patrick.net

This doesn't take into account the companies that are competing to find the next piece of equipment that will save lives. Big $ there. But I do agree that healthcare shouldn't be a commodity.

I am a physician in Northern California. The internet has changed some of what Galbraith mentioned. A market for healthcare can and does exist for elective procedures, which are the overwhelming majority of procedures. All one has to do these days is type your diagnosis into Google and you have everything you need to know to make a choice. The diagnosis could be "ACL tear" or "gallstones" or you name it.

The motivated patient will often come to the physician having worked out a plan of treatment in advance. Similar to how I can shop around when I get my car worked on, even though I don't know anything about timing belts or brake pads, I can get a few opinions, read online, and then make a decision. Healthcare, in principal should be no different. Automobiles are complex, often you need them fixed immediately, often there may be some barrier to seeking another opinion, and yet a market exists.

I hate to agree with George Bush on this one, but when he said the problem is that someone else is paying, he hit the nail on the head. I see people every day that don't value something because they didn't pay for it.

Here's a recipe for fixing our system:
There should be regulations making it illegal to turn away anyone on the basis of "pre-existing conditions". Physicians should be required by law to accept uninsured patients up to a certain percentage of their practice (perhaps 15%), and all physicians should be required to take ER call when appropriate and maintain hospital privileges. Ownership of surgicenters should be allowed as long as physicians maintain surgical privileges and cover ER call somewhere.

Insurance companies should not be allowed to negotiate with physician groups to offer lower payments for members only. This has created a system where the uninsured individual cannot get the same rate as the insurance company. The deck is stacked against the uninsured. The doctor's fee should be the same for everyone, whether insured or not.

Medical savings plans should be allowed, and people should be encouraged to have high deductibles and reasonable copayments, to prevent abuse of the system. When a significant portion of the payment is paid by the person getting the service, a market exists and the doctor will be accountable to the patient, not to the insurance companies. Doctors should be working for patients, not insurance companies. Ever wonder why you don't get "satisfaction guaranteed or your money back" at the doctor's office? Because it's not your money! The doctor spends a huge amount of resources jumping through hoops for the insurance company. Wouldn't you rather have your doctor jump through hoops for you?

The medicare clause that says only patients older than 65 and those will end stage renal disease are eligible is ridiculous and should be reformed. That clause should be phased out or coverage for other people with chronic illness should be phased in. This has created a huge market for renal transplants and dialysis centers at the expense of everyone else... from children who need vaccines to AIDs patients, cancer patients, and anyone else with a chronic disease. Transplant centers are profit driven and have way too much power in hospitals.

oh yes, the public sector has done such a marvelous job at containing health insurance premiums.

does this guy live in solitary confinement?

davidwrunyanjr says

oh yes, the public sector has done such a marvelous job at containing health insurance premiums.

In which country? Private insurance costs in the U.S. are growing faster than Medicare costs, and much faster than the costs of the plans of most other countries.

That said, the original post is spot on, and sums up my basic issue with the american system in general. The 'free market' only applies to insurers, which is no free market at all.

Lucky me, I get to choose between the guy who screws me a little or the guy who screws me a lot. Innovative!

How can this guy say that a market in health care could not exist. That is so obviously wrong. For example, how much medical care would you want if you had to pay for it yourself, clearly much less than if someone else is paying the bill. Those are your market forces right there.

Sad to see you reading such a shitty book.

Healthcare is in the same boat as the housing collapse. The push to nationalize healthcare and the widespread support from doctors and pill factories is an all out effort to artifically keep prices high and avoid market corrections. Washington knows the medical industry is going to be soon swamped with aging babyboomers that will devastate the insurance industry and add to the mix the unemployeed not paying premiums it adds up to huge loses for the industry. My father, (deceased) became a doctor in the 1930's before there was insurance. He did it out of compassion and generally made the same as the guy working in a factory. Many times he said insurance ruined the profession. Before insurance the cost of treatment was market driven and based on what people could afford. After insurance (someone else paying) the cost has skyrocketed. Why shouldn't it, people paying a small premium can careless how much it cost as long as their premium stays the same. Most people never argue what the doctor or hospital charges but they sure will raise hell when the insurance premium goes up. The point is the doctors are going with nationalizing so they can get a guarantee income instead of ever lowering what they make or beholden to the uncertainty of what people can pay. My dad always said before he recently died: Doctors rationalize their huge salary saying it pays them back for all their expensive education. BS, if that was true then why doesn't an engineer or anyone else in college do the same? They can't because their salary isn't being paid by a huge collective insurance scheme. The truth is with government education grants, scholarships and tuition reducing work programs this argument doesn't fly.
The best solution is no insurance and no government intervention at all (I know that'll never happen) but the point is doctors, hospitals and pill makers would NOT be able to artifically keep prices high so no one can afford them, either, it be insurance premiums or taxes for national healthcare. Like the housing collapse they are trying to keep prices high so the doctors can keep making a relatively high salary and hospital CEO's can keep making huge profits, salaries and bonuses. No matter which way it goes we simply cannot afford it anymore - will we ever learn that we all bankrupted the country?

athomas,
a minority of doctors want national health care. Most doctors want the bubble world of private insurance to continue. The doctors that want a one-payer system acknowledge that their paycheck will suffer but realize that the present situation is unsustainable.
Unfortunately for Obama and Congress, healthcare costs will not be solved painlessly by "efficiency".
The work of many hard working people in health-related fields is over-compensated or unnecessary. It'll be tough to make them realize the truth.

