Health Care and Public Education....Rights?

[Andy]

The WHO does have the resources, but I can't prove that they are unbiased.

You don't have to prove that WHO is biased or not. They say so in their own literature. This is a press release from WHO in 2000. Their ranking system includes...

Inequality
Fairness of financial contribution
Distribution of Health in the Populations
Distribution of Financing

In fact, read through the entire document, and determine for yourself, how much of it is based on access, money, cost, and so on, verses quality of care. Only one single section of the entire press release indicate quality of care is even factored. Everything else is social equality, free access, and so on.

The question is, would it cost more, or less, than the system we have in place now? Could it be run more efficiently, with a lower overhead? Other countries do just that, and so can we. If we're concerned about long waits and lack of adequate care, we have that now.

First, take a look at the tax system in these countries, and compare it to our own. Do you see a slight difference? Taxes are way higher in France, than here. By a large amount. I'll give you some examples. They have a TV tax. If you own a TV, just own it, you pay a yearly fee. They have a wealth tax. Your net assets, car, home, 401K, investments of any kind, add it all up, and you owe a tax on the total. You pay a duty tax. There's an income tax. And the list goes on.

How about the UK. In England, one pays 24% tax supposedly for health care, on top of the higher income taxes, and VAT. Let's see... say I earned 20,000 last year. That's $4,800. How much do you think I spent on health insurance? $120 a month X12 is $1,440. And their system sucks. People fly all the way to India to get treatment, because their system is so slow. People are pulling their teeth out because their system doesn't pay enough for Dentists to see them, even though someone earning the same as me, is paying 3 times as much.

I don't think you have looked very hard.

Half of Bankruptcy Due to Medical Bills

That's already been discredited. Common dreams? You don't know about Commondreams.org yet? They are so far left, the entire Democratic party is made up of religious conservatives to them.

That said, let's get to this "report" that claimed half of all bankruptcies were due to medical bills. This came from the Harvard report in 2005. Nearly every article or report you read claiming 50% due to medical blaw blaw blaw, all cite this report. The problem is, the report didn't really indicate that.

The Volokh Conspiracy, a blog of lawyers from various universities and law offices, writes:

The "objective" measures from the debtors bankruptcy petitions are, if anything, even more questionable. First, the authors count anything above 2 weeks of lost work income as a "serious medical problem." There appears to be no time frame over which this is measured, nor does it apparently even need to be consecutive lost work. So, for instance, if a restaurant waiter called in sick for 2 weeks or more in some indeterminate period of time prior to filing bankruptcy, this would presumably count as a serious medical problem.

Followed up with:

the authors do not compare the amount of medical debt they found to other debt or obligations that bankrupt debtors had. So, for instance, they would count as a medical bankruptcy a debtor who had $1,001 in medical bills, even if that debtor had say $50,000 in student loans, car loans, and other debt. It would be absurd, it seems to me, to say that the $1,001 in medical expenses "caused" that bankruptcy. Nonetheless, it would counted in this study, because the authors do not control for medical debt as a percentage or in relation to the debtors overall debt.

And even worse, the authors of the report themselves, have issued contradictory statements in prior publications on bankruptcy. Professor Warren and co-authors wrote, "The central finding is that medical debt is not an especially important burden for most debtors."

So, all those "50% of all bankruptcies are due to medical debt" are all just BS.

True enough. How long do you think a 60 year old would have to continue to work in order to replace the wealth earned during the past 40 years of life? Your philosophy works sort of well for young people. Remember, you won't always be young. There is only one alternative to getting old, and few choose it.

Better than having doctors in the UK say old people shouldn't be treated because it's not a good investment.
Elderly people could be denied NHS treatment because of their age after a Government climb-down, it has been claimed.

Charities representing older people have been campaigning for a law on discrimination because of worries that some elderly patients are losing out as NHS resources are prioritised towards younger people who might life longer after treatment

Makes sense... elderly people are going to die soon anyway, you have limited money, and limited doctors and hospitals. Best to give the younger folks who have a long time to live yet, priority over elderly.

Or wait... how about we leave it to consumers and providers. Then we don't have to have a lottery drawing for who get's medications.

