I'm generally in favor of reform to the US health care system and it was one of the selling points of Obama's candidacy for me. I think the system is broken in that I consider health care a basic right, inherently linked to the pursuit of happiness. Evryone shoudl have access to affordable health care, and no one should have to suffer and die because they don't have money. Especially in the most affluent society in the world.

That being said: i doubt a single payer system would work here in teh US - our population is too large. I aslo wouldn't want a government bureaucracy in sole charge fo teh entire system.

But i ahve no issue whatsoever with a government plan, like Medicaid that would compete with the insurance industry. I balme the insuracne companies for most of the excess costs and denail of service extant in the currnet system - though exorbitant legal costs certainly plays a aprt as well. Thus - I am in favor of Obama's efforts and i support the legislation making its way through congress at the moment. I am confdient something will get passed, i am confident it will not add ot the tax burden of the middle class, and i am confident that most people wiht their own insurance won't lose it.

What has irked me about the deabte so far is the argument that under the new paln - governement officals will dicatte when and what care you will get. Excuse me? Isn't that what we already have? Only its the faceless insurance companies that dicatte what care you get? i ahve experienced this personally on several occasions in the past twelve months, but even before this got personal - i already resnted how much sya the insurance companies had over what doctors I coudl see and how much they chared me for it.

I say if the government can run medicaid and medicare, let them set up an alternative. If the insurance companies can't compete - to bad for hem. isn't that how the markey is supposed tow rok? Competition adn all that? and if the government plan isn;'t to your liking - stick wiht Oxford or blue cross or whatever you have at the moment.

Costs need to come down. Period. And right now - a federal alternative to the existing system seems the best bet.

I'm fairly certain something will get done this year. at the very least, i expect legislation allowing you to keep your coverage even when you change jobs, or lsoe your job, and also i expect that the insurance companies will not be able to deny coverage for pre exisitng conditions. But I am hoping we get the government plan as an alterantive as well - and i think it will come down to teh courage of the Blue Dog democrats.

Stag Lord said:

I agree with you. The cost and unaffordability of healthcare is a huge problem in our country. I am deeply concerned, however, by the idea of the federal government taking over healthcare. The cost is simply too enormous to be borne by our government.

We need a solution, but I believe that solution lies in regulation and greater transparency of the healthcare system, not a new program

I dont see the plans as a government "take over" of the system.

Private insurance will still be around - don;t worry. They make far too much money to disappear. I argue that the Democrat plans under consideration will supplement private health care - by making sure all americans have access to it, and giving us the choice to opt out of the ridiculous private system if we want.

I would agree wiht you Joe, that government can't carry the burden by itself. Nor should it. single payer health care will never work in a country of thsi size.

Stag Lord said:

There is something inherently contradictory between treating healthcare as a basic right and expecting market competition to control both costs and prices. Competition characterizes a market. Markets, by their nature, assume that a balance will be struck between supply and demand. This means that a market will not necessarily fill all demand and that competition will not necessarily create a greater, or cheaper, supply because it may be more cost effective (or just plain easier) for the suppliers to pull out of the market. In short, there is no obligation to supply in a market or a competition, but if healthcare is a right, someone MUST have an obligation to supply for all demand.

(I'm not saying healthcare isn't a right. I'm saying that traditional economic principles of supply and demand do not apply the same way that it does for, say, commodities or manufactured good. I firmly believe that if we want healthcare to be a right, "market competition" cannot be trusted to keep costs down because someone will have to "supply" every "demand," regardless of cost or profitability.)

Stag Lord said:

Don't underestimate the legal costs part of it. It goes a lot further than healthcare providers passing on the costs of malpractice insurance. You know all the "unnecessary tests," "excess costs" and "procedures with little to no medical value" we keep hearing about? Most doctors know that they order too many tests, but if they don't order them and something goes wrong, not ordering that test becomes "Prosecution Exhibit A." So much of these "superfluous" procedures are done from a CYA point of view because professional judgment is not an acceptable defense and, as Murphy will tell you, the one time you don't order it is the one time you find yourself in court. Honestly, healthcare reform without tort reform will end up a losing battle (~ according to me and my crystal ball, anyway ).

Oh - I'm well aware of the problems with litigation,and the resultant hits to both doctors and insurance companies. This should certainly be a part of the solution, but it can't be the only, or even the primary aprt. look at missouri. as Claire McKaskill was pointing out -t hey ahve been energetic and successful in their tort reform efforts there over the past few years - and health costs have not come down.

