Let’s Fix Health Care
I think that our current health care system needs improving. I think that most rational people would agree, whatever their views on any current plans, that there are some major issues that we, as a country, need to address. Granted we might not all agree on what those specific issues are.
Now most of the people I see posting in the comments section here seem to be fairly bright. I bet between us we can come up with a whole bunch of workable ideas to fix health care.
And unlike a majority of the country, which seems to think that major national issues should be discussed with a maximum of volume, enthusiasm and a near total disregard for any semblance of etiquette, we can probably do this in a civilized and rational manner. Buy viagra over the counter from http://www.trendingdownward.com/generic-viagra-ed/ reliable indian pharmacies.
So everybody, what’s wrong with our health care system, and what can we do to fix it?
Here are the ground rules:
1) Facts are good, proof is better. If you are going to portray a piece of information as a fact, be prepared to back it up from a credible and ideally first-hand source. Failure to do so may result in mocking.
2) It is okay to contest evidence that someone else submits.
3) Play nice. No name calling, insults, insinuations, are any other such nonsense. Michiel, I’m looking in your direction for some reason.
4) I may make more rules if you guys get all “retards in a candy factory” on me.
Other than that, nothing is off the table. Let’s fix this.
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September 16th, 2009 at 9:35 pm
Assha…
Freaking moro…
Seriously, pull your head ou…
I can’t do this.
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September 17th, 2009 at 1:07 am
Very well. This will be interesting.
Note that I’m a foreigner so I don’t know exactly what you’re doing now, but I’ve noticed that your health care issues have made international news fairly often, lately…
This is what we’re trying to do in this country, and it … well, mostly works:
1) Establish a standard of minimum acceptable care. This’ll be the tricky part. Want to do this on a national, regional, municipal or what level? All possible.
There must be at least three categories of treatment, by degrees of urgency – immediate emergency care, semi-urgent issues that need to be handled within a week or so, and non-urgent.
And another important issue is time limits for admission. We learned that the hard way.
This may include subsidizing certain treatments only partially.
2) Require that local-level (county or municipality) authorities ensure that this minimum care is available for residents. They’re encouraged to contract to a low bidder – or several. Emergency care specifically must not be constrained to a specific contractor, nor to county borders or whatever, and if the contractor can’t handle any given issue within approved time limits they must get this service from someone else.
3) Establish a taxpayer-backed health insurance that pays as much as the low bidder charges, minus an yearly maximum co-pay of no more than a few hundred, for the minimum care. All local legal residents will be covered, non-locals using emergency health services get to sort it out with their own office back home AFTERWARDS. Non-emergency can handle the payment details beforehand.
This makes sure that hospitals and whatever don’t get unpaid patients. And the one that gets to chase after unpaid foreigners is the government.
Yes, immigrants bringing their uninsured, non-resident grandma in for treatment may easily get a bill of umpteen thousand. Or more. Or refused non-emergency treatment altogether, unless paid beforehand.
4) Patients are free to opt for a higher standard of care (including stricter time limits if available), paying the difference between this and the minimum care themselves or through optional extra insurance or whatever.
Like I said, this mostly works here. At least seems to.
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September 17th, 2009 at 3:12 am
There need to be several changes made.
1) Health Insurance is for the coverage of Catastrophic events. It should not be used for diagnostic checkups, preventive care and other normal expected costs. Then Insurance providers can offer discounts to those who get regular checkups and such.
2) Require health care providers to have their rates posted and easily accessible to customers. Customers should be able to price shop their care the same way they can with their groceries and most other goods and services.
3) Fix the malpractice laws. Any malpractice suit should have to go through a blind panel made up of doctors before it goes to trial. If the panel can find no evidence of malpractice then the suit stops there. Place all financial burden for suits on the shoulders of the prosecuting attorney and client unless the defending doctor is found guilty of malpractice. (there may be better ways to accomplish the goal of getting rid of BS malpractice suits, I am open to ideas)
4) Drugs can be expensive. The reason for this is that it takes years to develop them during which time the company has to pay the wages of the scientists working on the new drugs and pay for the various levels of testing required(which can take well over a decade just for the FDA testing). They have a limited time to recoup their expenses before they have to start allowing other companies to make the drugs they spent money and time developing and testing.
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SPC Hyle reply on September 17th, 2009 8:40 am:
1) They do. They still deny coverage to those who do these things.
2) This is not practical, as one has few options for health care locally. Also, the rates differ depending on whether or not you are insured, and by who. This is because insurers use their position to leverage better rates for their customers (which means increased profit for themselves). This can make it effectively impossible for any consumer to determine what the best rates are possible for himself.
3) This is pretty much already the case in many states. An independent panel of doctors has to conclude that the mistake was unreasonable–i.e. that the panel, in the same circumstances, could not have reached an identical conclusion.
4) This is only partially true. The demand for any life-saving drug is perfectly inelastic (price insensitive) as no matter the cost, those who need it to survive still need it to survive and will pay whatever price is asked or die. They price based on this to allow for maximum income.
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SKD reply on September 17th, 2009 10:10 am:
I would argue
1) that only catastrophic care should be covered, those who are at greater risk would naturally have to pay higher premiums based on their increased risk. If insurance were not expected to pay every time you have the sniffles and go into the doctor to be diagnosed and were prescribed common and relatively cheap drugs then they turn around and use the savings to offer lower premiums to all customers and coverage to those at greater risk.
2)define few options, please. I have been many through many areas and even small towns that you could blink and miss will have more than one doctor in town and several within easy driving distance(hospital emergency rooms should be excluded thanks to the fact that they are supposed to be for legitimate emergency care, minor illnesses should go to a private office). As for the insurance companies leveraging better rates, if they are not having to cover common doctor’s office visits and medications then there is no reason for there to be different rates to worry about. Add on to that a requirement to post rates and use the same rate for all patients and your argument goes out the window.
3) which states? I am not saying this is not true, but it should be the standard nationwide.
4)Life saving drugs are often also in lower demand than common drugs, a far greater number use aspirin than insulin for example. If you have to spend the same amount to develop a common drug than a lifesaving drug then naturally the lifesaving drug is going to cost more. It is an unfortunate effect of supply and demand.