I'm a social worker with 20 years of experience - I make less than a newly graduated R.N. CNA's, who do the majority of the physical work, make about $10 - $12/hr to start. While there certainly are overpaid people, part of the problem are the regs that mandate supplies be ordered at a huge amount from medical providers. The rules of patient care are totally out of whack.

My friend is an MD with her own practice. By the time she pays office rent, employees, insurances, student loans, misc costs, she clears about $200k. Yes, that's great. But certainly not wealthy. She could make more if she saw less patients, signed up with an HMO, etc but she chooses not to. The people that I see as overpaid are the insurance execs, hospital execs, etc.

Many docs are in the profession because they want to be, and because it's what they're supposed to be. They spend huge amounts of money to become an MD, and - yes, they do reap financial rewards - but they're often on call 24/7. For about 10 years, I was in an on-call position and even tho you're often compensated a couple of dollars an hour (or not, if you're salaried) the phone calls all night long and having to leave at a moment's notice aren't worth it in the long run.

I agree that there is not a market place for health care. My husband suffered of kidney stones few months ago. After going thru lithropsy (shock waves to brake the stones) he suffered from renal colic and it was awful. We had to run to the ER(we had not time to choose which hospital or doctors) because after 2 days the pain was still unbearable could not eat or drink any thing. At the hospital he was hydrated and given morphine for pain. It was also put through an unnecessary CAT scan. Hydration and morphine + the cat scan cost $7000!!! The doctor which talked to my husband for a minute was paid $1000. I am a European and I found the all thing crazy. The doctor should be paid a salary, a good salary, if we want to maintain costs. And we would need negotiations for drugs. Being a doctor in Europe is still prestigious but one receives a salary so there is no incentive in giving unnecessary treatment. And most of the time one becomes a doctor to cure and not to become rich. It is true that if there was no insurance the cost would go down. But it is also true that certain medical care is very expensive and very few of us could afford it. That would mean those that are lucky either rich or healthy would live good lives and those that are ill and cannot afford medical treatment are destined to suffer and die from curable illnesses. This is immoral. We should all contribute to a national universal plan to pay for those that are less lucky! Americans do not have any idea of what a relief of stress would be to have a national universal health system! I am sure it won't be perfect because nothing is but it would be better of what we have now.

moke says

How can this guy say that a market in health care could not exist. That is so obviously wrong. For example, how much medical care would you want if you had to pay for it yourself, clearly much less than if someone else is paying the bill. Those are your market forces right there.

He's saying that how much care you "want" has little to do with it. You go to the doctor when you need to. There's not a lot of choice there. You pay what they tell you. There's not a lot of choice there either. Those conditions make a "market" in health care ripe for abuse, meaning high prices, and a false choice between a small number of very similar insurers that provide no public benefit at all, only private profit from a captive customer base.

I think we would indeed all be better off with a government insurer. That's not the same as government health care.

My wife is an ob/gyn physician now practicing in New Zealand who would never return to practice in the states again even though the money would be over double and the cost of living much cheaper. Here are some observations from outside the system.

Yes people used to pay for doctors out of pocket. But the life expectancy at the time was something like 55 vs 75 now. Anyone who wants to can certainly return to those utopian days. Just please die quietly when something comes up you cannot afford. Which would be just about every medical advance since 1930. You want those extra 20 years provided by modern medical care then you must pay the cost of modern medical care.

Some doctors are money orientated some aren't. Here's a good article that address the issue http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?yrail

Engineers don't rack up an additional 4 years of medical school at 50k a year after graduating college then another 4 years of residency with 100+ hour work weeks for far below minimum wage while the interest is accumulating on student loans. Not to mention starting your savings for retirement at age 30 instead of age 22. We have physician friends back in the states who will literally pay their last student loan payment with their first social security check.

Doctors don't set prices. Doctors get paid whatever insurance companies decide they will pay for the service.

The average cost of health care per capita in the US is almost double cost per capita for the rest of the industrialized nations. Yet by almost any measure there are no better results. In areas like infant mortality the US is almost in third world range. The system is clearly very badly broken.

Here in NZ doctors are hired by the health district and just see the patients. A doctors office staff consists of a receptionist and a nurse. No billing staff, office manager, accounts receivable person, insurance coders, accounting person, etc., etc.. The average doctor here has less than one third the number of people on staff compared to the states. Who do you think pays for the two thirds of the staff doing medical billing and office management in the states? Santa Claus? Then of course there is the cost on the insurance company side, like lobbying, executive compensation, collecting premiums, paying out claims, profits for investors, marketing, etc.. Not one cent of those dollars goes to actual patient care. Someone remind me again how exactly is it that competition is going to make this all cheaper?

