Healthcare: Pride & Prejudice

[VJW]

THE VIRTUES OF SINGLE-PAYER HEALTH CARE

Employment-based health insurance is the only serious source of coverage for Americans too young to receive Medicare and insufficiently destitute to receive Medicaid, but it's an institution in decline. Between 2000 and 2004 the number of Americans under 65 rose by 10 million. Yet the number of nonelderly Americans covered by employment-based insurance fell by 4.9 million.

The funny thing is that the solution - national health insurance, available to everyone - is obvious. But to see the obvious we'll have to overcome pride - the unwarranted belief that America has nothing to learn from other countries - and prejudice - the equally unwarranted belief, driven by ideology, that private insurance is more efficient than public insurance.

Let's start with the fact that America's health care system spends more, for worse results, than that of any other advanced country. In 2002 the United States spent $5,267 per person on health care. Canada spent $2,931; Germany spent $2,817; Britain spent only $2,160. Yet the United States has lower life expectancy and higher infant mortality than any of these countries. But don't people in other countries sometimes find it hard to get medical treatment? Yes, sometimes - but so do Americans. No, Virginia, many Americans can't count on ready access to high-quality medical care.... Americans are far more likely than others to forgo treatment because they can't afford it. Forty percent of the Americans surveyed failed to fill a prescription because of cost. A third were deterred by cost from seeing a doctor when sick or from getting recommended tests or follow-up.

Why does American medicine cost so much yet achieve so little?... The U.S. system is much more bureaucratic... because private insurers and other players work hard at trying not to pay for medical care. And our fragmented system is unable to bargain... for lower prices. Taiwan, which moved 10 years ago from a U.S.-style system to a Canadian-style single-payer system, offers an object lesson in the economic advantages of universal coverage. In 1995 less than 60 percent of Taiwan's residents had health insurance; by 2001 the number was 97 percent. Yet... this huge expansion in coverage came virtually free: it led to little if any increase in overall health care spending beyond normal growth due to rising population and incomes.... The economic and moral case for health care reform in America, reform that would make us less different from other advanced countries, is overwhelming. One of these days we'll realize that our semiprivatized system isn't just unfair, it's far less efficient than a straightforward system of guaranteed health insurance.

Paul Krugman

http://select.nytimes.com/2005/11/07...gewanted=print

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[Dingoluv4eva]

Agreed. Three things in any society should be Public and Government controlled.

1. Police and Army Protection.
2. Fire Protection and Disaster Relief.
3. Hospital Care and other Health type things (aside from cosmetic)

everything else should be tradable, and fair game to try make money on.

[Gailete]

I was a college student in Canada for four years in the 70's. While there I was covered by their National Insurance. It was wonderful and I never 'took advantage' of the system. Currently, I'm on disability, but haven't been on it long enough for my Medicare to kick in, yet my COBRA has run out. Just trying to be sure I have and can afford my various medicines is an interesting experience. My hubby is self-employed and due to herniated discs in his neck no one would insure him even if we could afford it. Hard to afford insurance when we we are already laying out $6000 or more each year to pay for our own doctor, meds, and hospital bills. Last year while paying COBRA our out of pocket payment for health care was around $10,000.

We are not eligible for Medicaid as we are the working poor, so to speak, that owns a vehicle, property, etc. We are trying to care for our own financial needs, yet if we were sitting around picking our noses, Medicaid would have stepped right in and paid my hubby's $7000+ hospital stay from 3 years ago that we are still paying on.

I don't know what the answers are, but something needs to be done.

Gail

[miclason]

Originally Posted by VJW

No, Virginia, many Americans can't count on ready access to high-quality medical care...

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I must admit, until I came to the online communities, I thought that in the US people had free access to medical care - without exceptions and without limits...that is what we foreigners think...

[jmjj215]

VJW, could you provide a few reputable links to some basic instruction on what exactly "universal health care" entails?

I DO believe that the insurance companies have driven up the cost of health care to outrageous extremes. Consumers are blind to the price, can't negotiate or pick their supplier (doctor) on price, and only look at the mostly meaningless amount of their deductible. In the mean time, their premiums are going up year after year.

One "medical" practice that has steadily declined in price? Cosmetic surgery. Why? Because insurers don't cover it, so doctors have to actually compete for your business because consumers are price sensitive to it.

[Bruce Wayne]

It always tickles me when people say the British health system is something to aspire too

[jmjj215]

I wonder what correlation we'd see w/ the stats above:

In 2002 the United States spent $5,267 per person on health care. Canada spent $2,931; Germany spent $2,817; Britain spent only $2,160. Yet the United States has lower life expectancy and higher infant mortality than any of these countries.

and the US people's lack of exercise and reasonable dietary habits. That's GOT to be in there somewhere.

[Bruce Wayne]

The ironic thing is that under the current government Britain has been trying as hard as it can to spend money on healthcare left right and centre. The NHS now swallows around £90bn a year or around £1,500 a year per person ($2,600 approximately). Yet here we have our resident socialist saying that healthcare spending should go down. Gotta love that

I don't really understand a great deal how the US healthcare system works but the problem seems to be that there is very little choice offered to the individual. If you're going to offer no choice to the end user then it doesn't really matter whether the system is run privately or publicly, it will still deliver a poor service.

[sweeps]

One of the main problems is the huge windfalls from malpractice lawsuits. It's bad -- really bad -- to have a pair of scissors left in you after surgery. But what is fair compensation for that error? $10 million? I don't think so.