There is no perfect solution to any of these issues, but we can try to find a way to solve them in a way that works well for the greatest number of people
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SPC Hyle reply on September 17th, 2009 11:39 am:
1) Precluding preventive care is bad policy, period. Regular examinations and check ups reduce the frequency and severity of catastrophic care. There is a reason insurance companies, profit motivated one and all, cover and encourage such visits.
2) My zip code has two non-hospital providers, and one of them is a single practitioner. This is a town with 25,000 permanent residents and two colleges. There is a larger clinic 50 miles away, but this limits access.
Even if there are no other doctors visits, insurers will still use their influence to leverage different rates for catastrophic care. If 500,000 people are under your plan, you bet your ass you have the ability to leverage cheaper care rates.
3) I’m pretty sure New York, and I’ve been told of a few others (can’t recall which, sorry). But this cannot be made a national standard, as tort is a state matter by definition.
4) I’m sorry, but this is not about supply and demand. Most drugs (lifesaving ones especially) have a perfectly inelastic demand curve–the price does not effect quantity demanded. If you need chemo, you will pay whatever they charge or die. There is a reason that 50% of all bankruptcies are caused by medical bills, and most of those people were insured. You pay the price or die. Pharmaceutical companies know this, and charge accordingly. Insurers know this, and deny further coverage once you hit a certain point. So then you take out every damn loan you can to live. Maybe you can pay them back. Maybe you can’t. But if you had a choice between bankruptcy or death, you’ll take the former.
Janice reply on September 17th, 2009 10:12 am:
1) The problem with this is that it has long been established that the key to reducing the need for spending on catastrophic care is regular checkups so problems are caught early. As someone who has had to pay for these things out of pocket with no insurance, I can say with confidence that you’re looking at $110-$150 *at least* just for the visit, not counting routine lab work (standard for annual physicals) or if something is found requiring routine follow-up to discuss lab results, double-check findings, etc. Now multiply that by a family of 4 every 6 months to a year and you get a sizable bill. Many won’t be able to afford it. Or if they can, they just won’t bother. The more spent on expensive care for many people, the more insurance companies raise their rates across the board and not just for those that needed the expensive care.
4) Not really. Drugs are expensive in the U.S. The same drug, by the same company, tends to be sold at a reduced rate in other countries. This is why many Americans now order their prescription refills for the same brands via pharmacies in Canada. Big pharma has massive profits. I currently take a drug that is $293 to $225 (depending on what state I’m in) without insurance. This is because they hold the patent and there is no generic, thus no competition. They can charge as much as they want. And yes, its to recoup their losses but also because they know that just about everyone buying it will be using some form of medical coverage, whether insurance or Medicare.
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September 17th, 2009 at 4:41 am
I’m not expert and I’ll admit that right here. I’ve heard lots of ideas and many of them sound good and some just suck. Posts 2 and 3 alone sound pretty nice. My big bitch is a system where I pay for some lazy slackass who doesn’t contribute. That people think that just because they want “free” healthcare, they have some sort of “right” to it. The fact of the matter is that nobody does. I don’t, I have the privilege of good health care because I work hard and can afford to pay for it. Actually saved me about $1700 this year.
If we’re going to do some form of government run healthcare, which seems to be the trend, I think there should be strong accountability on all fronts and the understanding that if you CAN contribute and you DON’T, we as a country are not responsible for you. That doesn’t mean letting little old retired gradma go untreated because she can’t work or dad because he’s got a bad back. Its those folks who are perfectly capable of working and for whatever reason choose not to.
If everybody works and everybody puts in and we’re honest and grown up about it, I can see a government run system maybe working. I’ll start posting more specific ideas like 2 and 3 if and when I get them.
As a final note on point 3 from SKD, dude, our whole method of sueing needs to be rethought. To expand on your idea, I think we should adopt something similar to the Brits where if you bring a frivolous lawsuit before the court, you pay everbody’s court fees.
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SPC Hyle reply on September 17th, 2009 8:10 am:
The natural rate of unemployment would tend to suggest that your claim of “lazy jackass” is rather irrelevant. Unless you like persistent double-digit inflation, you will never see unemployment below 2-5%, depending on general economic conditions. This is a basic macroeconomic fact. Also, unemployment figures cover only a certain sector of people who have no jobs–those who have lost a job recently and are looking for a new one. If their search is unsuccessful, they fall off of those rolls after a certain period of time (about 6 months).
Then you have people who do not work because there is no advantage for them doing so. They will not get enough hours and pay to bring them above their current economic situation (i.e. welfare) so there is absolutely no reason, from an economic point of view, for them to get a job that they are capable of holding. Also, don’t even try to bring up workfare. That is a corporate wage subsidy, and it allows them to cut their wages at taxpayer expense and get employees who are beholden to them, and cannot seek training to get a job beyond unskilled labor.
Then you have to factor in that students, or formerly employed people undergoing re-training, often cannot realistically work and maintain a presence in school, but are also excluded from unemployment statistics.
And there are also the homeless–try getting a job once you hit there. It’s very easy to fall into a downward spiral, and once you’re in, there is no way out.
Those are all people who want jobs but aren’t seeking them–and there aren’t enough jobs for those who are seeking them. Getting more people to seek jobs will not help the situation, it will exacerbate it.
The actual number of true leeches in the system is really low and crafting a system to exclude just them, and not those who are making an effort, is simply more expensive and difficult than just including them, especially once you consider the costs to those who are unfairly excluded.
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StoneWolf reply on September 17th, 2009 9:53 am:
Like I said, I’m not a professional economist. I’m an engineer/technitian. If you are correct, and I rather hope you are, I suppose I can live with like 0.1% leeches in the system. But I have personal experiance living with a leech, and its a huge fucking drain.
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SPC Hyle reply on September 17th, 2009 10:02 am:
Oh, yeah. Leeches suck. And every system has them. Employers have leeches, and know about them, but don’t fire them because it’s cheaper and safer to keep them than to risk someone worse than they are.
I don’t have a degree in econ, but I have studied it a bit, and my father does have a PhD in the subject, so I got to hear a ton of the background information on this–especially with unemployment and supply/demand.
Most of it isn’t too hard, if you have sound reasoning skills you won’t have too many problems.
Minty reply on September 17th, 2009 12:25 pm:
Just to build on the “actual number of true leeches in the system is really low” point, have you thought of stay-at-home parents? Many of them can work, but choose not to because 1) their morals dictate that they stay home; or, 2) the cost of daycare is equal to or more than what they would make at a job. Are these people deadbeats?