And I agree that it is difficult to apply market principles to health care, especially since we have always treated it as a commodity, and much of it has been commodified. (medication, tests, treatments). Regardless - teh saoring costs do need to be addressed, and competition form teh feds should pull the costs down.

Stag Lord said:

Absolutely. It is certainly true that insurance companies drive a lot of the superfluous tests, too. The MD says "I need to do X" and the insurance company says "I can't authorize X until you show that it isn't really Y." So there is still a "need" to do all these superfluous tests, even with less pressure from a generally litigious society. I'm just saying there is another side to the coin. Without tort reform, providers (physicians, hospitals, insurers, etc.) will still see a "need" for the superfluous procedures - even if it isn't a medical need.

BTW: Two other considerations on the "competition from a government insurer will force private insurers to drive cost savings in order to match" issue:

1. Much of this is predicated on the idea that the government insurer will not have to turn a profit, so they are at an advantage. While true in principle, it may not be true in fact. The government insurer will have to provide coverage for all comers, and its resources will not be infinite. As such, they will have to turn a profit - in the sense that they cannot "live in the red" and need to provide essentially infinite coverage with finite resources. Medicare doesn't have to turn a profit, either, but one of the main forces behind the need for healthcare reform is that if things continue, Medicare is going to "run out of money." So Medicare needs to be "more profitable" (and they only pay 70% of cost - not price, cost - as it is). Why do we think a government insurance option will be any different?

2. There is a disconnect between the "competition" for members on an insurance plan and the "profitability" of the insurance plan based on payments and reimbursements. The old joke that insurance companies are in business to not pay claims is pretty accurate, really. Insurers, including a government insurer as outlined above, may try to be more profitable not by finding a way to offer lower premium prices and thus attract more members, but by lowering reimbursements to providers - whether the providers can handle it or not. This is as likely to put providers out of business (ultimately) as it is to encourage cost savings, improvements, etc. That's actually the situation we're in right now. The consumer is not the payer. The patient has no real feeling for how much their care costs (or else they might be more compliant with treatments, preventions, etc.), and the insurers have no real feeling for what it's like to need the care (or else they might not make patients and providers jump through so many hoops to justify the need for various services). That's the disconnect that I don't see addressed anywhere in the healthcare reform plans.

On a slightly tangential note, one thing that gets overlooked in the discussion of Health Care reform is overall healthiness reform, if you will. Americans are fat, and seemingly getting fatter ever year. Soon, it will be trendy to be fat (More to Love anyone?).

I don't have anything personally against fat people, I used to be overweight myself, and I'm fighting hard to lower my BMI to healthy levels for the sake of my health.

I guess my point is, healthcare costs are going to continue to soar as Americans across the spectrum grow unhealthier. The interesting question becomes, if free healthcare were provided as a "right," would Americans continue to grow fatter? Would their concern about their health be lessened because they know their treatment will be paid for, or will increased exposure to medical professionals serve to raise their awareness of their poor state of health?

jmccarthy said:

An excellent tangent, actually. It feeds into my question about the disconnect between payer and consumer. If Americans in general paid the price/cost of their healthcare (for reasons unfathomable, Americans do not associate the cost of their insurance premiums with the cost of their actual healthcare), would they be more likely to do the things we know prevent health problems, or at least lower health risks?

Let's put it this way; the average American is more willing to pay $40 for some (unproven) herbal weight loss pill than they are to pay the $20 co-pay on their prescription drug plan. So apparently, we think we're getting some value for the Stacker-2 that we're not getting out of the antibiotics. Or maybe it's because we think of the prescription drug as a "right" (and thus shouldn't have to pay for it), but the other is a choice?

The psychology of American healthcare is actually pretty fascinating (and mind-blowing).

Stag Lord said:

I really think Giuliani had the best starting point for this - that is to make any health insurance premiums fully deductible for individuals on their taxes (not just if they exceed AGI limits). Currently, the premiums are deductible for businesses, but not really for individuals. Get the consumer more involved in the decision making, and you'll see far more competetion - that is move away from the model where the employers provide the coverage & make the decisions.

ktom said:

Bingo. I guess ktom's already summed up what I view as a vital aspect of any reform.

Here's another tangent. I came across this while reading up on the general topic in the last few weeks.

http://mises.org/article.aspx?Id=1547

The author basically claims the AMA, acting as a labor union, is the primary driver for the scarcity of physicians in the United States. I'm all for people with highly specialized and extensive education making good money, but if this article is true, it seems pretty shady that the "supply" of physicians is artificially restricted despite the overwhelming demand.