I find no or very little difference in the actual care here. Life expectancy is actually higher. I am of an age where I use health care regularly so I'm not going by anecdotal. I have also used the Canadian and French health care systems. I did not see the horror stories that everyone seems to be able to dredge up about other countries health care. Everything here is done on a strict cost benefit basis. You won't get the latest greatest drug or procedure unless there is some clear benefit. You won't get a hip replacement if you are 90 years old with terminal cancer and 3 months to live. People here don't expect or desire huge amounts of intervention if they are clearly dying. Most would prefer to die at home with family if possible rather than eke out another couple of months in a hospital.

Ditto on the on call thing. Getting called out at midnight and getting home at 6 for a quick breakfast with the family then go to work on a regular basis gets old really fast.

My wife is an ob/gyn physician now practicing in New Zealand who would never return to practice in the states again even though the money would be over double and the cost of living much cheaper. Here are some observations from outside the system.

Yes people used to pay for doctors out of pocket. But the life expectancy at the time was something like 55 vs 75 now. Anyone who wants to can certainly return to those utopian days. Just please die quietly when something comes up you cannot afford. Which would be just about every medical advance since 1930. You want those extra 20 years provided by modern medical care then you must pay the cost of modern medical care.

Some doctors are money orientated some aren't. Here's a good article that address the issue http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?yrail

Engineers don't rack up an additional 4 years of medical school at 50k a year after graduating college then another 4 years of residency with 100+ hour work weeks for far below minimum wage while the interest is accumulating on student loans. Not to mention starting your savings for retirement at age 30 instead of age 22. We have physician friends back in the states who will literally pay their last student loan payment with their first social security check.

Doctors don't set prices. Doctors get paid whatever insurance companies decide they will pay for the service.

The average cost of health care per capita in the US is almost double cost per capita for the rest of the industrialized nations. Yet by almost any measure there are no better results. In areas like infant mortality the US is almost in third world range. The system is clearly very badly broken.

Here in NZ doctors are hired by the health district and just see the patients. A doctors office staff consists of a receptionist and a nurse. No billing staff, office manager, accounts receivable person, insurance coders, accounting person, etc., etc.. The average doctor here has less than one third the number of people on staff compared to the states. Who do you think pays for the two thirds of the staff doing medical billing and office management in the states? Santa Claus? Then of course there is the cost on the insurance company side, like lobbying, executive compensation, collecting premiums, paying out claims, profits for investors, marketing, etc.. Not one cent of those dollars goes to actual patient care. Someone remind me again how exactly is it that competition is going to make this all cheaper?

I find no or very little difference in the actual care here. Life expectancy is actually higher. I am of an age where I use health care regularly so I'm not going by anecdotal. I have also used the Canadian and French health care systems. I did not see the horror stories that everyone seems to be able to dredge up about other countries health care. Everything here is done on a strict cost benefit basis. You won't get the latest greatest drug or procedure unless there is some clear benefit. You won't get a hip replacement if you are 90 years old with terminal cancer and 3 months to live. People here don't expect or desire huge amounts of intervention if they are clearly dying. Most would prefer to die at home with family if possible rather than eke out another couple of months in a hospital.

Ditto on the on call thing. Getting called out at midnight and getting home at 6 for a quick breakfast with the family then go to work on a regular basis gets old really fast.

The real issue which is almost literally unknown is that 80-90% of healthcare costs are used in the last year of a persons life.
What we will have to get real about is what constitutes a dignified way to die. Having endless surgery in the last year of your life is a miserable way to go but that is the choice almost everyone (or their family) makes.

m1ckey6 says

The real issue which is almost literally unknown is that 80-90% of healthcare costs are used in the last year of a persons life.

What we will have to get real about is what constitutes a dignified way to die. Having endless surgery in the last year of your life is a miserable way to go but that is the choice almost everyone (or their family) makes.

Yes, that seems to be true. My parents both died last year, and the preceding 12 months for each of them were certainly filled with expensive medical costs, including a helicopter airlift for my dad, and brain surgery for my mom. Must have cost Medicare quite a lot.

Thank you bob23. You've covered the issue well. My guess is that there aren't any health providers in NZ making 124 million a year like United Healthcare's CEO did by depriving patients of healthcare either.

BTW, Patrick, that book was a real eye-opener for me.

While it is clear from escalating costs alone that our private insurance health care system is failing, I find it hard to believe that turning it over to government is a workable solution to the problem.

Our government has been the sole "manager" of many large systems deemed too important to fail and yet, arguably, some of the worst in the civilized world.

We have a postal system that cannot provide tracking for simple packages and is getting torn apart by private competition, despite ongoing subsidies.

We have a passenger train service that cannot run on time, nor compete with air, bus or car despite massive subsidies.

We have now subsidized the building of the lowest quality cars in the world

We have monopolized power distribution through regulation resulting in rolling blackouts in high usage markets (I'm in CA) despite 5% annual increases in costs.

We have monopolized water distribution resulting in notices like last year's from EBMUD claiming that allocations would be reduced by 10%, with non-compliance punishable through massive surcharges. And because we're reducing consumption by 10% we get a 10% price hike. WTF?