And what about migrants? Migrants work their asses off for shit pay, and their lifestyle makes it hard for their kids to move up, economically. Do they deserve less medical benefits than some pampered trophy spouse?
Just a little food for thought.
LoC the Pinko reply on September 17th, 2009 7:26 pm:
these are all reasons I’m all for a welfare system. One that provides food, clothing, and shelter DIRECTLY to people who don’t have such things. The problem with our current one is simply this: it gives them money that they can spend on essentially anything.
Unfortunately, what I describe requires an infrastructure the American people aren’t likely to fund building… ’cause that’d be socialism.
Janice reply on September 17th, 2009 10:20 am:
Good list. Also add in the self-employed. Private coverage for us is ridiculously expensive. It costs far more than what you get on a group plan through an employer. So many of the self-employed are insuranceless.
And there are currently a lot of people in this country laid off and hunting for work but just can’t find anything. Unemployment is very high right now.
Then we also have lots of people that are employed, but in positions or at companies that do not offer insurance. You don’t get insurance when you work minimum wage, or if you are hired as a contract employee, or hired for short-term employment, etc.
The assumption that everyone that doesn’t have insurance is just some lazy jerk that wants to live on welfare is part of what keeps hurting progress on finding answers to this problem. Because at the moment, too many see it as just leeches rather than real people with real obstacles to obtaining health care.
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StoneWolf reply on September 17th, 2009 11:43 am:
To be clear, I didn’t and don’t see EVERYBODY without insurance or a job as lazy leeches. I figure most of them probably aren’t and SPC Hyle seems to back that up. My complaint is the socialist idea of “FREE HEALTHCARE”. It isn’t free, its the rest of us paying for somebody. I don’t mind helping somebody who actually needs a hand, presuming its short term and they’re trying to get back on their own two feet. I just hate having to take care of somebody who can take care of themselves but won’t especially when its somebody else telling me I have to. Done that twice before I learned my lesson.
skippy reply on September 17th, 2009 11:59 am:
True Stonewolf, but to be fair, most people who are for healthcare reform aren’t saying “FREE HEALTHCARE”. They’re saying “Healthcare for everyone is worth the price.”
September 17th, 2009 at 5:39 am
Some things I would like to see:
1. True competition amongst insurers. This means removing the boundaries states have put in place that cause some states to almost become the personal fiefdoms of a single insurance company.
2. Require insurance companies to stick to their word. If you get a pre-approval from your insurer, they should be required to pay all related costs to that pre-approval. I have a friend who had to fight the insurance company tooth and nail to pay for a surgery after she got the pre-approval.
I’m not sure if you saw it, but I posted my reaction to the latest proposal from the senate.
http://dracphelan.livejournal.com/751482.html
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Janice reply on September 17th, 2009 10:33 am:
Fair points. My understanding is that these 2 items were in Obama’s original proposal. I remember specifically seeing/hearing him speak on removing state boundaries even before he was elected. I’m fairly certain I heard him address point #2 from your stance too. Mainly because so much of the impetus for his fight for health care came from his family fighting with the insurance company to get them to cover his grandmother’s procedures and meds for cancer.
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September 17th, 2009 at 7:26 am
How about establishing a non-profit, national HMO outside of the government itself? If the profit motive really is the problem as so many say, it should work just fine.
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Tim Covington reply on September 17th, 2009 9:00 am:
That’s what the co-op plan in the most recent piece of legislation to come out in the Senate basically is.
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SKD reply on September 17th, 2009 10:14 am:
too bad nothing that comes out of the government will ever be run by anyone but the government
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SPC Hyle reply on September 17th, 2009 9:07 am:
The profit motive isn’t just on the insurers end. Also, medical administrators need to show profits to someone quite frequently, medical schools need to show large profits to someone, and drug companies are looking for as large of profits as they can get their grubby hands on. All of those points need to be addressed.
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September 17th, 2009 at 7:36 am
The US Government at one point in time seized control of a brothel out in Nevada (Mustang Ranch in 1999 due to tax evasion). As law required the tried to run the ranch to recuperate losses. They ended up losing more money.
If the government cant even run a sex and liquor store, how do we ever expect them to create a medical plan and then run it?
My feelings are, create a free market and remove the restrictions so that the costs don’t have to be inflated (ever see a $25 aspirin on your hospital visit) to help pay for under or uninsured and so that people can afford insurance or afford to self insure.
I may not have the answer, but I can say with certainty the Government in this case is certainly not the answer, but will only lead to more problems.
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SPC Hyle reply on September 17th, 2009 8:15 am:
The free market has not worked in this situation, because it cannot actually truly exist. In order for there to be a free market, there must be no barriers to entry for those who wish to provide services. There are substantial barriers in the medical practice–licensed and (heavily) regulated doctors and patent laws both ensure that there are substantial barriers to entry. Also, there is a substantial cost to train to become a doctor (several hundred thousand dollars, with not inconsiderable interest rates). Realistically, only one of those barriers (the cost of becoming a doctor) can be lowered or removed. The licensing and regulation of doctors ensures the safety of the patient, and patent laws will not be removed.
The free market cannot solve problems that deal with public welfare. To assume it can and will is a gross misunderstanding of Smith.
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Janice reply on September 17th, 2009 10:27 am:
I would not use one incident by one state as proof that it can’t work. I’d like to point you to the United States Postal Service, which competes quite well with FedEx, UPS, and the like. It has been in business for over 100 years now and has gone on to embrace new technologies.
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SKD reply on September 17th, 2009 10:48 am:
I would argue that the only thing keeping the USPS in business these days is junk mailers and the fact that it is paid for by our tax dollars
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SPC Hyle reply on September 17th, 2009 11:10 am:
It’s mostly bulk mailings that keep the price as low as it is.
I’ll tell you this: I mailed two large tough boxes home when I left the Army, and I UPSed two more (weight restrictions). Both were dropped off and paid for by me within 20 minutes of each other. I went cheapest rates for both, and the USPS delivered abut 2 days before UPS. Now, this is just one instance, but the USPS is in general very fast, very reliable, and very cheap compared to UPS or FedEx. Email is one of the bigger factors in increasing their rates, as letters are becoming increasingly uncommon.
SKD reply on September 17th, 2009 1:46 pm:
I’m glad you have had good experience with the USPS over UPS.
In my experience UPS(haven’t used Fedex or DHL) has been more reliable.
