Health Care and the alternative point of view

[Financialculture]

According to an Associated Press release if Democrat , Sen. Max Baucus, Montana were to have his way, according to a plan that made health care insurance mandatory for all Americans you might have to cough up to $ 3,800 as fines for not taking the health insurance. Ridiculous isn’t it? But this seems to be an outcome of the Baucus’ efforts to make premiums stable and affordable.

The President is not party to this. According to him “Punishing families who can’t afford health care to begin with just doesn’t make sense.” Earlier he had proposed a compulsory health insurance only for children. But the Baucus proposal seems to be applicable to all Americans regardless of their ages. Individuals would be charged $750 annually and families would be charged $1500 in the same time period. Those who make more than the government defined poverty income levels of $66,000 are the ones who’ll be charged the maximum penalties. Families would have to pay up to $3,800 annually and individuals would have to pay $950.

Remember the Massachusetts health care law of 2006 known as the ‘individual mandate’ that made it compulsory for all residents of the state to be insured under the mandate or face penalty? The individual mandate enabled free health care insurance for those below the poverty line and increased it for those above the poverty line with the highest income health insurancegroups paying up the most. The heath care exchange in similar lines as the health care connector is meant to provide less expensive private insurance for those who are not covered by the government subsidized insurance schemes. Those who did not fit into both plans were exempted from the fines.

Making insurance mandatory for everyone seems to be an effective way of enforcing the mandate amongst the maximum number of people because otherwise no one will heed the government advice. It seems now only those few who are insured are actually paying up the costs for those who are not insured and this makes them pay very high premiums. By making it mandatory all people will be insured and the overhead on the existing insured will be reduced very much. Also when the risk is spread the costs will be reduced on the whole.

[Seeker]

I did a quick google of 'number uninsured americans 2009' and came up with several numbers ranging from 9 million, 45.7 million and 86.7 million (over two years).

And this article is interesting about the statistics of determining the number of uninsured. It was written over a year ago, and I can't say whether the source is credible or not.

http://www.census.gov/prod/2008pubs/p60-235.pdf

Interestingly enough the Census Bureau is the "source" of the 45.7 million number. But yes, this is data from 2007, before the economic issues came to crisis.

Credible? Numbers with moving targets are always non-credible considering that they are in constant motion. And considering too, where the Census Bureau gets it's info (for example in 2004 or 2005, I rec'd a some 30 page questionaire from the US Census that I did not set aside the time to fill out and send back to them. Some months later someone came to my door from that agency -- I was not home -- and my neighbor told me about him. Realizing that this would be a hit-miss situation I filled out the form (as best I could) and just waited for it to happen again. Which it did, and my husband met went him and they went through the answers. Now again, 2010, I have the same heavy envelope from them). Random sampling -- I think not! They need an address to send these questionaires to, and for the non-responders , they need to send out a live person to obtain responses. You answer their questions as best you can, but numbers are constantly in flux.

[jIM_Ohio]

jIM_Ohio, you have a very good point.

If you look at certain elective procedures or medications for which insurance does not pay, you will find that the cost of that procedure or medication, over the years, have come down. Take Lasik surgery, for example. Because you have to "pay cash out of pocket," you WILL shop around and look for a good price. For lasik surgery, better and more complicated machines have come out, but prices keep dropping. This is true market forces at work!

There is one area of healthcare that will always need HEAVY subsidies: children's hospitals. Most major cities have only one children's hospital (if they have one at all). This is because they are so expensive to run and can never earn a profit. For this reason, children's hospitals in the US are non-profit, affiliated with a major university -- I am not aware of a single for-profit children's hospital -- supported by constant community fund raisers and research grants (come to think of it, the phrase "for-profit children's hospital" simply sounds "wrong").

Others posted about the high cost of "end of life care" in the elderly. What about pediatrics? Because children are so "plastic" they can easily "bounce back" from major injuries and disease -- if they are given proper care (sometimes many weeks in the ICU) -- and can expect to live normal productive lives. Pediatric end of life care is very expensive.