Imagine living in one postcode and getting life-saving medications free from the NHS. Then imagine being notified the postcode has changed. You no longer qualify for the medication, because the free postcode moved across the street or across town, and you didn't.

The NHS failed to respond to my repeated requests for information about how the qualifying postcode is selected.

Of course, anyone would trade material goods for continued well being. Who would die for possessions? The thing is, no one should have to make that choice, at least not in a wealthy nation like the US.

That's kind of the way the world works my friend. You must pay for services. The doctor doesn't work for free. Just ask Brits looking for a dentist.
Patient "Are you taking new patients?"
Dentist "Are you NHS?"
"Yes"
"No"

You have two options. You can pay for it, or you can die in the waiting room.
Canadian Man Dies After 34-Hour Emergency Room Wait, Paper Says At least he waited for free.

You're obviously just getting started in life. Try earning back your accumulated wealth starting at age 64.

Colonel Sanders started KFC when he was 60. My uncle is sixty and started a new business. (of course he's an accomplished engineer) The point again is, I would rather pay a large bill and start over, than be completely dead. In socialized systems, where government money is limited, the elderly are always put to the back.

The Dutch had forced Euthanasia. Limited beds, guy wasn't likely to survive, or too old to do anything even if he did, younger guy had a very treatable illness, hospital maxed out.... no problem, kill the old guy, and poof... bed available.

So, everyone except Americans is getting crappy care, yet they don't know it?

No, I really think Canadians are smarter than that. Their system is not perfect, to be sure, but then neither is ours.

There are thousands that do know they have crappy service. In fact, businesses have been built, exclusively, around getting out of their crappy service.

Timely Medical Alternatives that operates in Canada for example.
From their web site:

Our organization was formed in 2003 to help Canadians from coast to coast, to "Leave the queue" and take personal responsibility for their own private medical services.. Since then we have helped hundreds of Canadians obtain second medical opinions, MRI's / CT scans / PET scans (within days) and surgery (within weeks). We have helped our clients to regain their mobility, to get relief from chronic pain, to get diagnoses of illnesses and we have, in some cases, helped to save the lives of a number of our fellow Canadians.

Watch this video clip about a patient of theirs.
http://www.youtube.com/watch?v=H4u5x9XAsAs
Another article said he would have had a 40% chance of dieing without going to the US.

We're talking about an increase by a factor of 44.

Of course, prices of everything went up between 1969 and 2001, but few things have increased by a factor of 44.

Yes, and you are not asking why. If we simply change a system, without knowing the cause of this systems problems (short of blind assumptions of greed and corruption), how do you know this will solve the problem? Further, can you show me an intervention by government, the result in lower over all prices? As in where the cost of a commodity went down? I can not.

 

[Andy]

It depends on what you mean by "nationalize". If you mean that the government would be running the health care system, then you're right. We'd wind up with an even more expensive and inefficient system than we have now. I think there are other options, however.

If it involves control, or funding through government, to me, that's nationalization. I have yet to find a case where either resulted in good effects. I would cite governments mandate of sub-prime loans to minorities of being a supposedly "non-nationalized" control over the system that didn't result in good. Can you show me a case where it did fix a problem?

Good one. Of course, health care was not much of an issue in Adams' time.

Of course the point was, that the government doesn't have the power under the constitution to deal with health care, whether it's a problem or not. "general welfare" does not cover health care. Period.

You are right. We're maxing out the limit of the forum. You can tell this is a hot topic for me, eh?

 

[Dr.Who]

Such as, for example......

Hidden costs:

The first of course is freedom of choice.

Then comes less availablility of exams, MRI units, CT scanners, inpatient surgical procedures, and really just about everything a health care system offers including the number of doctors, hospitals, clinics, and vairiety of procedures and drugs. In Canada they have less access to all of this. Everything is rationed, in short supply and delayed.

Canadians spend the same amount of GDP on drugs as we do but they only have access to 44% of the drugs that we do.

This all translates to diminished health and shorter lives, loss or of loss of gdp.

Canadian doctors only earn 40% as much as us doctors and as much as 13% of canadian doctors have left canada to come to the us while less than 1% of us doctors have gone there. That is lost gdp.