Janice reply on September 17th, 2009 1:55 pm:
I’ve had better experience with USPS over the years than the commercial businesses too. I actually canceled the FedEx business account I was using after they tried to get out of paying for computers they broke in transit.
Sequoia reply on September 17th, 2009 12:15 pm:
Every time the government has tried to get involved with some aspect of any business, bad things have happened. There’s that brothel example of Chris Hershberger, but let’s also look at railroads. In the early 1800s, America was building railroads all over the damn place. I forget the exact specifics now (I try to avoid most memories from when my AP US History class was taught by the damn student teacher), but the U.S. Government gave grant money to all but 1 of the railroad companies. After the Panic of 1873, I believe, all the railroad companies BUT the one that didn’t have Federal Grant money failed.
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Janice reply on September 17th, 2009 12:23 pm:
What about the governments running things we use every day? Water, waste water, gas, electricity and trash. These have been managed by government run organizations for decades with little complaint. In fact, in most areas, your choice is that city service and no other option is available. How about public transportation? Public schools? There are private options available for both. But there is often a thriving public option still in play in many areas.
Janice reply on September 17th, 2009 12:30 pm:
And those railroad examples are real old. Over 100 years. How about something from recent history? Something in the past few decades?
Sequoia reply on September 17th, 2009 12:32 pm:
My dad is a government employee. And if there is anything he has ever taught me it is as follows: The government is NOT good at organizing things.
SKD reply on September 17th, 2009 1:50 pm:
@Janice: I don’t know about you but every place I have lived has utilities run by private companies these days.
Don’t even get me started on Government Schools. If there is any institution that better illustrates why the government should not be allowed to run anything I can’t think of it.
Janice reply on September 17th, 2009 2:00 pm:
@SKD Every city and town I’ve lived in had city utilities in one form or another. And I’ve moved around a fair bit over the years. I’m always making my monthly check payable to “City of…” for some thing or another.
As for public schools…I don’t entirely pin that on the government. Schools are very much run by the parents. They have a chokehold on how schools are run. Many of whom (parents) are ignorant and demand material be taught that is incorrect, that don’t insist their children study or learn, and that expect the school to be more of a babysitting service than educational institute. So many of them have a fit when their child isn’t praised, or “given” a good grade, and do their children’s homework and projects for them.
Meanwhile, parents who send their kids to private schools tend to already have a much better understanding of the importance of a good education and what it takes to achieve that. Those parents know that knowledge, excellence and self-esteem aren’t given…they are earned.
StoneWolf reply on September 17th, 2009 2:58 pm:
@ Janice
My mother has taught public school for longer than I’ve been alive and by and large you’re right. Recently the parents got her old principal “retired” since they had kids with failing grades. New principal sweeps in, equality this, fairness that, no child left behind my ass, her math program got hosed. She’s been teaching 5/6 Math up to an including basic algebra and had a Standard, Basic and Advanced level class. Now she teaches one class and if she tries to teach even the Standard the kids from Basic get left behind, so now she can only teach Basic to everybody. So now about 3/4 of her kids are not getting the education they should, the education they can handle, because 1/4 of the kids just aren’t up to it and mommy and daddy whined that little Timmy is in “Dumb Math”. For the record, my Mother never considered Basic “Dumb Math”, it was a decent math course tailored for the kids who are just not as skilled at math as others.
Janice reply on September 17th, 2009 6:38 pm:
@Sequoia I’ve worked for a number of major corporations in the past 15 years. They’re no better at organizing either. Nothing but giant slow bureaucracies mired in internal politics, out-of-date attitudes and procedures, ancient technologies (even telecoms have some old stuff internally!), and a lack of willingness to risk anything new or do anything better. They move on most things at a snail’s pace. A few of the big projects, we see hit the general public. But a great many things that need to get done behind the scenes….ugh…what a pain… Just like government jobs.
Sequoia reply on September 18th, 2009 3:01 pm:
It probably doesn’t help that I live in perhaps one of the worst states, politically, economically and socially (we’re all douches and the goddamn trolls refuse to admit we yoopers exist).
PS If you haven’t been able to figure it out, the state is Michigan.
September 17th, 2009 at 8:18 am
I really don’t know much of the US health care system… but I would think that if some country has a GOOD and BALANCED HCS (Health Care System) you should copy certain things and develope a strong system…
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SKD reply on September 17th, 2009 10:21 am:
Which country with a GOOD and BALANCED HCS should we copy?
And another thing that needs to be pointed out, NO government plan has ever stayed within budget. With our current government doing its best to set a record on national debt that cannot be broken why should we trust them to run a health care system without further accelerating our spiral into national bankruptcy.
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SPC Hyle reply on September 17th, 2009 11:15 am:
First of all, there are plenty of governmental plans that have stayed within budget. Last I checked, the NEA didn’t exactly go over budget. Nor have many grant-providing agencies. So that claim isn’t correct. Also of note is that corporate plans often go over budget as well.
Secondly, who says we have to copy someone else? Are you saying that we spent our ingenuity during the 19th and 20th centuries? We can come up with our own system, thank you very much. What we have now is not a system, it’s barely an arrangement.
Our debt, in terms of GDP, is very low compared with most other industrial nations, and much, much, much lower than it was (again, in terms of GDP) during WWII.
Debt, even increasing debt, is not a necessarily a bad thing, especially if your revenues increase at a rate faster than debt accrues.
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SKD reply on September 17th, 2009 1:57 pm:
I didn’t say we should copy someone else, that was the original poster. And the NEA is a teacher’s Union. Grant providing agencies have the ability to just stop giving out grants til they get a new budget.
Our national debt, both current and projected, is ridiculous. How about we try holding our politicians feet to the fire and telling them they need to figure out how to spend only what they have or less before they even think about raising a single tax? I don’t know about you but I manage to live within my the wages I earn, something the government seems to have trouble doing when it is not in any kind of emergency state.
SPC Hyle reply on September 17th, 2009 4:08 pm:
The NEA isn’t a teacher’s union, so minus one point. Second, grant providing agencies are still governmental operations. Minus one point.
When you say the debt is ridiculous, what exactly do you mean and, more importantly, why? We’ve had much larger debts before in terms of GDP, other nations have much, much higher debts than ours (again, in terms of GDP) and our debt is not like most other debt. It’s in bonds. It does not accrue interest on the interest.