I have a good friend which is a children's doctor (surgeon) at cincinnati children's... he has pointed a few things out to me...
1) His hospital will refuse insurance if the insurance company is known to "talk down" a price- meaning if the insurance company considers their role to negotiate fees, they will quickly find their plans on the "not accepted" list at hospital. I believe if more hospitals did this, how insurance is seen by both consumers, doctors, and insurance industry would change.

2) Cincinnati has great communication amongst its hospitals- there are 3 hospitals which share staff (on rotations), research and communicate. Most cities have the hospitals competing amongst themselves, in Cincinnati they collaborate on care. How many cities have 3 level 3 NICUs for newborns? Cincinnati does... and for a city we are not "that big".

thx for reply

[jIM_Ohio]

http://www.census.gov/prod/2008pubs/p60-235.pdf

Interestingly enough the Census Bureau is the "source" of the 45.7 million number. But yes, this is data from 2007, before the economic issues came to crisis.

Credible? Numbers with moving targets are always non-credible considering that they are in constant motion. And considering too, where the Census Bureau gets it's info (for example in 2004 or 2005, I rec'd a some 30 page questionaire from the US Census that I did not set aside the time to fill out and send back to them. Some months later someone came to my door from that agency -- I was not home -- and my neighbor told me about him. Realizing that this would be a hit-miss situation I filled out the form (as best I could) and just waited for it to happen again. Which it did, and my husband met went him and they went through the answers. Now again, 2010, I have the same heavy envelope from them). Random sampling -- I think not! They need an address to send these questionaires to, and for the non-responders , they need to send out a live person to obtain responses. You answer their questions as best you can, but numbers are constantly in flux.

Even if the sampling had 50% error, its decent data for the points I wanted to make.

For example if USA has 300 M insured and 45 M uninsured, would the stats matter if it was 275 M insured and 90 M uninsured?

My point is why should the 90% which have insurance pay taxes to insure a very small minority (1/10 to 1/4 the size of the other population).

Even if the number (45 M) is off by 50% (90 M) which I do not think would happen with the dynamic statistics... it does not change that still a vast super majority of people have insurance already.

[jIM_Ohio]

According to an Associated Press release if Democrat , Sen. Max Baucus, Montana were to have his way, according to a plan that made health care insurance mandatory for all Americans you might have to cough up to $ 3,800 as fines for not taking the health insurance. Ridiculous isn’t it? But this seems to be an outcome of the Baucus’ efforts to make premiums stable and affordable.

The President is not party to this. According to him “Punishing families who can’t afford health care to begin with just doesn’t make sense.” Earlier he had proposed a compulsory health insurance only for children. But the Baucus proposal seems to be applicable to all Americans regardless of their ages. Individuals would be charged $750 annually and families would be charged $1500 in the same time period. Those who make more than the government defined poverty income levels of $66,000 are the ones who’ll be charged the maximum penalties. Families would have to pay up to $3,800 annually and individuals would have to pay $950.

Remember the Massachusetts health care law of 2006 known as the ‘individual mandate’ that made it compulsory for all residents of the state to be insured under the mandate or face penalty? The individual mandate enabled free health care insurance for those below the poverty line and increased it for those above the poverty line with the highest income health insurancegroups paying up the most. The heath care exchange in similar lines as the health care connector is meant to provide less expensive private insurance for those who are not covered by the government subsidized insurance schemes. Those who did not fit into both plans were exempted from the fines.

Making insurance mandatory for everyone seems to be an effective way of enforcing the mandate amongst the maximum number of people because otherwise no one will heed the government advice. It seems now only those few who are insured are actually paying up the costs for those who are not insured and this makes them pay very high premiums. By making it mandatory all people will be insured and the overhead on the existing insured will be reduced very much. Also when the risk is spread the costs will be reduced on the whole.