In canada it has gotten so bad that their supreme court has ruled that Quebecs single payer monopoly was so bad that it violated the individuals right to preserve ones own health. In two other provinces citizens are challenging the system based on constitutional grounds.


In fact, if we look at access to health care in general Canada has the same rate of people who don't have access to health care as we do in the US except that here the rationing is done based on how hard one has worked to earn a living and there it is done by a beauracrat. Here however we get the best and newest and the choice to see whatever doctor we want to see and fast (unless we are poor). If one is poor then one gets a system that is equivalent to Canada's.

But what about when the government cannot fund it anymore either because it has just gotten too expensive (in canada it is expected that half of all gdp will be spent on health care by the year 2035) or because of some boom in the population? Will they print money? Will they raise taxes? Will they and do they tell you that they are stealing from the general fund?

But if you want a national health care system that is as efficent as the DMV...

We get to choose any doctor who is signed up for our HMO or PPO, whichever type of insurance we have.

Exactly. That freedom of choice costs money.

Other than cosmetic surgery, I've seen no evidence that the French have to forego surgery due to access.

According to the WHO survey you mentioned France ranked 16th on the measure of responsiveness, worse than Oman. And when it comes down to it don't you really want your doctor or hosptial to respond to (treat and cure) what ails you rather than to let you wait along with everyone else? Guess who ranked first? The US. On the things that matters the US is first, on the things that don't matter it is given a weighted score that counts against us the very things that make us free.

Both, of course. It is of little value to have good health care if it means the loss of home and assets needed to stay healthy.

It is of great value to have a healthy body even if it means not having large home. That can be replaced. Just about everyone would willingly trade material things for health. And that is a trade that cannot be avoided through universal health. One way or another that trade will be made. I just prefer it to be made by my own choices rather than those of president Obama or Bush.




Costs do rise faster than inflation, and have been doing so for decades.

When my son was born in '69, for example, the cost of a normal childbirth and an overnight stay in the hospital was $230. When my grandson was born in '01, the cost for the same had gone up to over $10,000. That is in increase of nearly 5,000%. What else has gone up that much?
[/QUOTE]

The same thing is happening in Canada.

"promote the general welfare".

The phrase as originally written never in any way authorized these kinds of government "services."

I can provide direct quotes from founding fathers and early leaders spcifically saying that it does not authorize this kind of expense.

 

[PLC1]

I have to admit you're making a very good case.

Still, there must be some reform of the medical system. We simply can't afford what we have for very long. In my example of the price of medical care vs the price of automobiles, we would have already priced ourselves out of the family car had the cost increased as much as medical care has. In many cases, we have priced ourselves out of medical care, but it's easier to get along without a car than it is to die.

What we need is a real, non partisan, non ideological discussion of how to rein in costs.

In the example of the high taxes in European countries, we need to add together the cost of medical care (part of the government there) plus the cost of our federal government. The first costs around 18% of the GDP, the second (before the stealfromus package and the attempt to spend our way to prosperity that is) was around 20%. Added together, the two account for 38% of the GDP, and that's before state spending. That much expenditure is simply not sustainable. Of course, part of the solution is cutting back the size of the federal government, but part of it has to be cutting medical costs as well.

Remember my subsidized Mastercard idea? The more I think of it, the more I like it. If we could get human medicine to cost only, say, 50 times as much as cat medicine, then an overnight stay with minor surgery would cost about $2,000, instead of the $20,000 or so it costs now. Surely, we can treat human beings for 50 times what it costs to treat a cat.

Makes sense... elderly people are going to die soon anyway, you have limited money, and limited doctors and hospitals. Best to give the younger folks who have a long time to live yet, priority over elderly.

Or wait... how about we leave it to consumers and providers. Then we don't have to have a lottery drawing for who get's medications.

Interestingly enough, it is the elderly (if 65 can be considered elderly) who already have national health care in the USA. A national health care system wouldn't actually affect them, would it?

In my experience dealing with medical issues with my elderly (really, late 80s is elderly) parents, I found that the national health care for the elderly, AKA Medicare, actually works pretty well. There was never an issue of long waits, of lack of adequate care, or of the doctors wanting to off them to make room for someone else.