Did you buy a house or a car? Did you pay cash? No? Welcome to deficit spending. You just spent more than you made.
September 17th, 2009 at 8:34 am
The best solution is a single payer system. The current arrangement (it is NOT a system by any definition) in the US ensures that a profit motive exists. In order to maintain profits, supply will not meet demand, period. This is basic economics. Even if we allow only a normal profit (which has a strict economic definition, where once opportunity costs are met, there is zero profit), supply will still not meet demand. You have to subsidize, directly, and often heavily. Given that demand often means living or dying, this situation is one that we should not tolerate.
Solution: scrap insurers, scrap private ownership of hospitals. Subsidize and/or forgive portions of medical school loans (or cover them completely and forgive all outstanding ones). This reduces costs of training doctors, which means that the supply will increase. Wages can be lowered somewhat because there is less need for higher wages (to pay off substantial debts).
This also puts the government in a position to directly negotiate with drug manufacturers for a lower price. Given that the demand curve for life-saving drugs is perfectly inelastic (no matter the cost, their demand will not change), drug companies are in a position to charge vastly more than their cost (including development) would justify. There is a reason that chemotherapy can cost thousands of dollars for a dose, and it isn’t because of the expense of manufacturing it.
The same goes for many tests. If you need an MRI to live, you’re going to pay what they charge you. Or die. So the price will rise to whatever will maximize income.
Healthcare should be treated as a public good. My good health positively impacts your good health. If I don’t have communicable diseases, I can’t very well give them to you, now can I? If I do not have to contend with illnesses, I take fewer sick days and therefore produce more. If my employer must not pay insurers to maybe pay for my treatment, their cost of employing me drops, which means that the price of their service decreases and the number of employees that they can have increases.
Everybody who isn’t an insurer or a drug manufacturer benefits in this arrangement, and the drug manufactures can simply be regulated to a fair market price (i.e. they make a normal profit)) which means they are where the market would actually price them. The horror.
Before anyone starts spouting off numbers of people who died while awaiting treatment in single-payer countries, please convert that to a rate. 50 deaths may seem a lot, but out of how many? 100 would be a rather high rate, but out of 1 million it’s rather low. And please try to find out the relevant statistic for the US.
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StoneWolf reply on September 17th, 2009 12:05 pm:
You’ve just given me an odd idea. I’ve been looking at the HCS like a service the Feds are trying to take over a-la-socialism. Which I think is bad. But if you look at a HCS as part of Public Works (one of the three basic functions of government), such as roads and the post, and treat it accordingly. I’m not sure this idea works though. I’ll have to think more on this.
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Janice reply on September 17th, 2009 6:47 pm:
Actually StoneWolf, you’ve verbalized better what I and some others are trying to say. The key phrase there is Public Works. You’ve hit the nail on the head.
To many of us, this is just one more facet in a system of public services. This is why I and others are blown away when we see and hear the “zomg socialism! Health care is evil!” reactions. To us, health care is a vital and missing part of the existing system. Many of us see it as no different than any of the other basic functions of government.
Further, we expected any health care system to be treated as such. We don’t hold the assumption that it will lead to deaths and ruin and making the current health care situation worse. Mainly because the fire department, military, and road systems may see cutbacks now and then, but they don’t go away, or stop being used, or get rationed to the point of uselessness. They are necessary for keeping things moving in this country. This is the other reason I and some others are confused when we see the reactions from the extreme far side that see health care services as a very bad thing.
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September 17th, 2009 at 9:08 am
I belive that my opinions on healthcare have already been shown in a comment I left on a previous post. Natural selection should be part of it. If a person gets hurt by doing something that they knew better than to be doing I.E. skateboreding off of a rooftop, throwing knives at each-other, ect. then the injured person must either pay for it themselves, w/o insurance, or they arn’t treated at all. Also, doctors should be able to tell people to “tough it out” instead of showering a person with a stubbed toe with pain killers. Insurance should have both competetive companies, and a very basic government insurance that is just added into your yearly taxes. If a mother has more than 4/5 children, she is also forbidden to have any more, same with fathers. The number is up to debate. That is about all I have for now. I’m sure that this will all be torn apart by the rabid debate dogs, but I stand firmly by my belifes.
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SKD reply on September 17th, 2009 10:45 am:
I would say that anyone who is being supported by the state should be on mandatory birth-control and I don’t mean the pill which people can forget to take.
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StoneWolf reply on September 17th, 2009 12:08 pm:
Supported like with Welfare? Oh Hell yes! Welfare girls breed welfare babies who become welfare girls, etc etc. Generalization I know, but largely true. You either pay for the kids with the product of your own labor or you let the people taking care of you decide how many of your spawnlings they’re willing to put up with.
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Minty reply on September 17th, 2009 1:02 pm:
While I like your “stupid people have to pay for their stupidity” clause, it, like leeches, is going to be very hard to prove in a lot of cases. Obviously not the “skateboarding off the roof” one, but what about “throwing knives at each other?” I can always claim that I wasn’t involved and got hit by accident, and the thrower can always say that it just slipped out of their hand and hit me.
I’m squeamish about putting a unilateral cap on how many children people can have. Look at China–there are tons of abandoned babies. I propose something a little more extreme–adjust the cap according to income. So, Brad Pitt and Angelina Jolie can have more kids than the blue-collar Jon and Betty Smith, simply because they can afford it.
As for Welfare Mamas, hold off on the sterilization for the moment. Instead, adopt a “once is an accident, twice a coincidence, three times intentional” rule. One baby and you’re fine. Two babies and you’re under scrutiny. Three, and it will automatically be assumed that you’re too lazy/stupid/selfish to use contraception, so your children will be removed by social services until you can get off Welfare and earn enough to support them (parents with 3+ who had jobs, lost them and wound up on Welfare for whatever reason would be excluded under the assumption that their baby manufacturing is not an attempt to sponge off the taxpayer).
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StoneWolf reply on September 17th, 2009 3:06 pm:
Actually Minty, what you’ve proposed is pretty close to what I was thinking in my own post (can’t say for Billy or SKD). But being me, I was a little cranky and so didn’t really explain my thought, I just ranted a bit. I think the idea of capping spawnlings if you’re on the dole is good, we can negotiate the details later.
Captcha: Firebomb Elizabeth-Well, it’ll make her a hottie.