We have taken a free republic democracy and turned it into a corrupt special interest oligarchy where our so-called representatives often vote directly against the will of the people.

And you want to put this government in charge of life-critical decisions such as whether or not to pay for your cancer treatment?

Sure, they'll lower costs by fiat. But they'll raise taxes to pay for it too. And then they'll run inefficiently and have to start cutting services. Cutting services that directly affect taxpayers and voters is a favorite ploy of politicians because it causes voters to turn out in favor of the "necessary" tax hikes. Put health care in their arsenal and we're headed back for a 90% marginal tax or worse.

No thanks. I'd rather take my chances with a PPO, I prefer to be able to demand an MRI when my own research tells me it is necessary. And if the costs get high enough, which they are, the free market will provide a cheaper solution, provided we can get the government out of the way.

We have a passenger train service that cannot run on time, nor compete with air, bus or car despite massive subsidies.

Train works well in Europe though. How come we can't do that? I suspect political interests (cars, trucking, airlines) block effective train usage in the US.

We have monopolized power distribution through regulation resulting in rolling blackouts in high usage markets (I’m in CA) despite 5% annual increases in costs.

Actually, it was DE-regulation that did that. Re-regulation fixed that particular problem.

We have taken a free republic democracy and turned it into a corrupt special interest oligarchy where our so-called representatives often vote directly against the will of the people.

Why don't we try direct democracy? At least we should be able to override our Rep or Senator representation of us via a website, so Congressional votes per member would be not be aye or nay, but 0.998 and 0.002 etc. Then it would all reflect the will of the people better.

Sure, they’ll lower costs by fiat. But they’ll raise taxes to pay for it too.

But your insurance premiums will go away, hopefully evening it out.

And you want to put this government in charge of life-critical decisions such as whether or not to pay for your cancer treatment?

Right now, we have a hostile bureaucracy making your cancer treatment decision. If they find a way to deny your coverage, they win! I argue the current deny-coverage-if-possible private insurer system sucks worse than a government insurer. At least the government wouldn't have a private profit motive to hasten your death like insurance companies currently do.

m1ckey6 says

The real issue which is almost literally unknown is that 80-90% of healthcare costs are used in the last year of a persons life.
What we will have to get real about is what constitutes a dignified way to die. Having endless surgery in the last year of your life is a miserable way to go but that is the choice almost everyone (or their family) makes

My family is living through that scenario right now. My husband's father is 88 (will be 89 in September). He has advanced dementia, neuropathy and leg pain so badly he cannot walk, his knees don't work, he's incontinent, had a pulmonary embolism a couple of years ago that left him with blood clots that require strict medication management (warfarin). That's just for starters. He was diagnosed with pneumonia 4 weeks ago. Instead of letting him pass with the help of morphine, he was put on intravenous antibiotics (3 different types) was subjected to numerous xrays and scans, and spent 3-1/2 weeks in the hospital. He developed congestive heart failure. He was released to skilled nursing last week (where he is miserable; cries all the time, is profoundly confused,etc.). As of this morning he is back in the hospital because his blood oxygen is a bit low. He has a DO NOT RESUCITATE order, but that only applies if his heart stops beating. This is incredibly painful for everyone. We all wonder why the doctors won't just let the man die in peace. I can only imagine how much $ this will cost Medicare. And why? He's 88 and he's dying - it a natural process. I think that in order for any meaningful change to occur in the way health care is provided here in the US, we need to think more deeply about care at the end of life. What is actually appropriate? What is not? I know it's an area filled with legal landmines, moral/ethical issues and the rest, but I feel it must be addressed honestly by us as a country.

Patrick - Galbraith is a hard core Keynesian! Believes in government fiat spending into prosperity for our safety net and nanny state. The artificial prosperity of fiat money will come to a horrific end.

Others - be careful on what you wish for in government health care. You will see rationing, long delays, higher taxes and slavery.

Somebody on this thread quoted some stats on how we fare poorly vs other nations. Remember that a lot of these stats are bogus and not apple for apple.

We are all dead in the long run. Should we go bankrupt just to gain less than 2% of your remaining life? Thankfully Christians have eternal life with God.

Health care should not be view as a right. When it becomes a "free" right you end up stealing from Paul to pay Peter.

A large part of the problem is the corrupt American Medical Ass. They have monopoly control and require stringent licensing and certifications which drives up costs. They control the medical schools and hospitals. FDA is another corrupt institution serving big Pharma.

For starters read Tom Sowell
http://www.news-record.com/content/2009/01/09/article/thomas_sowell_health_care_myths

And Austrian economics.

What is it about life expectancy that is not apple to apple pray tell? America ranks down with Bosnia and Albania. Infant mortality is another stat that is pretty foolproof to calculate. America ranks just behind Cuba and depending on whose chart you look at just ahead of the Faroe islands or Croatia.

Not much bang for twice the bucks.

The people throwing out hyperbole like "slavery" or "rationing" are very careful to avoid noting that in the other industrialized countries the public health system provides a basic level of care. You are free to purchase private insurance and see private physicians if you please. This isn't exactly slavery. Private insurance is not very expensive because most people use the public system for the bulk of their health care and use the private system for elective care. No one is in slavery or forced to do anything if they choose not to. I'm not sure how being a slave to health insurance companies in America is any better. Harvard did a study in 2001 that found half of all bankruptcies are precipitated by medical bills and really surprising was that most of these people had health insurance.