That's kind of the way the world works my friend. You must pay for services. The doctor doesn't work for free. Just ask Brits looking for a dentist.
Patient "Are you taking new patients?"
Dentist "Are you NHS?"
"Yes"
"No"

That's true enough, and most of us can afford dental care. It's medical care that can run in to the tens or even hundreds of thousands of dollars rather quickly. Usually, dental care is a few hundred, or, if there is extensive work to be done, perhaps a few thousand.

Yes, and you are not asking why. If we simply change a system, without knowing the cause of this systems problems (short of blind assumptions of greed and corruption), how do you know this will solve the problem? Further, can you show me an intervention by government, the result in lower over all prices? As in where the cost of a commodity went down? I can not.

OK, you're starting to convince me. Now, what is your plan for reining in the cost of medical care? As an example, how could we get a normal childbirth that cost that $230 in '69 to cost, say, only five to ten times as much today, instead of more than 44 times as much?

And, further, how can we get the cost for the uninsured, those who pay themselves, to be the same as for those who have insurance? Why should the uninsured pay three or more times as much as the rest of us?

 

[Andy]

I have to admit you're making a very good case.

Still, there must be some reform of the medical system. We simply can't afford what we have for very long. In my example of the price of medical care vs the price of automobiles, we would have already priced ourselves out of the family car had the cost increased as much as medical care has. In many cases, we have priced ourselves out of medical care, but it's easier to get along without a car than it is to die.

What we need is a real, non partisan, non ideological discussion of how to rein in costs.

In the example of the high taxes in European countries, we need to add together the cost of medical care (part of the government there) plus the cost of our federal government. The first costs around 18% of the GDP, the second (before the stealfromus package and the attempt to spend our way to prosperity that is) was around 20%. Added together, the two account for 38% of the GDP, and that's before state spending. That much expenditure is simply not sustainable. Of course, part of the solution is cutting back the size of the federal government, but part of it has to be cutting medical costs as well.

Remember my subsidized Mastercard idea? The more I think of it, the more I like it. If we could get human medicine to cost only, say, 50 times as much as cat medicine, then an overnight stay with minor surgery would cost about $2,000, instead of the $20,000 or so it costs now. Surely, we can treat human beings for 50 times what it costs to treat a cat.

Comparing the cost of a Cat to a human, is not even close to being legit, but you know that. People tend to not sue over a cat dying. Moreover, somehow, I doubt that the requirements for being a cat doctor, are as difficult as 10 years of schooling, plus residence, and over $100,000 worth in school tuition.

I'm just guessing it's not close.

That said, I would wager that we could learn a lot from India. I wish there was a more in depth discussion of the differences, and costs involved with India.

Interestingly enough, it is the elderly (if 65 can be considered elderly) who already have national health care in the USA. A national health care system wouldn't actually affect them, would it?

In my experience dealing with medical issues with my elderly (really, late 80s is elderly) parents, I found that the national health care for the elderly, AKA Medicare, actually works pretty well. There was never an issue of long waits, of lack of adequate care, or of the doctors wanting to off them to make room for someone else.

Yes, but you are missing the reason for that. The reason why Medicare does a great job in this area, is because YOU are subsidizing it's cost. The reason there aren't in long waits, and people wanting to make trade offs for bed space and care, is because YOU are subsidizing it.

That is one of the reasons health care costs have risen so much, is because YOU are paying for your elderly Medicare patients. Both in Taxes, and in the cost that medicare doesn't cover. Hospital care cost, doesn't decrease simply because the Senate voted that the payout for Oxygen Tanks is only X amount.

The margin between the cost of service, and the payout from Medicare, YOU have to cover in increased health care costs. I cited the Oxygen tank because at one point there was a debate on the Senate floor about how much the government would pay for an elderly person to get one.

As soon as everyone is under the system, there won't be any way to subsidized the actually cost of health care. That's when the government enforced rationing of health care will come into play.

This entire debate is exactly what has happened around the world. A socialized health system is put in place, which depends on the subsidies of a private system. Then when the private system costs too much, instead of blaming the socialized system, they blame the private.