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Shadowydreamer reply on September 17th, 2009 4:16 pm:
Up here in BC, you can have welfare for two years.. you will still get your extra $$ but at the end of two years they say we don’t care how old your kids are or aren’t, you’re getting a job. We’ll pay for your daycare unless you start making more than X. K, thanks, have a nice day.
It’s amazing how many baby factories tried to claim disability after that legislation came in.
StoneWolf reply on September 17th, 2009 4:26 pm:
SD, that is beautiful. I’ve thought we should have an expiration date on welfare here for years (pretty sure we don’t). Glad to know somebody does it and that it seems to work.
Shadowydreamer reply on September 17th, 2009 9:47 pm:
As much as I kvetch about the BC Liberal government, they have done marvelous things for welfare and other social program reform in this province. The first being you have to live here for *at least* three months before we’ll even consider writing you a cheque. If you don’t have a permanent address, you get a hotel room, not a cheque, and food stamps.
The disability system is a little different, but you still have a once a year review to say ‘yup, still disabled.’ and show what work you’ve been doing or trying to do in the mean time.
M578Jockey reply on September 18th, 2009 6:29 am:
I am all for limiting the kids while on welfare and certainly support limiting the time you can spend on it. However there needs to be some flexibility. When I was in school I knew a woman who’s husband left her with four young children. She went back to school to study accounting. She had a 95+ average, but had to quit school after two years because they cut her welfare off. Another person I knew had two kids, wasn’t an american citizen, and, last I knew had been collecting welfare for about 10 years and was reaaly PO’d because the state told her she had to start working 15 hours a week. I think we need a set of Federal rules to run healthcare and services, but I think the government is TOTALLY unqualified to do it. The problem is that the government needs to be reformed, and the only people who can reform the government is …the government. The perfect Catch 22.
The only solution is to find a small island in the
South Pacific and lay on the beach the rest of my life.
Captcha: Tuesday & Sunday Marxists. Capitalists the rest of the week???
September 17th, 2009 at 1:34 pm
Healthcare right now is a business where profits matter more than people. But if you remove the profit motive you wind up with something like the post office. Long lines, poor service, but they do provide a basic service at a minimum of price. And as of yet the “socialist” goverment run post offices havent put the “capitalist” private companies like UPS or FedEx out of business.
I think the middle ground can be found by taking all healthcare related companies off the stock market.
Investors are the people that are demanding that a company have higher profits this quarter than the last one every time. Most right minded people would say that if a company makes a 100 million dollar profit in Q1 but only a 90 million dollar profit in Q2 that they are still doing fine. However the investor sees this as a bad thing driving companies into searching for an exponential climb in profits any way they can including at the expense of you, me, and everyone elses well being. Any company that is traded publicly has one focus, stock price. All the other focuses are in support of that.
So if your company does its business in healthcare (insurance, drugs, hospitals) then they must use at least half of their profits in each quarter to buy back stock, slowly removing them from the trading market.
I know this sounds like big government intervention. However it lets these companies stay private but at reasonable levels. And if the free market had anything resembling a moral compass left it wouldnt be necessary. Im not a stock market guru so if anyone has any ways to improve this idea let me know.
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September 17th, 2009 at 2:02 pm
Ok, I actually do work in an ER, here are my thoughts…
1. Co-ops, when properly run, work very well. Alot of the people around here us Group Health co-op and I have never heard any of them complain about their coverage.
2. I think that an ER should have the right to tell you that you don’t need to be seen for your hangnail/cold. Easily a quarter of the people that we see could be seen by their regular provider, or even just take a couple Motrin and sleep it off. Same goes for drunks.
3. If you are receiving state aid (welfare, food stamps, section 8) you don’t need to be popping out more babies! Either keep your damn legs closed or get on reliable birth control.
4. If you are receiving state aid you should be drug tested, frequently. If you can afford drugs, you can afford to buy your own shit.
5. I am in favor of what “mn” said about having a state run “minimal coverage” plan, and then if you want better coverage then go ahead. Minimal coverage should include pediatric care, pre-natal care and birth control at least. Also, if you are on that plan you have an assigned doctor and hospital, there are way too many “doctor shoppers” and people that bounce around to various ER’s trying to get narcotics.
6. We need to use more PA’s and ARNP’s. They are cheaper than MD’s and provide wonderful care. I get all my gyno stuff done by a Nurse Practitioner and she is AMAZING. and I’d trust alot of the PA’s I work with more than I would trust some of the MD’s
7. However, we also clearly need more Family Doctor’s in this country. Maybe the government should start offering incentives to those planning on going into primary care or pediatrics.
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Tim Covington reply on September 17th, 2009 7:11 pm:
I agree with everything you have said. One of the problems medicare is currently having is doctor’s not accepting it. This is due to cut’s in the rates.
As far as more primary care physicians, why would a medical student want to become one. After investing years (and putting themselves in debt up to their eyeballs), they can make ~$500/hour as a specialist, or ~$40 an hour as a PCP. Unless a person has a true calling to be a PCP, they will choose to be a specialist. (They were actually discussing this on NPR today).
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Minty reply on September 17th, 2009 10:45 pm:
Another thing about Family/General/Primary Care/Internal Medicine Practitioners–a lot of patients use them as gateways to specialists, because their insurance carriers require them to get physician referrals. The (unfair) opinion is that F/G/IM/PCPs don’t know what they’re doing, which disheartens the physicians. They got into it to practice medicine, not be regarded as the human equivalent of “Find-A-Physician.”
As for pediatricians, I hadn’t heard that their numbers were on the decline. If anything, PEDs have something of the opposite problem–aside from rheumatologists and oncologists, for serious medical cases, PEDs have a hard time finding specialists willing to treat children. But, this may have changed. It’s been a few years since I listened to PEDs bitch about their colleagues.
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Kat reply on September 18th, 2009 8:04 am:
Last time my daughter was sick we had two options. Wait three days for an appointment with her pediatrician. See another pediatrician in the same group later that day or go to an urgent care clinic. If I want to schedule a physical for her it’s usually two weeks out, if not more.
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Minty reply on September 18th, 2009 9:13 am:
Difficulty getting appointments has more to do with malpractice than lack of doctors. Malpractice insurance rates are so high doctors have to cram as many patients in each day as they possibly can, and until we become a less litigious society, availability will continue to remain a problem.