In America:
The association of medical colleges accredits medical schools not the ama. They are not related.
The Accreditation Council for Graduate Medical Education (ACGME) accredits residencies not the ama. They are not related.
Us Medical Licensing Examination association is the examining body that administers the 3 step usmle exams for physician licesnsing and is sponsored by the Federation of State Medical Boards not the ama. They are not related.
Physicians are licensed by the individual state medical boards not the ama. They are not related.
Physicians are board certified by their individual specialty boards after several years in practice and additional testing not the ama. They are not related.

Not much monopoly control that I can see. I for one am really glad the guy cutting a hole in my chest has had stringent licensing and certification.

<a href="/post/16446#comment-647572" rel="nofollow">stmfreak says</a>
<blockquote>
We have a postal system that cannot provide tracking for simple packages and is getting torn apart by private competition, despite ongoing subsidies.
</blockquote>
Huh? The US Postal Service delivers mail on a scale that is massively larger than any of the private package carriers, and does so with a nearly 100% success rate. They certainly have problems, but are one of the best run organizations in the history of the United States.
<blockquote>
We have a passenger train service that cannot run on time, nor compete with air, bus or car despite massive subsidies.
</blockquote>
Cars, Busses, And Airplane travel ARE subsidized, very heavily, and always have been. They are more highly subsidized than rail travel, which is why rail travel is in such bad shape. Rail is by far the most efficient means of transportation available, and when funded properly is much, much cheaper than any of the alternatives you listed. Rail, for some reason, has always been held to a higher standard of self sufficiency than air, bus, or car travel. NONE of them can ever be done well without public subsidy.
<blockquote>
We have now subsidized the building of the lowest quality cars in the world
</blockquote>

Cadillac was just named the #3 quality car in the world, with its rating being nearly the same as #2.
Just thought I'd inform you a bit. I think someone else addressed some of your other incorrect ideas.

My wife is on medicare and I have seen how doctors milk every dollar they can by giving her test after test. Most all of this is paid by medicare. While I'm no doctor I'm also no dummy and it's clear much of what they are doing is plain ol' CYA.

When the day comes and real tort reform is enacted, will be the day we get a handle on health care. That's just my take.

Oh by the way, I work at a homeless shelter and we send around 700 residents to the hospital each year. Most of these, imo, are just to get attention. But I've seen many over my 10 years working here that looked like death warmed over when they left , and were returned hours later looking about the same. No insurance, no extra tests.

bob2356 - what I meant on the stats are other countries don't use the same criteria as we do and are under reported or not fully reported.

What I meant by slavery is universal health care will contribute to profligate gov't spending, reliance on gov't, gov't borrowing, higher national debt, socialism/fascism, inflation and we end up being servants to the state and results in statism.

State licensing and certifications does lead to higher cost. The consumers should decide. Private membership associations can be formed to include competent doctors like what you have for chiropracters.

Anyway - thanks for clarifying who does the licensing and certifications. I do believe AMA does have too much influence.

That's why I specifically choose infant mortality and life expectancy. The rest of the industrialized world may be full of a bunch foreigners who don't have American sophistication but I am almost positive they have the necessary knowledge of record keeping and statistics to know how many people died and how old they were as well as being able to count the number of babies born and figure out many of those died. This is pretty hard criteria to differentiate. I would be interested in seeing the research on how these area's are being under reported.

All licensing leads to higher costs. I would not be terribly comfortable flying if my pilot was part of a voluntary association whose membership decides the level of training. Or, as is much more common around the world, the level of bribe to get the job (training, we don't need no stinking training). I think the licensing cost vs safety ratio is pretty reasonable here compared to other places.

All functions of government lead to increased costs. If you feel that government services are slavery then feel free to move to where to there are none. Zimbabwe and Congo come to mind. If you object to the concept of government services where exactly do you personally draw the line on using government services? Do you drive on the government provided roads, fly using the government provided air traffic systems. use the government subsidized internet? If so then it's more than a little hypocritical to object to government services don't you think?

Yes, having government provide health care funding is not ideal, but it would be hard to be worse than the current system in context of society in general. That is the basic question in the whole debate. When does the cost of providing a societal benefit less then the cost of not providing it. I really would like to believe that the free enterprise model of health care would be the best. I would really like to believe that the least government is the best. But the current system just isn't providing health care at a cost that is anywhere close to being in line with the results.

Bob, you would be surprised how other nations use infant mortality stats as compare to we do. It is not as simple as you think.

I am afraid we are heading toward a Zimbabwe nation (formerly the good old Rhodesia that got screwed up by the ultimate socialists - Marxists). I think mass inflation is coming someday. Don't forget the two massive gorillas - Medicare and SS. We have $52T in liabilities for our children. $52T!!!!