Huge malpractice judgments result in huge malpractice insurance premiums for doctors, nurses and hospitals. They have to pass along those costs to the consumer. I'm no fan of the insurance companies, but they do negotiate better rates for the consumer than the consumer can get on his or her own.

[Dingoluv4eva]

In universal coverage.. we the tax payers would pay for a decent portion of the compensation from lawsuits, so that the hospitals and doctor would not have to be as burdened by it.

Judge and Jury knowing that a portion of the money is going to come out of their own pockets, might put more thought into what judgement they agree on.

[jmjj215]

but they do negotiate better rates for the consumer than the consumer can get on his or her own.

only because the consumer doesn't have visibility of the "real" prices. If a doc offers $50 for a visit to "cash" customers, the insurance is going to want to tell their customers they "negotiate a lower price" so what happens? The doc raises his price to $80, the insurance "negotiates" the price down to $50.

So maybe you're saying, it's the same price? Nah - remember, now we're paying an insurance premium to be able to get that $50 price. It happens all the time.

When you have a middleman in there, price visibility is reduced (or eliminated), and you're paying more than you really should be because the insurance company has to run a whole freakin' business in that margin there. It's sick.

I think insurance companies are more to blame than malpractice lawsuits. Although the scissors are definitely a pointed example.

Heh.

[jmjj215]

Originally Posted by Dingoluv4eva

In universal coverage.. we the tax payers would pay for a decent portion of the compensation from lawsuits, so that the hospitals and doctor would not have to be as burdened by it.

Judge and Jury knowing that a portion of the money is going to come out of their own pockets, might put more thought into what judgement they agree on.

The jury members already do pay, in the form of higher premiums, or being unable to insure themselves at all.

[VJW]

Originally Posted by jmjj215

VJW, could you provide a few reputable links to some basic instruction on what exactly "universal health care" entails?

Physicians for a National Health Program

http://www.pnhp.org/

http://www.pnhp.org/news/articles_of_interest.php


Facts on our Current Situation

http://www.nchc.org/facts/coverage.shtml

One "medical" practice that has steadily declined in price? Cosmetic surgery. Why? Because insurers don't cover it, so doctors have to actually compete for your business because consumers are price sensitive to it.

Which is why elective surgery is a different kettle of fish. One cannot shop around when you have a broken leg or brain concussion. Not to mention that there have been rather dramatic advances in the field of cosmetic surgery.

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[VJW]

Originally Posted by jmjj215

I wonder what correlation we'd see w/ the stats above: and the US people's lack of exercise and reasonable dietary habits. That's GOT to be in there somewhere.

The vast majority of it is the insurance companies. Less than 50 cents of every dollar you pay in health insurance premiums goes to pay for medical care.

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[VJW]

Originally Posted by Bruce Wayne

I don't really understand a great deal how the US healthcare system works but the problem seems to be that there is very little choice offered to the individual.

That’s due to the increasingly privatization of the system. The more the system has been turned over to corporate HMOs, as Krugman stated, the more it became about trying not to pay for medical care to increase profits, instead of efficiently providing medical care.

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[Bruce Wayne]

Originally Posted by VJW

That’s due to the increasingly privatization of the system. The more the system has been turned over to corporate HMOs, as Krugman stated, the more it became about trying not to pay for medical care to increase profits, instead of efficiently providing medical care.

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I don't really understand how that works I'm afraid.

Lets say you have 10 companies offering health insurance. Each of those 10 companies will look to differentiate in some way because they all want to make money. Some may trade on excellent service, some on excellent value, some on location etc. but as long as the customer has the opportunity to choose the one that is serving them best then it's hard to see how they can do badly out of this system because you have 10 organisations trying their best to get the customer to spend their money with them.

Where such a system fails is if the customer doesn't get any choice in the matter. Then the company doesn't have to differentiate their service to gain custom, they get the custom anyway and the customer loses out big time.

Is the latter scenario accurate for the US healthcare market?

[VJW]

Originally Posted by Sweepsplayer

One of the main problems is the huge windfalls from malpractice lawsuits.

Actually not. Both the number and the value of malpractice awards have been falling for many years.

Huge malpractice judgments result in huge malpractice insurance premiums for doctors, nurses and hospitals.

There is no such correlation.

Malpractice premiums have risen because the insurance companies lost bundles of money in the securities markets and are ripping off the providers to make up for their incompetence.

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[VJW]

Originally Posted by Bruce Wayne

I don't really understand how that works I'm afraid.

Lets say you have 10 companies offering health insurance. Each of those 10 companies will look to differentiate in some way because they all want to make money. Some may trade on excellent service, some on excellent value, some on location etc. but as long as the customer has the opportunity to choose the one that is serving them best then it's hard to see how they can do badly out of this system because you have 10 organisations trying their best to get the customer to spend their money with them.

Where such a system fails is if the customer doesn't get any choice in the matter. Then the company doesn't have to differentiate their service to gain custom, they get the custom anyway and the customer loses out big time.

Is the latter scenario accurate for the US healthcare market?

No.

In most parts of the country, there are numerous different private companies to choose from. All bad, in regards to the consumer, because they all cherry-pick, and scheme to deny medical care to increase profits, with almost no regulation.

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[Bruce Wayne]

Originally Posted by VJW

No.

In most parts of the country, there are numerous different private companies to choose from. All bad, in regards to the consumer, because they all cherry-pick, and scheme to deny medical care to increase profits, with almost no regulation.

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So what is stopping new companies from entering the market and offering a far superior service?

[VJW]

A combination of greed and political influence. All three branches of government are controlled by the Republicans, and the health insurance lobby overwhelmingly funds the Republicans.

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