M578Jockey reply on September 18th, 2009 11:06 am:
My brother’s idiot ex-father in law (we’ll call him Biff) has been sick with a couple of kind of cancer and God knows what else for about four years. Recently he was told he had to go on dialysis. He went to a doctor about the dialysis and while giving his history, he told the doctor he had blacked out a couple of times while driving. Well given his history the doctor said he should he shouldn’t be driving anymore. Biff starts yelling and screaming and raising nine kinds of hell so he had to be escorted out of the office and then procede to file a malpractice suit. Obviously it will be thrown out, but there it is on the doctor’s record and on his insurance. And nothing will happen to Biff except he will have to pay his lawyer. If I had my way, Biff would be heavily fined for bringing a frivalous lawsuit, his lawyer would be reprimanded, and none of this would ever show up on the doctor’s record.
Ahh to life in such a Utopia…
September 17th, 2009 at 9:33 pm
ok I keep hearing, greed bad, profit bad, free enterprise bad…We have government run healthcare in this country, its called medicaid, Medicare for our senior citizens. We need to stop playing captain save a ho quit trying to solve everyones problems and create a modern utopia; following BHO off the cliff like a bunch of lemmings and lets get back to our roots of free enterprise and capitalism. If your employer doesnt offer benefits, get a job where they do. or buy your own. If you want a glimpse of what free medicine loos like, take a look at the VA.
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Minty reply on September 17th, 2009 10:56 pm:
1) True free enterprise, like we had at the turn of the 20th Century, was such a disaster for the consumer that it lead directly to Federal anti-monopoly laws. The consumer only dictates price when there are multiple providers to choose from. One provider for everyone means the provider dictates the price.
2) Government healthcare is not, nor never has been, “free.” What’s being discussed is a public option–meaning it’s paid for by the taxpayers (which is everyone, regardless of employment. If you buy something with tax, a portion of that goes to a government). So, a healthcare plan for the people, paid for by the people.
3) VA health coverage is not free. The only people who qualify for it are veterans and their families. Not only do these people pay for it through their taxes, but they have paid for it in blood, sweat and tears. The reason it’s as screwed up has to do with the insane prices the pharmaceutical manufacturers charge the American public, because the rest of the world has laws in place governing the cost of medicine. In other words, US Citizens pay through the nose because everyone else said “hell no, we are not paying $200 for something that cost you $5 to make.”
4) Fun fact: lemmings do not commit mass suicide.
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Kat reply on September 18th, 2009 8:00 am:
How about this, my best friend works for a major, national chain store (Lowe’s), she works 38 hours a week, not 40, if she works 40 hours, she gets written up. Why? because if she’s full time, they have to start insuring her. Just because you work at a company that has insurance, doesn’t mean you get it. I got very lucky working at the hospital. I am able to work part time and still have myself covered, however, if I wanted to cover my daughter I would have to pay extra. Thank god for Tricare.
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September 17th, 2009 at 9:54 pm
Greed an capitalism aren’t bad. But I don’t see why they get to trump human life.
Second, if you happen to be born with a birth defect, or other genetic condition insurance companies won’t cover you. If you get sick, then you either die, or go into debt. Hell if your wife is pregnant, and your company goes out of business, you lose your insurance. And unless you can find another group plan to take you in very soon, no insurance provider will take you.
Third, the VA is way better than not getting treatment at all.
Fourth, “Just get a job that has insurance or buy some” Not every person qualifies for those jobs, and there aren’t really enough of those jobs to go around. And if you have a pre-existing condition they won’t cover you even if you can afford it.
Dude, did you even fucking read any of the comments here? A whole laundry lists of issues with the current health care system and your solution is to pretend that they don’t exist?
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September 18th, 2009 at 8:11 am
Oh yeah, also, our disability system is fucked all to hell. My uncle, who has brain cancer and is on so much anti-seizure medication I’m surprised he can even function at all, had to fight tooth and nail to get disability. He can’t drive or live by himself and his short term memory is so poor that he sometimes forgets to eat. And the disability office was trying to say that he could work. I see people come in here every day who are on “disability” because they are so damn fat that they can’t walk! That is not a disability! Get your ass a job answering phones! And also, don’t park in the disabled spots right in front of the damn supermarket when you go inside to get your gallons of ice cream and jumbo bags of chips. Park in the back and walk your fat ass to the store!
~end rant~
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September 18th, 2009 at 3:49 pm
A lot of good ideas here. Truthful I don’t agree with a lot of them, but doesn’t make them bad, just may mean I’m a dumb ass… it’s happened before. ;)
I feel the government has less incentive to be efficient the most businesses. When a business runs out of money it closes it’s doors, when the government runs out of money, it raises taxes. Well, unless your business is unionized, but that’s a different topic, yeah GM/Chrysler, I’m looking at you.
What about expanding the Medical Savings Account (MSA) system?
What if, instead of your employer giving you two or three choices of insurance (or only one choice in some case) and then paying an unknown amount towards that choice, they instead put that amount in the MSA and then you add what you feel you want? Let this amount roll over year to year. Let you shop for your insurance like you do for car or home insurance and pay for it out of the MSA? Or if you choice not to get any at all, well that’s on you to pay for then.
Maybe we do need a “minimum” coverage system, but it REALLY needs to be “minimum”, it should cover major life treating issues (Cancer comes to mind) and that’s it. And let me shop for it.
My other gripe is billing. My wife and I just had our daughter 6 weeks ago. Those of you parents out there know how many bills I received… a lot! Why? I got one for the hospital, one from the lab, one for the OBGYN and one from the anesthesiologist (took me 10 mins to find that spelling). All the work was done at the Hospital, why not a single point of billing? Even with out MSA we couldn’t pay all of it right away (It did help a lot though), so we setup payment arrangements, four of them, that I know of, maybe more, I don’t get to run the checkbook in my house. ;)
Any way, that’s my two cents… feel free to tell me how I’m wrong.
BTW: Having the government compete with Private Health Insurance I feel is a non starter. There are a list of reasons why I think that is actually a worse way then a single payer. I just don’t have time at this point to get into it. If I have time have cuddling with my daughter tonight, I’ll add more.
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Janice reply on September 18th, 2009 4:22 pm:
Expanding MSA could be a good one. Having used something like this with employers, I can say its not enough and doesn’t supplement insurance at all. But it can be a help. Well, as you saw with the birth of your daughter (congrats!).