I agree the current medical care system is screwed up for many reasons, but you make it worse with universal care or single payer system. I have this to offer:

This faith in safety nets has sustained men's faith in
the expansion of central governments all over the world.
Voters have called for guaranteed retirement and guaranteed
medical care for the aged. Now this is about to be
extended in America to the poor through a system of
national health insurance. The voters are supportive.

For two thousand years, Western man had faith in God,
in private charities, in local churches, and above all the
family to provide safety nets. But he has steadily
surrendered his faith in all of these in favor of the
state. The state is seen as a healer. It is seen as the
provider of reliable safety nets. The state uses coercion
to construct these nets. It consumes capital. They got use of the safety
nets while there was still capital to confiscate in the
name of the People.

blacktower1 says

My wife is on medicare and I have seen how doctors milk every dollar they can by giving her test after test. Most all of this is paid by medicare. While I’m no doctor I’m also no dummy and it’s clear much of what they are doing is plain ol’ CYA.
When the day comes and real tort reform is enacted, will be the day we get a handle on health care. That’s just my take.
Oh by the way, I work at a homeless shelter and we send around 700 residents to the hospital each year. Most of these, imo, are just to get attention. But I’ve seen many over my 10 years working here that looked like death warmed over when they left , and were returned hours later looking about the same. No insurance, no extra tests.

Medicare pays well. Why not give every test available - it can be justified by noting that the technology is available so we should use it. Doctors are often hesitant to stop treating or recommend comfort care, because family members might not be ready. The other side is that hospices have sprung up out of the ashes and have figured out how to milk the system.

They often sign up people who don't need or want it by promising massages or bathing - never explaining that Medicare is paying them $140/day every day. See my post on high pressure marketing tactics in the nursing home forum, it's disgusting what some agencies will do and they're mostly unregulated in their tactics.

Universal Healthcare seems to work in many countries, and our system doesn't work. We're all getting older and facing a huge amount of elderly people who will need care. Now is the time to change the way we're doing things.

bob2356 says

What is it about life expectancy that is not apple to apple pray tell? America ranks down with Bosnia and Albania. Infant mortality is another stat that is pretty foolproof to calculate.

The huge unspoken difference is that the lower life expectancy and high infant mortality apply only to blacks. Remove them from the statistics, and the US has the same life expectancy and infant mortality as any other industrialized country.

Hi Patrick,

Actually you have to pull out hispanics and american indians also to get up to the rest of the industrialized world. On the other hand if you pull out asians and pacific islanders (who have much better numbers than whites) the numbers get much much more grim. So your point is what? All this shows is who is poor and uninsured. My only point here is that for close to twice the per capita cost there should be a noticeable positive difference in the results instead of having to quibble statistics so things don't look bad.

I'm not a big fan of universal health care in the US, but what are the other options at this point? The cost projections are not sustainable. Everyone already pays for the uninsured, the medical malpractice (both insurance and defensive medicine), the absurd cost of the entire system of billing (I used to write software for physician billing so I know a lot about what it costs), all the expenses of the insurance companies, etc. through higher taxes and higher insurance premiums. Santa and the tooth fairy aren't paying for er visits. The uninsured rightfully (to them) wait until they are very sick, when they are difficult and expensive to treat then go to the ER which is the most expensive place in the whole system to treat them. It would be much better to treat them in relatively inexpensive clinics (compared to er's) when they are slightly sick and much cheaper and easier to treat. If they are not insured by someone it's not going to happen.

It's actually not that important to me personally in some respects. I have several citizenships and if the tax burden goes off the scale I would very regretfully mail back my US passport. I am happily living and working overseas, perfectly contented with using dreaded government health care.

bob2356 says

So your point is what? All this shows is who is poor and uninsured. My only point here is that for close to twice the per capita cost there should be a noticeable positive difference in the results instead of having to quibble statistics so things don’t look bad.

My point is that there is less group-feeling in the US, and that's an impediment to universal health care. The whites do not want to pay for the non-Asian minorities, but they won't say it out loud. That's why the political discussion gets really frustrating.

I am for a government insurance plan and universal coverage regardless of pre-existing conditions. Our costs are crazy and much of that is wasted on private insurance company profit and billing systems like you describe.

I am for a government insurance plan and universal coverage regardless of pre-existing conditions. Our costs are crazy and much of that is wasted on private insurance company profit and billing systems like you describe.

A lot of people take your position (the majority I believe). Where is the gov't getting the money they don't have to fund this? They already have a $52T debt liability. They can't tax significantly more (bottom 50% don't pay taxes and top 10% pays 80+% of the taxes). They can't borrow significantly more (interest rates will go up and the availability of private money is limited). This is happening globally. They will create money out of thin air. We are likely to see mass inflation which is an onerous tax on everybody (robbery) or war.

Your solution at best is a band aid to a gashing wound which eventually leads to bleeding to death. It is also short sighted and narrow vision. We look at the State as a savior and our nanny. Eventually we will be servants to the State. Gov't liabilities are all about us relying on the gov't for safety nets. This game will eventually end and the consequences will be very painful and deadly I am afraid. Who knows what form it will lead to. The answer in my opinion is to get the gov't completely out of the way (no favortism/ no subsidies/reasonable regulations/no welfare, etc). The responsibilities would be absorbed by self-government, families, charities and churches just like in very olden time. Who knows - this could result in a "Wal-mart" model of health care. Everybody can afford merchandises from Wal-mart. Even the poor! Yes, health care is marketable.

wcalleallegre says

Where is the gov’t getting the money they don’t have to fund this?