That's true enough, and most of us can afford dental care. It's medical care that can run in to the tens or even hundreds of thousands of dollars rather quickly. Usually, dental care is a few hundred, or, if there is extensive work to be done, perhaps a few thousand.

The point of bringing up dental, was that it is a representation of the systemic problems inherent with a socialized system. The same problems experienced with Dental health in England, is also throughout the entire system, and every socialized system around the world.

OK, you're starting to convince me. Now, what is your plan for reining in the cost of medical care? As an example, how could we get a normal childbirth that cost that $230 in '69 to cost, say, only five to ten times as much today, instead of more than 44 times as much?

And, further, how can we get the cost for the uninsured, those who pay themselves, to be the same as for those who have insurance? Why should the uninsured pay three or more times as much as the rest of us?

One question I have is, why did your grandchild cost so much? Just a quick search found $2,000 from Wiki Answers. Now I have heard of $10K costs, but that's with insurance. I'll assume the one you refer to, was also covered by insurance.

Why is this important? Because the dirty secret of hospital charges is, they are arbitrary. I have this MP3 from EconTalk, where they interview Steven Lipstein, President and CEO of BJC HealthCare, a $3 billion hospital system in St. Louis, Missouri.

Now I do not agree with everything that Steven Lipstein says. For example, like most, he thinks government involvement in the health industry would be great. Granted he can't site an example where that really helped, but I digress.

The key thing I learned in this was that health care prices are just made up numbers. Lipstein, goes on to explain that all the major health insurance networks, negotiate every year for price discounts. Now, just like Medicare, just because the payout is reduced, doesn't mean the actual cost is less.

So in order to get enough money from the service, to cover costs, and have some operating profit, the hospitals simply raise their rates to cover the discount.

For example. Let's say the cost for specific service is $5,000. Then let us say that the major insurance carriers negotiate a price discount of 50%. In order to get enough money to cover the cost of the service, the price will have to be inflated to $10,000, in order to reach the $5,000 of revenue to provide the service profitably. My own hospital bills had a larger than 50% discount. If I can find it, I'll post it.

Further, one thing many people don't know is, if you don't have insurance, you get much different prices, than those with insurance. Again, without contractual discounts, you start to get the real cost of service.

This is one area that could be improved. Another would simply to look around for affordable alternatives. You don't have to go to the major ER to have a baby. There are dozens of small clinics and even general practitioners that do the same thing, for a fraction of the cost. But many people want the security of specialists and ER doctors on hand.... just in case there is a problem. And that's not a illegitimate concern either... but those people do cost money.

Finely, get government out of the health care industry completely. Subsidized Visa Health care or not, if you are paying to subsidize government Medicare... it's going to be expensive. That will mean new taxes. And when that doesn't work, health care rationing is right around the corner.

 

[Dr.Who]

PLC, I agree that we need to address costs.

The first step is to really decide if costs are too high. I had an ultrasound done a couple of weeks ago and when I saw the bill that the insurance company was going to pay it was $900. That seemed high to me.

I saw a tech for about 40 minutes in a hospital in a room that was devoted to that purpose. She sent the results to a doctor to analyze. I also saw a three receptionists and I am sure there are a few billing personnel involved between me and the insurer. Then there are malpractice insurance bills to take into account. In the end I do not know if it was too high or not, but...

But the point is that I don't care because I was not paying the bill (sorta). What we need is a system in which the person who pays the bill makes decisions about it before the service is given.

We are not going to get good prices without competitive forces driving down prices and there won't be any competition if no one shops around and if people don't even know how much something costs before they buy it and if the purchase of the medical care is divorced from the paying of it...

 

[Andy]

PLC, I agree that we need to address costs.

The first step is to really decide if costs are too high. I had an ultrasound done a couple of weeks ago and when I saw the bill that the insurance company was going to pay it was $900. That seemed high to me.

I saw a tech for about 40 minutes in a hospital in a room that was devoted to that purpose. She sent the results to a doctor to analyze. I also saw a three receptionists and I am sure there are a few billing personnel involved between me and the insurer. Then there are malpractice insurance bills to take into account. In the end I do not know if it was too high or not, but...

But the point is that I don't care because I was not paying the bill (sorta). What we need is a system in which the person who pays the bill makes decisions about it before the service is given.