There is a second side to the Massachusetts situation. That side is this- all people are "required" by law to have insurance. Part of this would then be everyone getting a primary care physician, not using emergency rooms for basic illness, and the result- a waiting list for patients to obtain a primary care- meaning the consumer is still paying the high emergency room fees to see a doctor because they have no family doctor of their own... the supply of doctors is not high enough to justify everyone having insurance.

My "worst case" scenario in the USA is now this- because EVERYONE has insurance, what is the government going to do to make sure EVERYONE can see a doctor when they want to (need to)?

If you have x patients and y doctors now
then increase x by 45 Million (the number not able to see a doctor now) without increasing y doctors, there is a problem- either people are going to pay for something they cannot use (insurance), doctors will have to see more patients (reduced quality of care) or some other weak link in the chain will break.

[bjl584]

The Constitution does not give the Federal Government the authority to force the citizenry to purchase any product or service. The 10th Amendment leaves all powers not explicitly given to the Federal Government in the hands of the states. When and if the provision that all citizens much purchase health care is found to be Unconstitutional we will all be back where we started. Or we will be worse off than we are now. A lot of people benefiting from the system but only a minority of those people actually paying into it.

What happens if you refuse to buy healthcare? Do you go to jail? How do you get someone that is unemployed and can't pay their electric bill to buy healthcare? How do you get them to pay a fine? Why would they even care?

[jIM_Ohio]

Health care should not be tied to employment. Individuals should be treated the same as companies, in that if companies get a tax deduction for providing their employees health insurance, individuals should also get a tax deduction for buying health insurance on their own. Health insurance is a benefit that should be taxed, but then individuals could write off their cost. You are supposed to count bartering as income, so why not employee benefits?

Tort reform wasn't included because trial lawyers have a very powerful and competent lobbying force in Washington, and many lawmakers are themselves lawyers.

Companies cannot compete against the government on price. The government does not have to break even when looking at price vs. cost. The government can force the price to be one thing while ignoring the cost, but companies have to actually break even or make money in order to stay in business. Also, the government does not have to pay taxes and companies do, an automatic disadvantage companies have to overcome if they are allowed to compete with the government. Government should be referees, not participants.

I like HDHPs and Health Savings plans, where the person actually pays money out of pocket before the insurance portion kicks in. I dislike that these are disappearing with this new law. I do like your (someone above's) idea on 5 year out of pocket caps or lifetime oop caps.

I am worried that doctors are going to quit rather than deal with this new law and new regulations. I am already 30 miles away in two directions from the nearest hospital or doctor's office. Most hospitals out here are more like triage centers...stabilize and airlift to a big hospital 2 1/2 hours away. The nearest ob/gyn that knows anything is over an hour drive away.

I think the biggest problem is that the users of health care don't have to directly pay for anything. Even if individuals had to pay the costs up front and then submit to insurance, I think people would get a better understanding of how much these things really cost. It is like when you are a kid and your parents complain about the cost of going out to eat. You don't know how much work went into earning the money for a night in a restaurant, you just know the food tastes good and you would like that experience again.

I don't know why insurance companies can't sell across state lines, and even with that law, I don't know why states didn't set up agreements between themselves to have the same requirements so that one company could sell the same kind of policy to multiple states. The state insurance commissioners really dropped the ball on this one. If they had diluted some of their individual power by working with other states, they might have saved some power instead of losing it all to the federal government. Is there still a need for an insurance commissioner in a state? Perhaps for auto insurance and fire insurance, but won't the health insurance part of their job be gone now?

LOL
I am glad I read your post...

Health care should not be tied to employment.

I agree. My stance is health care needs to be a level playing field. How "level" is defined is open ended, but here are some thoughts... it should NOT be tied to who you work for, it should NOT be tied to what state, city, or location I live in. It should NOT change in price because of location or insurance provider. If I need open heart surgery, the price of that procedure needs to be defined, and all insurance companies should reimburse the same amount (the price should not be negotiable).

