating a national consensus on constraining public-sector
spending. Health care costs, as a major contributor to the deficits, became
an obvious target. The degree of success can be seen in Exhibit 2. Health
spending as a proportion of GDP (Japanese government estimates) increased
from 4 percent to 6 percent in the 1970s. However, the pace
slackened greatly in the 1980s. A similar pattern can be observed in the
premiums that employers and employees contribute to the governmentmanaged
health insurance plan: the rate increased from 7 percent in 1970
to 8.5 percent in 1982 but has now decreased to 8.3 percent. This has
been reflected in the reduced proportion of an average worker’s income
devoted to health services. Currently, the average worker’s health care
expenditure (insurance premiums plus out-of-pocket expenses) amounts
96 HEALTH AFFAIRS | Fall 1991
Exhibit 2
Changes In The Ratio Of Health Care Expenditures In Japan, 1970-1988
Sources: Kousei Tokei Kyokai, “1990 Trends in the Nation’s Health,” Kousei No Shihyou 37, no. 9 (1990): 234;
and Kousei Tokei Kyokai. Hoken to Nenkin no Dokou (Tokyo: Kousei Tokei Kyokai, 1989), 63, 107.
to 3.7 percent of income, a reduction to a mid-1970s leve1.17
The actual negotiations for any revisions in the fee schedule take place
in the Central Social Medical Care Council of the Ministry of Health
and Welfare. This council comprises eight representatives from providers
(five physicians, two dentists, and one pharmacist), eight from payers
(four from insurers, which includes two from the government, and two
each from management and labor), and four to represent public interests
(three economists and one lawyer). Global increases are based on the
periodic survey made every second year of the financial state of hospitals
and clinics (the latter being equivalent to a study on physicians’ income).
As noted, beginning from the revision made in 1981, the government
has exerted strong pressure to contain increases in the fee schedule.
Revenues used to grant fee increases derived largely from reductions in
government-regulated prices for pharmaceuticals. Thus, while medical
fees were allowed to increase 27 percent from 198 1 to 1990, a 52 percent
decrease in drug prices and cuts in laboratory test fees left the net increase
for fees and prices at only 2.4 percent, far below the 15 percent increase
in inflation that occurred during this period.
As a result of these cost containment measures, Japanese health care
costs have been kept at a level considerably below that of the United
States. The average cost per day, inclusive of all services, averages only
13,523 yen ($101) for inpatient care (including physician expenses) and
4,329 yen ($33) for an outpatient visit (including medication). For new
technology, the fee is set by comparing it to the nearest existing procedure,
equipment, or drug. For example, the fee for a magnetic resonance
JAPANESE SYSTEM 97
imaging (MRI) examination is only 23,000 yen ($177), just 4,000 yen
($28) more than for a regular CT body scan. Importantly, the total
revenue derived from billing for itemized services must pay not only for
operating expenses, but also for capital acquisition costs. This practice is
particularly significant for the physician owners of clinics and hospitals
because they have very few revenue sources outside of the services
provided under social insurance. This explains why the physician owners
cannot make large investments in high-technology equipment.
Another constraining influence on medical costs is the retrospective
review of claims sent by providers to third-party payers. Detailed itemby-
item claims of the services rendered must be sent by every institution
at the beginning of each month to the intermediary payment funds that
operate at the prefecture level. These claims are then inspected by the
funds’ designated panel of physicians. If the panel concludes that excessive
numbers of procedures or drugs have been provided, payment can be
denied for those items. In addition, claims over the amount of five million
yen ($38,462) are subjected to special reviews at the national level.
It is difficult to evaluate the effectiveness of this claims review mechanism.
The average time for reviewing each bill is less than one second
because of the huge number of claims (1.6 billion a year) that must be
reviewed manually; electronic billing is still not permitted in Japan. Even
with administrative screening,-there are still too many bills for objective
evaluation, Moreover, the only information available is in the form of
itemized services provided in the past month, which are checked against
the patient’s age, sex, and diagnosis. This has led to the practice of adding
a diagnosis so that a particular procedure will pass review. As a consequence,
it is common to see four or five, or even ten, diagnoses on a
patient’s bill. On the other hand, the peer review panel does have
empirical knowledge of the practice patterns of the institutions in the
community and tends to be more rigorous in checking claims coming from
the more questionable providers. The arbitrariness of this process, plus
the time-consuming nature of the appeals process, may discourage physicians
from providing more services to their patients than are deemed
clinically necessary. Thus, even though the actual ratio of the claims
judged as providing excessive care is less than 1 percent, the sentinel
effect of peer review may be greater than this figure suggests.18
lots of government involvement here oh no!!!
-
Headless,
Hmm....it went from "The US system is the best! It lets people choose not to buy care, like the 40 million who don't really want it, and it lets people like me rely on mom and dad"
To: "See, the US doesn't have a market system, because it's all paid for by private insurance...and the private insurance that pays private hospitals through privately negotiated agreements just isn't a market scenario like the government mandated savings and medical programs in Singapore."
To: "The FDA is keeping us all unhealthy by doing too must testing and delaying."
The only part that's consistent is the ideological rhetoric-the claims about the facts have waffled dramatically here. I'm not sure I know which solution you're advocating, or if you now believe there is a problem with the US system (you seemed to be denying it), or if you think that people come from all over the world to the US because it's more inefficient and less market based or because it's more efficient and more market based...
Confusing, for sure.
-
see pages 105 to 108 in the pdf on the japanese system for a summary
-
Headless,
Hmm....it went from "The US system is the best! It lets people choose not to buy care, like the 40 million who don't really want it, and it lets people like me rely on mom and dad"
To: "See, the US doesn't have a market system, because it's all paid for by private insurance...and the private insurance that pays private hospitals through privately negotiated agreements just isn't a market scenario like the government mandated savings and medical programs in Singapore."
To: "The FDA is keeping us all unhealthy by doing too must testing and delaying."
The only part that's consistent is the ideological rhetoric-the claims about the facts have waffled dramatically here. I'm not sure I know which solution you're advocating, or if you now believe there is a problem with the US system (you seemed to be denying it), or if you think that people come from all over the world to the US because it's more inefficient and less market based or because it's more efficient and more market based...
Confusing, for sure.
Oy. Your reading comprehension fails you. Lemme make this dirt simple for you, since you're so easily confused. We'll take it one item at a time.
Ready? Here we go. Try to keep up.
First...
The US system is better than the UHC systems typically used in developed Western countries. If we're only considering those options, the US system is definitely the best.
The Singapore system is better than the US system in many ways, and better than Western UHC in almost every way.
None of these are perfect.
-
Still with me?
Second...
Costs respond to economic factors. Incentives are probably the most important such factor for our purposes here
If there are strong incentives to keep prices down, prices will naturally tend to stay down. If there are no incentives to keep prices down, prices will naturally tend to rise, unless arbitrarily capped by an outside force.
Outside forces (government) can mandate low prices, but that comes with side effects such as shortages.
-
man me and the japanese health system feel left out and it deals with 122 million folks too
-
The tone of this thread is disappointing, to say the least.
"Since you're so easily confused..."
"Try to keep up..."
Umm, no. The thread's outlived its usefulness, and probably well before C&SD began posting text and links hither and yon sans explanation.
As for the others? Well, they're basically talking at each other, and obviously not using their best manners in doing so. See excerpts, above.
Put a fork in it, because this one's done.
Next...