We are not going to get good prices without competitive forces driving down prices and there won't be any competition if no one shops around and if people don't even know how much something costs before they buy it and if the purchase of the medical care is divorced from the paying of it...

I wager that if you take into account the negotiated discounts, that $900 turns into a few hundred.

You do have another good point. Most medical practicies of any kind, have a full time person to just deal with insurance forms and fileings. That too adds to the cost. In India, the free-market capitalist hospitals, have no insurance to deal with. They simply give you a bill, and you pay it.

 

[PLC1]

Comparing the cost of a Cat to a human, is not even close to being legit, but you know that. People tend to not sue over a cat dying. Moreover, somehow, I doubt that the requirements for being a cat doctor, are as difficult as 10 years of schooling, plus residence, and over $100,000 worth in school tuition.

I'm just guessing it's not close.

I think it is pretty close. A vet has to get a degree in biological sciences, then go on to vet school. I'm sure it is not quite as intensive as medical school, but a good vet is still a professional. Anyway, I'm still willing to give the doc ten times what the vet charges. We'd still be paying a lot less.

That said, I would wager that we could learn a lot from India. I wish there was a more in depth discussion of the differences, and costs involved with India.

We need to take an in depth, objective look at a lot of other countries, then come up with the best system for ourselves. We won't, of course, as reforming the medical system is a political process, and therefore not affected by logic, reason, or pragmatism.

Yes, but you are missing the reason for that. The reason why Medicare does a great job in this area, is because YOU are subsidizing it's cost. The reason there aren't in long waits, and people wanting to make trade offs for bed space and care, is because YOU are subsidizing it.

That is one of the reasons health care costs have risen so much, is because YOU are paying for your elderly Medicare patients. Both in Taxes, and in the cost that medicare doesn't cover. Hospital care cost, doesn't decrease simply because the Senate voted that the payout for Oxygen Tanks is only X amount.

The margin between the cost of service, and the payout from Medicare, YOU have to cover in increased health care costs. I cited the Oxygen tank because at one point there was a debate on the Senate floor about how much the government would pay for an elderly person to get one.

As soon as everyone is under the system, there won't be any way to subsidized the actually cost of health care. That's when the government enforced rationing of health care will come into play.

This entire debate is exactly what has happened around the world. A socialized health system is put in place, which depends on the subsidies of a private system. Then when the private system costs too much, instead of blaming the socialized system, they blame the private.

Good points.

Except that I'm not paying for Medicare any more. I used to, but, then I retired, and no longer pay "payroll taxes." I'm still not on Medicare just yet, still covered by private insurance, but you will be paying for my medicare costs pretty soon now.

One question I have is, why did your grandchild cost so much? Just a quick search found $2,000 from Wiki Answers. Now I have heard of $10K costs, but that's with insurance. I'll assume the one you refer to, was also covered by insurance.

You have put your finger on one of the causes of the rise in costs. Yes, my grandchild was covered. My son was not covered. Even though we had medical insurance, normal childbirth was not covered at that time, so we had to pony up.

I think one of your points is that if we all had to pony up, costs would go down. That one is a no brainer.

So in order to get enough money from the service, to cover costs, and have some operating profit, the hospitals simply raise their rates to cover the discount.

For example. Let's say the cost for specific service is $5,000. Then let us say that the major insurance carriers negotiate a price discount of 50%. In order to get enough money to cover the cost of the service, the price will have to be inflated to $10,000, in order to reach the $5,000 of revenue to provide the service profitably. My own hospital bills had a larger than 50% discount. If I can find it, I'll post it.

Correct, as Dr. Who's post demonstrates. The real cost, the negotiated cost, the amount billed, are often off by a factor of 4 or 5. Nowhere else do prices vary that much.

Further, one thing many people don't know is, if you don't have insurance, you get much different prices, than those with insurance. Again, without contractual discounts, you start to get the real cost of service.

You get different prices if you cry poor. You are billed the same as the insurance companies are billed, then have to do your own negotiation.

What we need to be able to do is compare prices beforehand, but how can that be done in a medical emergency? Are you going to phone around while someone is lying in the street bleeding? There has to be a better way.