Companies cannot compete against the government on price. The government does not have to break even when looking at price vs. cost. The government can force the price to be one thing while ignoring the cost, but companies have to actually break even or make money in order to stay in business.

I do not agree with this point you made. Saturn did this with GM, and last I checked GM just went bankrupt. The government cannot use the attitude that it can force price. If this is what health care reform is, then I want nothing to do with it. Saturn used fixed pricing from its suppliers... meaning if an axle cost $20, Saturn would say it would pay only $12 for the part. Take it or leave it... if the supplier backed out, GM would pull ALL its business from the supplier, so the supplier lost money on the GM parts, but you know they overcharged on the other GM parts (for Buick, chevy etc...) to cover the lost profits from saturn.

On a level playing field (item #1 above) once a price is established (there is a way to do this without government deciding it), after a brief "phase in" period, the price controls could be lifted.

Right now every location doing an MRI does not tell the consumer how much the MRI costs. My take on level playing field is that an MRI should cost the same (in general) wherever its done, with some minor exceptions. Once that playing field is level, and every MRI provider plays by those rules for 18-36 months, the price control could be lifted, with the idea that price disclosure is more important than price controls.

I like HDHPs and Health Savings plans, where the person actually pays money out of pocket before the insurance portion kicks in. I dislike that these are disappearing with this new law. I do like your (someone above's) idea on 5 year out of pocket caps or lifetime oop caps.

I did not know HDHPs were going away, as I think these are smart plans to use for everyone except those with chronic conditions.

I think the biggest problem is that the users of health care don't have to directly pay for anything. Even if individuals had to pay the costs up front and then submit to insurance, I think people would get a better understanding of how much these things really cost. It is like when you are a kid and your parents complain about the cost of going out to eat. You don't know how much work went into earning the money for a night in a restaurant, you just know the food tastes good and you would like that experience again.

LOL the #1 problem with healthcare is everyone wants it, they don't want to pay for it, and believe that they are entitled to the best care possible whenever they get care from anyone.

Means the people providing it, in general, cannot meet the high expectations of the consumer, the consumer has expectations way out of whack with what things cost ($20 co pays to see a doctor have set a really difficult expectation to most consumers- if you told them the doctor visit costs $150 they would dislike that soo much, but $20 to see a doctor and another $5 for a drug is a "bargain".

I don't know why insurance companies can't sell across state lines, and even with that law, I don't know why states didn't set up agreements between themselves to have the same requirements so that one company could sell the same kind of policy to multiple states. The state insurance commissioners really dropped the ball on this one. If they had diluted some of their individual power by working with other states, they might have saved some power instead of losing it all to the federal government. Is there still a need for an insurance commissioner in a state? Perhaps for auto insurance and fire insurance, but won't the health insurance part of their job be gone now?

All excellent points, thank you for pointing these out (had not thought about problem in these terms).

[Andrew Jackson]

anyway, one of the points I brought up (reiterated from news I heard during the weekend)

There are 30 million people without health insurance
There are 300 million people with health insurance

no source was given for the information on the newscast...

can anyone tell me if those numbers are fact or fiction?

.

Off the top of my head I thought there were 300 million people in the US. A little bit less actually. So I would think their would be less than 300 million insured at least. But the 30 million uninsured might be accurate I guess.

[EEinNJ]

I don't view reforming healthcare and insurance costs as a "liberal agenda" at all- this is a consumer, and fundamentally, human issue. Whatever your politics, employment status, or genes, we will all one day get sick, need care, and die. As a consumer, how long can you afford to buy a product (insurance) that is going up in price in double-digit percentages every year?

As a consumer, is it fair that a hospital or doctor will charge "full price", whatever that really is, to an individual, and settle for a fraction of that amount when a big insurance company is dictating how much they will pay? How about insurance companies refusing to pay on claims after pre-approval? Or clerks deciding what is medically necessary? Or doubling a patient's co-pay for drugs simply because they can get away with it?

Reform is necessary, but sadly, government screwed it up because of the insurance and pharmaceutical companies, the hospitals and doctors- they want to keep squeezing the goose that's laying their golden eggs.