I promised Stag I'd rejoin the boards and talk crap, so here I am. Sorry it took a month, though

I've always felt that most discussions on health care were not based in reality.

Uninsured people are still taken care of. If an uninsured diabetic gets rushed to the emergency room because of kidney failure, a likely scenario, they will be treated and taken care of. If this person is then unable to pay for those services, another likely scenario, then those costs are passed to those of us that do pay for medical care. My point is that uninsured people are still taken care of and their costs are still put onto those of us that have the means to pay.

Instead of the uninsured getting rushed to the emergency room for reasons that stem from otherwise treatable and manageable ailments it seems to me that we would be better off insuring them so that they could get treatment. It seems logical that if, nothing else, properly treating all people with diabetes so that they don't have many of the problems associated with it later on would save a lot of money and better treat the people.

I don't see how we can have an equal and vibrant democracy without some sort of agreed upon standards for our people. I think health care, especially for children, and education should be provided so that people don't have to suffer overmuch from the failures of their parents.

I know someone will eventually come here and start propping up and knocking down strawmen about long wait times and other bad care in Canada and/or the UK. Of course, I rarely hear of anyone from those nations doing so What I have seen from family and friends is how the health insurance companies will do whatever they can to totally screw people out of care or otherwise charging them for care they had received. When you set up a system where people are making money off of medicine you have a problem. Yes, I know doctors make a living and that's not what I'm talking about.

I think a single payer option, and I'm talking about that as any other idea is out of the question now, works. Yes, some taxes will need to be increased. I'd also like to see federal sales tax on soda, alcohol, fast food, and other unhealthy items as means of dissuading people from consuming them and as a means to pay for the health ramifications of them. At the end of the day, however, I am confident that we can make the nation healthier with little extra cost as most costs stem from prolonging life beyond what a normal person would consider reasonable and by treating chronic problems before they have need to be rushed to an ER.

As a funny side not, I've gone to a few healthcare demonstrations to talk to people. It seemed that most of the older people talking about how they "wanted their country back" and other nonsense were on Medicare. That's my other major problem with how the argument is framed: the government already runs healthcare for millions of seniors, children, poor, military, and others and Medicare is oftentimes better run and efficient than corporate run health insurance.

CaseyVa said:

Coincidentally, I was just referred today to an EXCELLENT article on health care costs vs. health care quality. I think this is a MUST READ article for everyone remotely interested in the topic. It takes an apolitical (IMO) look at the health care in the costliest county in the costliest country in the world, and tries to figure out why. It is both unsurprising and shocking. (It's also lengthy, but well worth the time.)

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

edit: clickified the URL.

The United States spends the largest percentage on health care in the developed world and has one of the worst ratings from the WHO on health care in the developed world. Something is wrong here. I agree that costs need to go down but I don't think private insurance is a way to do this. I also agree that health care is a right and thus the point made that market forces shouldn't be involved in something that is a necessity is a valid one. Other countries with socialized medicine for lack of a better term have people that are healthier, live longer and generally happier. Yes, you could argue part of this is culture but I think not having medical bankruptcies and denial of service is a large contributing factor to their in general positive health care system.

I believe three things need to happen in America to make health care work:

1. Insurance companies need to become non-profit and thus they compete for the service they give and not their share holders' portfolio.

2. Everyone gets the same level of basic care and people can pay more for more specialized care like guaranteed private rooms, etc.

3. A non-interested party needs to set the costs of all procedures so that getting an aspirin in the ER doesn't cost $10 a pill.

In general I think these resolutions would reduce health care operating/administration costs and provide everyone with at least the same level of not so great health care they are getting now. A single payer model has its ups and downs and I think it would work in the US. Just because we have the fourth largest population doesn't mean that a single payer model isn't feasible.

I urge everyone to read that McAllen, TX article. I'm all for health care reform, but this guy's findings about cost/quality are incredible. If what he found holds true in general (and there's no reason to think otherwise), the biggest problem is with the "culture" of our hospitals and medical practices.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

Agreed with all three recent posters, though I doubt this country is ready to go that far. I'll settle for :

No denial of service for preexisting conditions

No lifetime caps on benefits

Portability

But none of this is going to wrok wht out a government option. I was glad to see Obama clarify today that this HAS to be part of the process. If there isn't a government option that people can choose - the only freaking winners will be the insurance companies - and really: why bother at all then? There has to be a governemnt run alternative in order to drive costs down.