This is one area that could be improved. Another would simply to look around for affordable alternatives. You don't have to go to the major ER to have a baby. There are dozens of small clinics and even general practitioners that do the same thing, for a fraction of the cost. But many people want the security of specialists and ER doctors on hand.... just in case there is a problem. And that's not a illegitimate concern either... but those people do cost money.

Yes, they do. Risking birth defects to save a few bucks is not a viable alternative IMO.

Finely, get government out of the health care industry completely. Subsidized Visa Health care or not, if you are paying to subsidize government Medicare... it's going to be expensive. That will mean new taxes. And when that doesn't work, health care rationing is right around the corner.

We have health care rationing now, and always will. There is no such thing as unlimited care, not even with the best of insurance plans.

Well, maybe if you have the resources of Bill Gates, or Warren Buffet, but not for the rest of us.

What are you going to do about people who need expensive care, but don't have the money to pay? The alternatives are to simply let them die, or give them the care that they need, then try to collect. Since no one seems willing to just let them die, then someone has to pay somewhere. If the government is out of it completely, then the hospital will have to eat the cost, and then pass the difference on to paying customers.

Some things simply don't fit neatly into a market model, and health care is one of them.

I still think the medical Mastercard idea would work. Few people actually have to pay out more than 10% of their income in any given year, so the cost to government would be small. Since the customer would be paying directly, the providers would have to keep prices competitive. It's a perfect marriage between market economics, and government, one that keeps costs under control. If employers didn't have to pay for medical insurance, they'd save a ton of money, far more than enough to pay for what is essentially an emergency service.

Make health care costs tax deductible without having to meet the current 7 and a half percent of taxable income hurdle, and we'd all be able to afford needed care.

The next step is to cut out the lawyers and their multimillion dollar malpractice suits. That's yet another cost that gets passed on to patients, to insurers, and to the government.

 

[Andy]

We need to take an in depth, objective look at a lot of other countries, then come up with the best system for ourselves. We won't, of course, as reforming the medical system is a political process, and therefore not affected by logic, reason, or pragmatism.

Good points.

Except that I'm not paying for Medicare any more. I used to, but, then I retired, and no longer pay "payroll taxes." I'm still not on Medicare just yet, still covered by private insurance, but you will be paying for my medicare costs pretty soon now.

Not exactly. As long as you are under private insurance, your premiums are going to higher costs the hospital charges to offset medicare. Of course I am for as long as I remain in the US.

You have put your finger on one of the causes of the rise in costs. Yes, my grandchild was covered. My son was not covered. Even though we had medical insurance, normal childbirth was not covered at that time, so we had to pony up.

I think one of your points is that if we all had to pony up, costs would go down. That one is a no brainer.

Absolutely.

Correct, as Dr. Who's post demonstrates. The real cost, the negotiated cost, the amount billed, are often off by a factor of 4 or 5. Nowhere else do prices vary that much.

We should find a way to eliminate insurance contractual discounts. That at least would give us a real understanding of where costs are.

You get different prices if you cry poor. You are billed the same as the insurance companies are billed, then have to do your own negotiation.

A co-worker of mine recently had a child. According to him, on the back side of the bill was a price adjustment work sheet for those without insurance. I'll have to see if I can find my bill. I may not have it anymore.

What we need to be able to do is compare prices beforehand, but how can that be done in a medical emergency? Are you going to phone around while someone is lying in the street bleeding? There has to be a better way.

That's not really possible. In a medical Emergency, you just go and deal with the costs later. It's non-emergency treatments we can deal with. That's ok with me too. It's better than Canada where dozens of people wait hours on hours in the hospital to not get care. Ironically the same has happened in Massachusetts, MassHealth. Massive lines, waiting over 24 hours to get a bed. But hey... it's free. That's the important part.

Yes, they do. Risking birth defects to save a few bucks is not a viable alternative IMO.

I'm not sure a birth defect is going to be prevented by a doctor. If a baby needs attention for such a non-emergency problem, you could always take them to a full service hospital later. The real issue come with complications, or life endangering issues where the mother or the child is at risk. Again, that's the trade off.