Well, for one thing you won't have to pay insurance premiums.

Another is that costs could go down by half and still pay for care like every other industrialized country.

Your fear of government is encouraged by people who profit from inefficiency.

"My wife is on medicare and I have seen how doctors milk every dollar they can by giving her test after test. Most all of this is paid by medicare.e While I’m no doctor I’m also no dummy and it’s clear much of what they are doing is plain ol’ CYA.
When the day comes and real tort reform is enacted, will be the day we get a handle on health care. That’s just my two cents"

LOL @ "doctors milk every dollar" and "test after test". Unless your doctor owns the equipment that he is ordering all of these tests on then he sees zero dollars for all of these "unnecessary tests". Since you've already stated that you "aren't a doctor" how do you know that the tests were unnecessary? Even if he does own the equipment you should see how many people need to be employed to make sure that the practice sees some kind of reimbursement for the multi million dollar PET/CT or MRI that was just leased.

Just try to deal with the cookbook, by the numbers medical care your insurance company adheres to when you try to get a procedure approved. Talk about bureaucracy and bullshit. Go visit the member services, provider relations, pre authorization, contracts, pharmacy, referral or any of the other myriad departments in an insurance company. After you do that I'll show you our coding and pre auth department, not to mention billing and accounts payable departments. Then I'll introduce you to our useless managers and various and sundry secretaries and administrative assistants all there to deal with the bullshit that is our current system.

My partner and I have worked in health care for over 20 years combined (specifically cardiology, oncology and diagnostic imaging and I've honestly never seen a physician order a test to generate income or "just because". Usually you have a family or patient that does not understand what is happening to them and cannot grasp that fact that medicine is mostly an art and that sometimes there just aren't concrete answers.

We are our own worst enemy:

We fail to take care of ourselves
We feel entitled to the "best" care yet distrust physicians
We seek answers in unproven and potentially dangerous holistic and naturopathic remedies
We are non compliant
We are mostly ignorant and uneducated about our bodies and how they work
We cannot accept our own mortality

Sorry for the rambling post but the "greedy physician" thing really pisses me off and in my experience is for the most part untrue. There are easiers ways to make a lot of money than by being a physician.

if anyone has any specific questions feel free to ask.

wcalleallegre says

What I meant by slavery is universal health care will contribute to profligate gov’t spending, reliance on gov’t, gov’t borrowing, higher national debt, socialism/fascism, inflation and we end up being servants to the state and results in statism.

Yeah, because that's exactly what has happened in the other 50+ countries with universal health care.

The problem isn't physicians. Yes, physicians in the US ARE overpaid, but they have to be -- we also have unaffordable universities that saddle them with a shit ton of debt. It's a lot easier to accept $200k a year instead of $400k a year when you don't have to worry about $500k in student loans.

The problem is the insurance companies. Every dollar that goes to an insurance company's profit or overhead is a dollar not being spent on health care. If you subtract the profits of the insurance companies and the cost of their overhead from the total US spending on health care, the gap between the US and the rest of the world in health care spending suddenly doesn't look so large.

Health care for the elderly is certainly a big problem as well, and most people are too ruled by emotion to make a logical decision about it. Spending $200k+ to give someone an extra year's worth of life is not worth it for the rest of society. Realistically, only the obscenely wealthy can actually afford to pay these bills late in life, and in many cases the cost of the last few years (or even months) of a person's life is more than the total amount of money that person made during their entire career.

There are bigger problems with the elderly than just the health care though, of course. We can't afford to pay for social security, either, and we are going to wind up in a situation where health care and financial support for the elderly will consume half of GDP within a century.

Kevin,

You are right that physicians are overpaid, but they don't have to be. Yes, medical school is expensive, but if the salary didn't justisfy the expense, no one would go to medical school. Medical Schools are expensive because they can be, because doctors know that even if they do rack up 500K in debt (which I sincerely doubt, btw. Med school is 4 years after undergrad, residencies are paid, poorly, but still paid.)
To illustrate, to get to 500K in debt by year one of doctors salary lets assume 5 years of residency without any interest or principal payments. At 7% interest, the debt before residency is about 360K. That seems high. The average cost for private schools for tuition is about 45K/yr, add in 20K for living expenses and you get 65K. For public schools the average cost is 24K, add in 20K for living expenses and you get 44K. At 7%, the debt after 4 years for a private student would be about 290K, and after not paying on the loan for five more years, the debt would be about 400K. For a public student, the debt would be about 195K after med school and about 275K after residency. And lets say the average starting salary for a physician is 175K while for a normal college grad, it is 35K. Lets also assume that the physician decides to tackle the student loan in a twenty year term. And lets assume that the physician pays an average income tax of 28% while the college grad pays an average of 12%. Student loan interest is tax deductible. After tax/after loan repayment income for the private school physician nine years after he graduated from undergrad is about 95K, for the public school physican it is about 104K. For the college grad, who had nine years of income growth at say, 4%, is about 44K. So, for taking the extra four years of school and five years of training, and taking on that debt, the physician is able to make more than 2 times the average wage even accounting for paying back the debt. In order for a doctor to not have the incentive to go to medical school, the starting salary would have to be less than 90K for a private med student and about 75K for a public one. Even at those levels it would be worth it because 4% growth on a higher salary is more growth, and the loan is gone after 20 years (age 51). Bottom line, there arent many poor doctors...and no empty seats in medical schools. What needs to be done is the construction of more medical schools, with more enrollment.