Worse, the changes that have been mandated will not contain costs, and will cost taxpayers even more.

Over 15 years ago health insurance was "reformed" here in NJ. The state mandated insurers to offer 5 plans, ranging from a basic level to what a corporate employee would get. No one can be turned down. You can buy it as an individual, but it's very expensive. Group plans, such as I had through a trade association, basically aren't available anymore because the sponsors of the plans won't sell them in NJ.

I work for a very small company now, and the premiums are astronomical. Last year we had to take a lesser plan because the rate went up so high. My employer covers me, but I had to pay my wife's premium. It got to the point I could no longer afford it (went from 650/mo to 725 JUST for her) and she took a retail job for the insurance. She got laid off, but the COBRA cost is still well below what I was paying.

I could go on with my own stories, or those of friends who ended up charity cases, or are about to lose their homes. To me, health care costs are the single biggest threat to financial security.

[jIM_Ohio]

Hello JimOhio - long time no post. I hope you are fine.

Here are my liberal leanings:

1. I do think healthcare needed/needs reform.
2. I did think a Public Option (key word - option) wasn't the coming of the Anti-Christ
3. I do think some consideration to the "self-employed" (i guess your brother falls here) needs to be made. We pay double SSI, don't get double the benefits and they are the "seeds" of the economic engine in this country. The next Bill Gates could be sitting in a cubicle somewhere, afraid to go out and upstart the next Microsoft for fear of losing his crappy HMO that him and his family are on.

I am not saying give the self-employed healthcare. . .just some consideration and an opportunity to pool resources (as per the exchanges).


Here are my Conservative leanings:

1. I think VAT (value added tax/sales tax) is the best way to fund healthcare and change behavior. Placing VAT on cigarettes, sugary sodas, tanning beds, fatty and sugary fast foods, chips, etc. could fund healthcare and reduce costs and was a platform the GOP really missed out on during the whole debate.

No one says Americans have a God-given right to tax-free unhealthy food. Hey, I know I'd pay a $.50 chocolate bar tax (like my dark chocolate).

Scanner- good to "see" you LOL

Agree on these points
1. I do think healthcare needed/needs reform.

3 I do think some consideration to the "self-employed" (i guess your brother falls here) needs to be made. We pay double SSI, don't get double the benefits and they are the "seeds" of the economic engine in this country. The next Bill Gates could be sitting in a cubicle somewhere, afraid to go out and upstart the next Microsoft for fear of losing his crappy HMO that him and his family are on.

I think a public option was jumping about 4-5 steps too far ahead. My logic is this...

20-30 years ago doctors made most of the money in health care. Then came managed care.

HMOs were popular about 20 years ago, but have more or less gone away, or are MUCH smaller than they used to be. Probably because to turn a profit, there were some problems with "managed care" and HMOs had expecations (for their patients) too high to realistically make a decent profit.

So fast forward 20 years (now), and insurance companies are managing care (they way HMOs used to) and they are not called HMOs anymore (they are just insurance companies).

So whoever controls health care makes money. 30 years ago it was doctors, then HMOs and now insurance companies. Moving the control to the government is not a good "next step". I believe other avenues should be examined which could help consumers and enable free market to exist with health care.

For example, consider these as ways to fix small aspects of the problem (none of these are a total solution, but they can work towards a less government involved solution):

1) Provide a number where most americans (tax payers) should be expected to pay each year in health care. It does not cost more to keep Bill Gates alive than it does Barak Obama. It does not cost more to keep Obama alive (outside of the secret service LOL) than it does me. MY GUESS is that this number is about $7000 for a family, and maybe $4500 for a person.

Similar to an HDHP, that floor means if you are not paying $4500 for health coverage each year, its best for you to just bank the money and spend it when you need it.

1a) the point of the floor above is to point out a vast majority of people will have low health care costs, once you go above the amount above, some insurance can kick in, and having insurance for you is NEEDED to some degree.