If you want cheap health care, you can't be paying full-time surgeons and specialists to be on standby. They simply don't work for free, but people for some reason like to think they do.

My own sister complained that she was billed for a doctor visit during her delivery. But I explained, if you had a problem wouldn't you want her there? If you don't pay her to be there, you think she'd hang around the hospital 'just in case' you needed her? Of course not. If you don't want to pay for such people to be available, go to a clinic where they are not, and it will be cheaper.

We have health care rationing now, and always will. There is no such thing as unlimited care, not even with the best of insurance plans.

There is a huge difference between controlling how much health care you want by virtue of how much you are willing to pay, and being forced to accept what the government is willing to give you.

Health care is unlimited based on your ability to pay. Even if I have no insurance, I can get unlimited medical service for the rest of my life by simply paying the bill. Just like there no such thing as unlimited food, although as long as I keep paying I can eat for the rest of my life. Right?

Well, maybe if you have the resources of Bill Gates, or Warren Buffet, but not for the rest of us.

What are you going to do about people who need expensive care, but don't have the money to pay? The alternatives are to simply let them die, or give them the care that they need, then try to collect. Since no one seems willing to just let them die, then someone has to pay somewhere. If the government is out of it completely, then the hospital will have to eat the cost, and then pass the difference on to paying customers.

Some things simply don't fit neatly into a market model, and health care is one of them.

Well in case you missed it, that is what is happening now. Who do you think is paying for S-chip, and Medicaid (heath care welfare)? Us. We're paying for it, and it's driving up costs. The very costs your complaining about saying we need a new government program to fix.

I still think the medical Mastercard idea would work. Few people actually have to pay out more than 10% of their income in any given year, so the cost to government would be small. Since the customer would be paying directly, the providers would have to keep prices competitive. It's a perfect marriage between market economics, and government, one that keeps costs under control. If employers didn't have to pay for medical insurance, they'd save a ton of money, far more than enough to pay for what is essentially an emergency service.

Make health care costs tax deductible without having to meet the current 7 and a half percent of taxable income hurdle, and we'd all be able to afford needed care.

The next step is to cut out the lawyers and their multimillion dollar malpractice suits. That's yet another cost that gets passed on to patients, to insurers, and to the government.

I was thinking about that today, and I happen to think about Food Stamps. Right now immigrants are getting food stamps, buying the food, putting it in their stores, and selling it for cash.

The mafia will give people Cocain in exchange for food stamps, which they use to buy food for their store fronts.

Who's to say that find some way to exploit health cards? Right now we can't even prevent dead people from collecting Social Security. What if a druggie let's someone else use his health card, that will be subsidized by the government cause he's broke, in exchange for drugs?

 

[Pandora]

Who's to say that find some way to exploit health cards? Right now we can't even prevent dead people from collecting Social Security. What if a druggie let's someone else use his health card, that will be subsidized by the government cause he's broke, in exchange for drugs?

Well you know the government is the solution to every problem. So here is what our darling president will probably suggest. We just mark everyone with a micro chip so that wont happen and the chip can be used for lots of other things too. Buying and selling, finding lost children, national ID exc.

 

[PLC1]

OK, so you've convinced me. The government can't really solve the health care cost escalation problem. I have to say, I'm not surprised, as government doesn't seem to be able to solve problems very well in other areas either.

What is the solution, then?

Are we to only give care to those who can pay? If not, then who pays for those who are broke? are we willing to allow people to die, or remain incapacitated if they don't have enough money to pay?

As it is now, we pay one way or another for the uninsured poor, either through government programs, or through the hospitals and doctors charging extra to those who can pay. There is no set price for services, as it depends on what insurance you have and what the negotiated price is. Meantime, the doctors have to pay big bucks for malpractice insurance, and, of course, must pass those costs on to the patients. That, along with the army of clerks whose job it is to try to collect from dozens of private and government entities, drive up the cost of medical care.

Why else would a procedure that takes all of an hour of time from a skilled surgeon cost upwards of $20,000 or so? Sure, the surgeon isn't going to work for free. We expect doctors to be able to make a good salary. What we have is the doctors who are best at business, not the ones who are best at healing, making the most money.

Solutions?