If you belive in effective experince

[Azazello1313]

so for decades we have had a system that was half public, half private, (increasingly more public over that span) with a system of tax shelters that blatantly encourages overconsumption and insulates the whole system from market mechanisms for controlling costs. and on top of that, we basically got to fund the rest of the developing world's medical R&D. gee, I wonder why we spend so much?

 

potential responses:

1) let's double-down on that "mixed system" by pouring in a bunch more government funding, yet keeping fully in place the tax incentives to overconsume. (this is obamacare)

2) go to single-payer so the government can dictate prices and ration care "appropriately"

3) strip away the employer-paid health care tax shelter, thus letting market forces back into the fold.

[Ursa Majoris]

so for decades we have had a system that was half public, half private, (increasingly more public over that span) with a system of tax shelters that blatantly encourages overconsumption and insulates the whole system from market mechanisms for controlling costs. and on top of that, we basically got to fund the rest of the developing world's medical R&D. gee, I wonder why we spend so much?

 

potential responses:

1) let's double-down on that "mixed system" by pouring in a bunch more government funding, yet keeping fully in place the tax incentives to overconsume. (this is obamacare)

2) go to single-payer so the government can dictate prices and ration care "appropriately"

3) strip away the employer-paid health care tax shelter, thus letting market forces back into the fold.

Even though you think I'm a socialist, I'm not. I'll take #3 every time, followed by #2. #1 is off the table, it's a ruinous shambles. That said, my original premise was that health care is a gigantic scam and as currently constituted, it is. The fact that it's a gigantic scam is precisely what is preventing it being properly and efficiently reformed - too many people making too much money.

[Yukon Cornelius]

- too many people making too much money.

this be the key

[Azazello1313]

I'll take #3 every time, followed by #2. #1 is off the table, it's a ruinous shambles. That said, my original premise was that health care is a gigantic scam and as currently constituted, it is.

 

then hey, we agree completely. problem is, when people say our health care costs are higher than, say, canada, the implication is that we have a freer market than canada, so it must be the free market's fault. but this is one of the most regulated industries in our country, where government already pays 50% of the costs (and rising). the more government has gotten involved, the more prices have gone up -- seems an odd choice of industry to try and implicate the free market. the government policy creating this hybrid public-private mess, while generally providing a good level of care, almost looks like it was designed to create runaway costs. (I've linked to this graph before, but in these discussions it is always extremely relevant IMO) as usual with this sort of arrangement, the profits are privatized and the risks are socialized.

 

I am sure there are more efficient solutions involving more government, and there are also more efficient solutions involving less government. I guess it comes down to how you feel about government, and whether you want more power in their hands or in the hands of individual consumers.

[Perchoutofwater]

then hey, we agree completely. problem is, when people say our health care costs are higher than, say, canada, the implication is that we have a freer market than canada, so it must be the free market's fault. but this is one of the most regulated industries in our country, where government already pays 50% of the costs (and rising). the more government has gotten involved, the more prices have gone up -- seems an odd choice of industry to try and implicate the free market. the government policy creating this hybrid public-private mess, while generally providing a good level of care, almost looks like it was designed to create runaway costs. (I've linked to this graph before, but in these discussions it is always extremely relevant IMO) as usual with this sort of arrangement, the profits are privatized and the risks are socialized.

 

I am sure there are more efficient solutions involving more government, and there are also more efficient solutions involving less government. I guess it comes down to how you feel about government, and whether you want more power in their hands or in the hands of individual consumers.

 

The graph is very telling IMO. Had government not gotten involved in the free market capping wages the insurance scam as Ursa likes to call it never would have come to pass. If government (up until recently state governments) didn't require insurance policies provide certain coverages that are not needed by some, cost would be lower. If we break the link between employer and insurance that would be a hugh start in getting things under control. If people were allowed the buy only the insurance they need instead of one size fits all coverage, insurance would be much cheaper. If you want to look at why insurance costs are so high you need look no farther than when government started getting involved with capping wages, and regulating coverage.