I don’t really agree with the government vs. corporate analogy there. Your reason for why corporate is better than government just killed your own argument for me: corps just go out of business. So while the government could go on giving the needed services, the business would just shut down leaving hundreds of thousands or millions without health care with an “oops, our bad”.
With corporations, there is a strong chance that could happen too. Corporations are remarkably inefficient. The bigger, the worse. And when they have money problems they lay off employees, close branches, and cut back services. Sometimes, to stay open, they stop paying everyone they owe money to in order to stay in business. They can just declare bankruptcy constantly. (How many times has Donald Trump’s corp declared bankruptcy and then bought back his business for pennies on the dollar?)
As for the minimum coverage for only life threatening issues…I think that wouldn’t be enough. We would need to expand the definition a bit and include quality of life too.
As an example, I have Hashimoto’s thryoiditis, a form of hypothyroidism. I had to get this treated with my own money at first, since I had no insurance back then. While it was not life threatening from the usual standpoint, it was severely damaging my quality of life. At its worst, I was exhausted 24/7. All I could do was sleep. Under the “life threatening only” scenario, if I had not been able to get it treated (and I’m sure there are many that can’t) I would have ended up staying at home sleeping all the time while people stood around and called me lazy. (And there were some who thought I was just lazy or at best, depressed.) The results of taking Synthroid the fist week were night and day. My life is far better now and I take my meds religiously. That problem with lack of energy is gone as long as I have my meds. Meanwhile, I bet there could be others who need it and can’t afford it who are called lazy by everyone else.
We as a society do far better by having those that need medications working rather than not working.
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September 21st, 2009 at 2:42 pm
I’ll preface my comments with this caveat: I am a doctor.
The problem that I have with what passes for “health care” in this country is that it is neither healthy, nor caring, and is more appropriately termed “incident intervention”. It does not seek to promote health or prevent disease as much as it seeks to respond with great concern to incidents of graphic drama.
Instead of “Health Care”, we have the “Ambulance down in the valley”.
‘Twas a dangerous cliff, as they freely confessed,
Though to walk near its crest was so pleasant;
But over its terrible edge there had slipped
A duke and full many a peasant.
So the people said something would have to be done,
But their projects did not at all tally;
Some said, “Put a fence ’round the edge of the cliff,”
Some, “An ambulance down in the valley.”
But the cry for the ambulance carried the day,
For it spread through the neighboring city;
A fence may be useful or not, it is true,
But each heart became full of pity
For those who slipped over the dangerous cliff;
And the dwellers in highway and alley
Gave pounds and gave pence, not to put up a fence,
But an ambulance down in the valley.
“For the cliff is all right, if you’re careful,” they said,
“And, if folks even slip and are dropping,
It isn’t the slipping that hurts them so much
As the shock down below when they’re stopping.”
So day after day, as these mishaps occurred,
Quick forth would those rescuers sally
To pick up the victims who fell off the cliff,
With their ambulance down in the valley.
Then an old sage remarked: “It’s a marvel to me
That people give far more attention
To repairing results than to stopping the cause,
When they’d much better aim at prevention.
Let us stop at its source all this mischief,” cried he,
“Come, neighbors and friends, let us rally;
If the cliff we will fence, we might almost dispense
With the ambulance down in the valley.”
“Oh he’s a fanatic,” the others rejoined,
“Dispense with the ambulance? Never!
He’d dispense with all charities, too, if he could;
No! No! We’ll support them forever.
Aren’t we picking up folks just as fast as they fall?
And shall this man dictate to us? Shall he?
Why should people of sense stop to put up a fence,
While the ambulance works in the valley?”
But the sensible few, who are practical too,
Will not bear with such nonsense much longer;
They believe that prevention is better than cure,
And their party will soon be the stronger.
Encourage them then, with your purse, voice, and pen,
And while other philanthropists dally,
They will scorn all pretense, and put up a stout fence
On the cliff that hangs over the valley.
Better guide well the young than reclaim them when old,
For the voice of true wisdom is calling.
“To rescue the fallen is good, but ’tis best
To prevent other people from falling.”
Better close up the source of temptation and crime
Than deliver from dungeon or galley;
Better put a strong fence ’round the top of the cliff
Than an ambulance down in the valley.
— Joseph Malins (1895)
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Sequoia reply on September 21st, 2009 6:02 pm:
Let me get this straight, you, as a doctor, believe that the goal of health care reform should be to make the necessity for hospital visits less likely?
I know this is worded poorly, I apologize. Tis a bit late for my required 6:00 mornings.
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David reply on September 22nd, 2009 9:08 am:
In a nutshell, thats right.
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September 28th, 2009 at 5:15 am
Just got back into town.
Whether or not you want govt to run health care, for the federal govt to take charge, they would have to do thru an amendment to the Constitution because any other way would violate the 10th Amendment, and a violation could be considered if you squint your eyes and look sideways a bit. If it does pass congress and the Prez signs, the Supremes could kick it out as unconstitutional and reserved to the states.
I had socialized medicine in the army and in Holland – I lived there for a time. Good points and bad. Everyone is covered, but if there is high traffic, you could have a bit of a wait. If the equipment is down, tough luck. Broke a finger in Holland and 3 weeks later the xray machine was finally repaired. Problem was my finger had not been set correctly due to no xrays, so I have an extra large knuckle that has chronic pain, limited mobility, etc.
If you get a bad doc, sucks to be you. My little sis took her baby to the hospital when he had complications from chicken pox. Waited one full day to be seen and was told to come back the next day. On the 2nd day doc refused to see the baby – he was crying and screaming in pain – and wrote on the record that the patient was uncooperative. She was able to go to a civilian doc and the kid was treated.
At this point congress is being disengenious with their refusal to post the bill in its entirety online, refusing to consider riders and amendments to it that would deny illegals treatment – they still would be treated as emergency rooms as they are today – or the amendment to not cover abortion, while saying that they won’t allow illegals to be treated and that abortions wont be covered. Side note, I don’t advocate refusing medical treatment for anyone, I am just showing 2 points where congress is speaking out of both sides of their collective mouths.
A few points to consider: do you want the people that run the IRS, the USPS and FEMA to be in charge of your health care? Scares the crap out of me.
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Speed reply on September 28th, 2009 5:17 am:
oops – 1st paragraph correction: also a violation of the 9th Amendment if you squint your eyes etc
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