2) Treat health insurance like life insurance or car insurance. If you want to drive, you need car insurance. If you want to die you need life insurance.

(those are tongue in cheek)

If you want to see a doctor, you need health insurance.

see- that does not hold water based on first two premise-
the government does a "decent" job of forcing every driver to carry car insurance. But 1-800 safe-auto exists for a reason... we need a health care plan like safe auto which prevents people from going broke on health insurance. It does not need to be a government plan, it just needs to suggest a person pays that first $4500 or $7000 in item #1, then helps with costs after that.

Not everyone which dies has life insurance... its not needed to die... however if I collect on my life insurance (or collect on wife's I guess is a better way of putting it), the payout comes from all those the insurance company collects premiums from.

I see some parallels to health insurance... and I see some places its disjointed (for example some people are disqualified from life insurance because of high blood pressure, cancer etc...)


3) On the life insurance analagy, give me the ability to have a combined life insurance-health insurance plan. The demographics are LINKED (meaning all the stats and mortality tables and health care expenses).

Allow me to pay "in" $1000/mo or something like that to my policy. If I get injured, it pays out for my health care bills and lowers my life insurance my wife could collect.

However, it has some floors and ceilings...
for example it will always pay out a minimum of 500k to wife if I die
it pays me out 500k if wife dies
it requires me to pay the first $1500 and 20% of costs up to $7000 (similar to HDHP)
if I do not spend the money on health care, my premiums the next year either go down, the life insurance goes up, or the $7000 ceiling the next year is lower.

Over time that build up cash value to where I no longer need 500k of coverage, and the likelihood I need more health coverage goes up (to stay alive). It all balances out IMO regardless of stage a person's life is in.

It also gives the insurance company incentive to keep me alive. Right now in current system, if I enter hospital and end up on my death bed, the insurance company would rather see me die because their payout is lower if I die quickly.

[cooliemae]

In addition, government plans(tri-care,medicare, medicaid and the plan government employees are on) do not pay full price causing the private sector to pick up the tab.

I'd be interested to see some documentation on this. I believe that the government gets a better deal because of the size of their pool. The same would be true of a large company that can negotiate with the insurance provider.

This was the whole idea behind a public option. Bring a large group of people under one tent and negotiate as a group for better prices, that then forces any company that wants a piece of the large group to lower their prices.

[jIM_Ohio]

I'd be interested to see some documentation on this. I believe that the government gets a better deal because of the size of their pool. The same would be true of a large company that can negotiate with the insurance provider.

This was the whole idea behind a public option. Bring a large group of people under one tent and negotiate as a group for better prices, that then forces any company that wants a piece of the large group to lower their prices.

I agree seeing the math behind this would be helpful

I see this as a bandaid (combining people to get lower prices). The real problem is the pricing model and how that pricing model is funded and money is distributed.

If I had a choice, reform would be changing the pricing model, not pooling more money together.

an MRI should cost about the same whether done at a hospital, testing facility across the street, or at one 30 minutes away in a suburb. The only variables which change would be the real estate cost, and possibly an orderly wheeling a hospital patient from one floor to the next for test if done at a hospital... until that level of efficiency in pricing is reached, most other fixes are band aids and not treating root cause.

[cooliemae]

Another thing that I wish that health care providers would do is to combine billing departments.

My wife recently needed a MRI performed. It was done at the same hospital as the doctor who ordered it, however the MRI is actually performed by a separate company with a separate billing department, even though they are all in the same building. Talk about inefficiency!

[feh]

A few other questions I have trying to understand the "need" for health care...

Is there any documentation that having universal healthcare stops the "spiraling" costs of health care. My thought on this is Obama and Democrats are "banking" on everyone having insurance as the way to stop the spiraling costs of health care.

Disclaimer: I consider myself progressive/liberal; I think single payer makes the most sense, but realize that will likely never happen in the US.