If we had more doctors, the costs would be lower. If we got rid of health insuranance all together, costs would go down because doctors and hospitals would have to charge a fee which their customer could afford. The best doctors and hospitals could charge more, the worse ones would need to charge less. Medical insurance wouldn't be neccesary if the cost of surgery more closely resembled a used car or a fancy television compared to a house. The medical profession, because of the high salaries, has attracted the best and brightest. People can generally be counted on to act in their own best interest...keep that in mind when you hear that medical professionals are pushing for health care reform, and they want universal health care or government sponsored health care or insurance. If the smart guys, who are acting in their own best interest, want things one way, do you really think that way is going to lower cost (their salaries)? They know the current system is unsustainable, they see the bubble coming, and they want reform that will only continue their status. Reform in the opposite direction would truly be reform. Forcing more people and more revenue streams (tax coffers) into a system isn't going to lower costs. Talk to any old time doctor who was around before medicare. Before medicare, they made a wage that was good, and greater than the average wage, but not a wage 2-5 times the average wage.

I received this message yesterday:
Message from Congressman Gary G. Miller
Dear Mr. ******:

Thank you for contacting me with your thoughts on reforming our nation's health care system. I appreciate hearing from you on this important issue. I strongly believe that Congress must control skyrocketing health premiums and ensure quality delivery by giving consumers more options, so they can choose the best health care for themselves and their families.

As you may know, an estimated 40 million Americans are not covered by health insurance. To resolve this problem, some have proposed implementing a government-run health care system that would cover each and every American. While the theory behind universal health care is well-intended, it does not provide a realistic solution to the problem. Not only would it cost American taxpayers billions of dollars, it would compromise the quality and effectiveness of our healthcare system. By eliminating competition between hospitals, the incentive to provide quality healthcare would be dramatically reduced. However, if Americans are able to make their own health care choices, competition would increase and health insurance premiums would be reduced.

For this reason, I favor market-based approaches to reduce the number of uninsured Americans. For example, I am a strong supporter of the creation of Association Health Plans (AHPs), which would allow small businesses and the self-employed to pool their resources to purchase health insurance. AHPs can reduce the high cost of healthcare by providing small entrepreneurs with the same buying power that large employers and unions enjoy, and can reduce health insurance costs by 15 to 30 percent. In addition, I have continually supported legislation that increases health research funding, provides modern benefits to Medicare, and expands the number of tax deductions available to those individuals who pay for their own health care.

With constant diligence and thorough consideration, I strongly believe that Congress can improve access to quality health care for more Americans. As this process continues, please be assured that I will keep your thoughts in mind. Again, thank you for contacting me. I hope you will remain in touch in the future on other issues of importance to you.

Sincerely,

GARY G. MILLER
Member of Congress

This is a great documentary by PBS on what other countries do.

http://www.pbs.org/wgbh/pages/frontline/video/share.html?s=frol02n71cq101

I don't understand why people get so mad when some rich person gets sick & racks up medical bills, thus losing their wealth & people think this is just so horrible & unjust. What about people who have been sick their entire lives & never had the oppportunuty to become rich? They have to live their entire lives being poor & sick! How is that fair if we bailout people who have enjoyed most of their lives being healthy & rich, while the person that has suffered in sickness & poverty their entire life doesn't get shit?

I can't agree more with Patrick. I am getting first hand experience with my Insurance company who stopped paying for Occupational and Speech Therapy for my son who has autism with a reason that they cannot pay more than 60 days(some language hidden inside the huge cheat sheet written by insurance company attorneys). This is clearly denial of coverage. Only way out if to decide in front of a jury.

moonmac says

I don’t understand why people get so mad when some rich person gets sick & racks up medical bills, thus losing their wealth & people think this is just so horrible & unjust. What about people who have been sick their entire lives & never had the oppportunuty to become rich? They have to live their entire lives being poor & sick! How is that fair if we bailout people who have enjoyed most of their lives being healthy & rich, while the person that has suffered in sickness & poverty their entire life doesn’t get shit?

Nobody is concerned about "some rich person" racking up medical bills. If they're rich, even very expensive treatments aren't going to bankrupt them.

We're more concerned about the 40 year old who loses his job and gets cancer, or, in my case, my 54-year-old father who was diagnosed with COPD and was unable to work for over a year (during which he lost his insurance) and racked up hundreds of thousands of dollars in medical bills before he finally became eligible for medicare. He still wound up declaring bankruptcy, though, and if it weren't for his pension he'd probably be living with my sister now.