 

If individuals actually had to pay their premiums, and had more choice in the coverage they bought, you'd see the cost of medical care plummet. As long as everyone wants someone else to take care of them whether it be the government or the employer we are doomed for more of the same, unless of course the government takes over the entire system in which case some will be paying a lot more others won't be paying much if anything at all, and care will be rationed. Yes I know care is rationed to a point already, but not like it will be under a full government run system. At least now there are some options, as bleak as they may be.

[Ursa Majoris]

then hey, we agree completely. problem is, when people say our health care costs are higher than, say, canada, the implication is that we have a freer market than canada, so it must be the free market's fault. but this is one of the most regulated industries in our country, where government already pays 50% of the costs (and rising). the more government has gotten involved, the more prices have gone up -- seems an odd choice of industry to try and implicate the free market. the government policy creating this hybrid public-private mess, while generally providing a good level of care, almost looks like it was designed to create runaway costs. (I've linked to this graph before, but in these discussions it is always extremely relevant IMO) as usual with this sort of arrangement, the profits are privatized and the risks are socialized.

 

I am sure there are more efficient solutions involving more government, and there are also more efficient solutions involving less government. I guess it comes down to how you feel about government, and whether you want more power in their hands or in the hands of individual consumers.

One question about the whole "returning power to the individual consumer" thing. Given the importance that is apportioned to the size of the "group" in the current system in holding down costs and given that if that completely disappears in an individual market (as it surely must), doesn't it follow that costs would immediately rise to cover high risk individuals currently hidden in the herd?

 

Another point: Will such radical moves begin to lower costs or merely lower the rate of increase? I ask because theoretically the costs would go down but in reality, no-one on the supply side is going to want that so the best that could be hoped for is decreasing increase.

[SEC=UGA]

One question about the whole "returning power to the individual consumer" thing. Given the importance that is apportioned to the size of the "group" in the current system in holding down costs and given that if that completely disappears in an individual market (as it surely must), doesn't it follow that costs would immediately rise to cover high risk individuals currently hidden in the herd?

 

Another point: Will such radical moves begin to lower costs or merely lower the rate of increase? I ask because theoretically the costs would go down but in reality, no-one on the supply side is going to want that so the best that could be hoped for is decreasing increase.

 

I simply do not see how you can effectively lower costs without drastically reducing the quality, availability, and access to care.

 

Say we do make "affordable" healthcare available to all, that is going to stress the current resources in the medical care field. You won't have enough CT machines, hospital beds, or doctors to treat all of the patients as people will begin to use the medical resources more often (frequently for ailments that don't need doctor care). By putting a lower price on care, you have to begin to reduce costs somewhere, is that going to be in Doctor's salaries? If so you are going to not have as many people going into the medical profession. Look at the shortage of primary care physicians currently, they are a dying breed because the money isn't their to justify them choosing this path.

 

Say one does make the argument that with more patients, even at lower price per service rendered, the doctors should be able to make up that lost revenue through having a higher volume of patients. With more access and more volume of patients, even at the same level of doctor's that are out there right now, you begin to tax that resource. A doctor can only effectively work so many hours and see so many patients and effectively diagnose and care for them. If doctors take on a much larger burden of patients care will certainly decrease.

 

So, now you have a growing demand, fewer or the same number of practitioners and all of a sudden access and availability of doctors becomes more scarce. As doctors can only see a limited number of patients they are going to have to schedule appointments for further out and further out as they don't have enough time in the day to address the demand that has been created. So now you have a bottleneck and would need to create some sort of priority scheduling. Well, without an initial diagnosis how can you priortize what patients to see. Yes, you may have some with a known condition that you know an issues needs t be addressed immediately.

 

Finally, if you do move to a nationalized healthcare system you run into other issues that have plagued our government at many levels in most capacities that they handle. Fraud will be more rampant than it is currently. They can already not keep up with the billions in fraud that occurs in Medicare and Mediccaid currently... Once you add another 46 million people to the rank of the insured you are going to see that fraud blossom even more as regulation is severely lacking.