Stag Lord said:

I'm still not sure how a government run option is supposed to drive costs down.

ktom said:

The operating costs for Medicare and Medicaid are very low, around 3%. Private insurance companies operating costs are in the high single digits or low teens. The main reason why Medicare and Medicaid cost so much is that when they were created the government purposely crippled them on behalf of pharma and hospitals. There is language in the Medicare/Medicaid bylaws stating that the United States government cannot used its huge influence to drive down the cost of services and medication provided by hospitals and pharma respectively. The whole point of socializing medicine is the fact that the government can leverage down the cost of services and medicine. That is one of the reasons other countries with socialized medicine pay much less than the US does for health care costs.

All that says is "the government has influence it doesn't use." But what's the actual mechanism? What "unused influence" does the government really have (short of price fixing) and how would it actually work?

No particular view on this other than that I hope the conservative side in Australia never EVER behaves like our brethren in the US have over this issue.

Check this out- a Democrat politician putting one of the lunatics in their place. (Finally!)

Barney Frank FTW.

Seriously - I'm no fan of his, but he handled that a lot better than I would have. The Nazi comparisons and the swastika imagery associated wiht our President are nothing short of reprehensible.

To Ktom's question above: I feel that a governemnt option will compete with the insurance companies and enjoy advanatges which they do not. They will be able to provide a lower cost solution to health care options and the end reult will be that yes - some insurance comoanies may go under, but teh ones that survive will have to lower costs to stay afloat.

If you don't have a goovernment option, there will be NO incentive for the insruance companies ot lwoer cost. Health care isn't car insurance or home owner's insurance, or anything like that. helth isues are not a commodity - you have no choice but to use medical services when you get sick. I'm not sure the for profit insurance approach to health care is even a good idea to start with.

I strongly feel that like some House members were saying yesterday - if there is no government option don't even bother. jsut kill hte bill and try again alter - becuase forcing everyone into the insuaance pool, adding financial burdens to teh insurance companies and forcing businesses to provide insurance for all their workers is just going to make things worse if there isn't a government option. May as well just leave things alone then.

Stag Lord said:

Ah. We are looking at this from completely different angles. What you have described is how a government option is supposed to bring down the cost of health insurance . What I'm asking is how a government insurance/payer option (and the government's "unused influence") will bring down the cost of health care .

Yes - it seems we are.

And it goes back to your point that most people don't think in terms of what their actual care costs - the only see their insurance premiums and deductibles go higher and higher and wonder how the system can sustain itself. Or how they can keep it.

One of my huge, huge issues with the entire Democart appraoch si that there is little discussion about lowering the costs for care .

Stag Lord said:

And if you can't bring down the cost of care, bringing down the cost of an insurance premium isn't going to do anything good (and probably a lot of not so good) in the long run.

Now, there are some connections. Remember, for people with insurance, the care itself seems "free" because they pay so little (a deductible and/or co-pay at most) when they go to the doctor. For people without, they avoid seeking care until they have no choice, and their charges (which are now higher than they would have been if they had come in when the issue was more manageable) usually end up as "bad debt" for the healthcare provider. That bad debt turns into the healthcare provider needing to charge the people who do pay twice as much so they can cover their cost (assuming non-profit. ha). As costs rise, insurance rates rise. As insurance rates rise, more people are left without insurance, and so on.

So there is an argument for some form of universal coverage eventually lowering costs because there will be fewer uncovered procedures; providers will at least get something . But now we're back to the idea of overutilization. Overutilization (whatever the reasons) is indeed a primary source rising healthcare costs (more charges and more risks to the same number of patients). But people with insurance are far more likely than those without to overutilize.

There are two conflicting pressures on the cost of the actual care . Dealing with excessive uncovered and/or indigent care seems to be a pretty easy fix; universal care or at least an inexpensive government option. The overutilization thing is not so easy because all the answers seem subjective ("medical necessity") or the government getting into the business of practicing medicine ("rationing," or whatever you want to call it).

Kevin, you bring up some good points but there is a lot you are missing which is part of which I talked about earlier in that the government can't use it's influence to bring down prices. It is basically the Wal-Mart model where the seller decides how much the producer is going to charge. The other thing is that hospitals, pharma, and clinics know the government is going to pay so it doesn't have to worry about padding prices and what not which you touched on. Another thing that other socialized medicine countries do, especially the UK, is practice preventative medicine. This lowers cost substantially since shorter frequent visits and/or procedures is better than long infrequent ones. Also, the facts speak for themselves in that socialized medicine countries spend less of their GDP on health care than we do by a large margin.