To respond to your questions - I haven't heard much crowing from the Dems that the HCR bill will reduce health care costs. Perhaps I just haven't noticed it; it probably depends on your perspective. But, from what I've read, this bill won't do much (if anything) to reduce costs, and that frustrates me.

That being said, this bill may reduce the cost of health care insurance (not health care). If younger, healthier people are mandated to buy into the system, the average cost should theoretically decrease.

The bill does accomplish a couple things: 1) insurance company regulation so that they can't (as easily) screw a customer and 2) makes health care insurance much more affordable for those who would have trouble paying for it.

I see the spiraling costs and I already have insurance
so I just "don't get it" that everyone having insurance prevents the costs from continuing to increase.

Is there a reason tort reform is not on the liberal/ democrat agenda?- this seems the most obvious way to drive down the costs of doctors, and drive down those costs, then other costs to consumers should drop as well.

From what I've read, malpractice insurance accounts for something like 2% of all medical costs. Tort reform would make almost no difference in the cost of health care.

And my last comment, this thread may turn into the liberal vs conservative view points, please keep it civil... no reason to make enemies by attacking people personally. I prefer debates where people teach me a thing or two, not state opinions or belittle other people...

we are here for entertainment purposes as well as educational purposes...

While you don't mention it here, you do in a later post: letting the free market work. In short, the free market doesn't work well in all situations, and health care is one of them. Here's an article on that subject:

Why markets can’t cure healthcare - Paul Krugman Blog - NYTimes.com

[jIM_Ohio]

Disclaimer: I consider myself progressive/liberal; I think single payer makes the most sense, but realize that will likely never happen in the US.

While you don't mention it here, you do in a later post: letting the free market work. In short, the free market doesn't work well in all situations, and health care is one of them. Here's an article on that subject:

Why markets can’t cure healthcare - Paul Krugman Blog - NYTimes.com

Thx for article, I urge others to read it and comment. I do not think the author draws good conclusions. That is not to say the article's premise is wrong, that is to say he added 1+1+1 and came to a conclusion the total was 10... which was completely out in left field relative to the points building up to argument.


examples

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

"and this means someone other than the patient ends up making decisions"... bad conclusion.

If we need to reform, you do not use the existing (inefficent) system, you reform by creating a new system. If the decision to what is best for patient is not being made by doctors, fix that aspect of the problem first, do not let treatment be the byproduct of the system.


and towards end

There are a number of successful health-care systems, at least as measured by pretty good care much cheaper than here, and they are quite different from each other. There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work.

Again because there are a number of systems which work, but not one is "free market" does not mean free market won't work. The absence of data is not actually data- basic problem solving and statistical analysis tells people that.

I did state earlier free market needs to be used- to some degree- My standpoint is free market can drive the cost inefficiencies out of the system. I am not suggesting health care be 100% pure free market. Heck, even the loaf of bread the author used is not free market- because there are government subsidies and tax credits to the farmers which made the wheat, and its possible without those credits, the cost of that bread would be higher.


On one hand I suggest some cost control where there is some way to regulate that an MRI costs the same to anyone which uses a given facility. If I come in, get an MRI and it costs $200, if you get an MRI from same provider the next day or next hour, it should cost you $200 too. Right now the system does not do that, and that is "unfair". So I suggest some price controls or regulation to make that work.

I suggest that the MRI cost the same whether at a hospital, a clinic across the street, or in a suburb- that is not free market either- there needs to be some level of price control, for a short amount of time- to drive out the inefficiencies some have built in (if everyone has to charge $120 for same MRI, then if someone was profiting $90 before, they profit $10 now, and that $80 of lost profit will drive some efficiency into system (meaning MRI provider reduces costs to make MRIs more profitable).

Then once you have 3-4 years of cost controls like this, were inefficiencies are identified, you can remove the price controls and require price disclosure- we (as consumers) now know how much the MRI costs, and know what type of price to look for.

Right now the only price we know is what our insurance company tells us, and as the article points out, its not like the insurance company has our health in their best interest.