 

Aspects of HC reform could be very positive, but the direction that I feel we are being pushed, eventual nationalization, is very ominous.

[Ursa Majoris]

I simply do not see how you can effectively lower costs without drastically reducing the quality, availability, and access to care.

 

Say we do make "affordable" healthcare available to all, that is going to stress the current resources in the medical care field. You won't have enough CT machines, hospital beds, or doctors to treat all of the patients as people will begin to use the medical resources more often (frequently for ailments that don't need doctor care). By putting a lower price on care, you have to begin to reduce costs somewhere, is that going to be in Doctor's salaries? If so you are going to not have as many people going into the medical profession. Look at the shortage of primary care physicians currently, they are a dying breed because the money isn't their to justify them choosing this path.

 

Say one does make the argument that with more patients, even at lower price per service rendered, the doctors should be able to make up that lost revenue through having a higher volume of patients. With more access and more volume of patients, even at the same level of doctor's that are out there right now, you begin to tax that resource. A doctor can only effectively work so many hours and see so many patients and effectively diagnose and care for them. If doctors take on a much larger burden of patients care will certainly decrease.

 

So, now you have a growing demand, fewer or the same number of practitioners and all of a sudden access and availability of doctors becomes more scarce. As doctors can only see a limited number of patients they are going to have to schedule appointments for further out and further out as they don't have enough time in the day to address the demand that has been created. So now you have a bottleneck and would need to create some sort of priority scheduling. Well, without an initial diagnosis how can you priortize what patients to see. Yes, you may have some with a known condition that you know an issues needs t be addressed immediately.

 

Finally, if you do move to a nationalized healthcare system you run into other issues that have plagued our government at many levels in most capacities that they handle. Fraud will be more rampant than it is currently. They can already not keep up with the billions in fraud that occurs in Medicare and Mediccaid currently... Once you add another 46 million people to the rank of the insured you are going to see that fraud blossom even more as regulation is severely lacking.

 

Aspects of HC reform could be very positive, but the direction that I feel we are being pushed, eventual nationalization, is very ominous.

So as I said earlier, there are three alternatives. Pick one.

[SEC=UGA]

So as I said earlier, there are three alternatives. Pick one.

 

Move to Somalia and head up a gang of pirates was not on the list.

[Azazello1313]

One question about the whole "returning power to the individual consumer" thing. Given the importance that is apportioned to the size of the "group" in the current system in holding down costs and given that if that completely disappears in an individual market (as it surely must), doesn't it follow that costs would immediately rise to cover high risk individuals currently hidden in the herd?

 

well obviously, anyone who decides to forego insurance until they're sick and they expect their outgoing expenses to exceed the going insurance premiums (at which point it's not really "insurance" anymore, is it?) is going to be in a pickle. the most frequent proposal for dealing with problem that is tax credits. you eliminate the tax shelter for employer provided benefits, which means most people pay tax on an extra ~$10K of income, but then you provide a tax credit for most of the amount of a basic, fairly high-deductible health plan. obviously, if you don't get insurance you don't qualify for the credit -- so it's in peoples' interest not to the play the "hope I don't get unlucky" game. everybody gets the credit, so everybody can "afford" a basic health plan. if they want to pay more for a more insulating plan, that is their call.

 

Another point: Will such radical moves begin to lower costs or merely lower the rate of increase? I ask because theoretically the costs would go down but in reality, no-one on the supply side is going to want that so the best that could be hoped for is decreasing increase.

 

well, that's why we implement a freer market, so the supply-side doesn't get to just decide what they "want". they have to compete for consumers. right now, consumers are so insulated and insurers so regulated there is very little room for market forces to operate. look at what's happened with the cost of medical procedures insurers don't usually cover, like LASIK eye surgery.

[Ursa Majoris]

look at what's happened with the cost of medical procedures insurers don't usually cover, like LASIK eye surgery.

Pretty convincing example.