Politics debate continued from multiculturalism thread

[Maniac]

Originally posted by Drogue
But the US is one of only 2 developed countries where not *everyone* has access to medicine.

What's the other?

[Lord Avalon]

Originally posted by Starchild

$25 - 50% of the total costs? Any prescription I get in the UK costs me £6.50 ($13).

Yeah, it sucks. $10 if there's a generic, though.

This actually screwed me in budgeting for my Flexible Spending Account. At the beginning of the health plan year, I can allot an amount to be deducted from my paycheck, pre-tax. The FSA reimburses me for out-of-pocket costs (co-pays for doctor visits, test costs not covered by insurance - I actually don't pay the co-pay for prescriptions, as it gets deducted directly from my account, as long as there's enough in it). Last year coverage was expanded to pain relievers and other over the counter medicines.

Anyway, a month before the new plan year, I started on a new prescription. With the new % co-pay, I figured that was going to cost me $50 a month. So I put that in my FSA budget. Unfortunately, the drug went generic a couple months later, so I overbudgeted $40/mo. Any money not used up goes to the government. So now I'm going to be putting in claims for all the stuff I didn't use to: aspirin/ibuprofen etc (been buying name brand), OTC allergy meds, the knee braces I bought, so I can try to use it up.

[Lord Avalon]

Originally posted by KrazyHorse

Wow. You must think that people who run health care systems are absolutely retarded. Dozens of countries manage it without there being a dead period of a month at the end of the year when nobody can see a doctor or go to a hospital.

I guess I'm thinking of it from the standpoint if the US tried to switch from what we have now to a single-payer system, and what a clusterf**k that would be, what with all the pharmaceutical and insurance company lobbyists and our Congress & president.

Just because other countries manage it doesn't mean we could, at least at the beginning.

[Drogue]

Originally posted by Maniac
What's the other?

South Africa.

Originally posted by Lord Avalon
Anyway, a month before the new plan year, I started on a new prescription. With the new % co-pay, I figured that was going to cost me $50 a month. So I put that in my FSA budget. Unfortunately, the drug went generic a couple months later, so I overbudgeted $40/mo. Any money not used up goes to the government. So now I'm going to be putting in claims for all the stuff I didn't use to: aspirin/ibuprofen etc (been buying name brand), OTC allergy meds, the knee braces I bought, so I can try to use it up.

Wait, and you were asking how people could use too much with insurance?

[Adam Smith]

Insurance certainly contributes to the inefficiency of US health care, as KH and Drogue explained. Single payer would also lead to some efficiencies, since you wouldn’t have various parties arguing over who picks up what part of the bill. But these factors alone don’t fully account for what is going on in US health care. For example, the US has single payer for defense procurement, but nobody in his right mind would argue that defense procurement is a well-functioning market.

The big factor that nobody has mentioned yet is the cost-plus nature of large parts of the US healthcare system (which, btw, is also the big problem in defense procurement). Under the cost-plus system, providers produce a service, and payers reimburse them for their costs. Under the competitive contracting system common to most markets (and becoming increasingly common in US health care), providers and payers agree on a price up front before the service is provided.

The difference in payment method has enormous implications for innovation and technological change, which are very important parts of health care. Under the cost-plus system you get increasingly more expensive innovations which provide marginal decreases in the mortality or side effects of a given procedure, because payers are willing to reimburse the expense. Under a competitive contracting system, you get innovations that make procedures less expensive for the same level of mortality or side effects, because price is a major factor which is negotiated up front. Moving away from a cost-plus system would make US health care much more affordable, with little difference in mortality or quality of life.

[GePap]

And somehow the US manages to have higher mortality rates than Europe, including something as basic as the infancy mortality rate. Heck, CUBA has a lower infant mortality rate!

[KrazyHorse]

For example, the US has single payer for defense procurement, but nobody in his right mind would argue that defense procurement is a well-functioning market.

The big factor that nobody has mentioned yet is the cost-plus nature of large parts of the US healthcare system (which, btw, is also the big problem in defense procurement). (...)

That's an interesting point. I worry about the contracting system in health care, however. The contracting party (insurance, in most cases) would have to be very careful to avoid allowing the provider to skimp on necessary expenses. The problem here is that there's an agent between the consumer and the provider (the insurance company) who should not necessarily be trusted to put the consumer's interests ahead of their own. They might be incentivised to not ask too many questions about details in the contracts with providers if the right price is set.

[Lord Avalon]

Originally posted by Drogue
Wait, and you were asking how people could use too much with insurance?

I think you misunderstand - the FSA isn't insurance.

[Drake Tungsten]

The American health care system definitely has issues that need to be addressed. The real trick is coming up with a system that will address the current problems while preventing the level of service currently enjoyed by patients and the level of reimbursement enjoyed by health care workers from degrading to a European/Canadian level. That is an extremely difficult goal to achieve, for a variety of reasons...

[aneeshm]

I've always thought this to be a false dichotomy. Why can't we have parallel governmental and non-governmental systems, both competing (with the obvious condition - the government can't create unfair advantages for itself)? Even though I'd be in favour of a totally private system, a compromise is possible, and that's what we have here in India.

[KrazyHorse]

address the current problems while preventing the level of service currently enjoyed by patients and the level of reimbursement enjoyed by health care workers from degrading to a European/Canadian level

a) From what I've seen of the two systems the difference in quality of service is not especially wide

b) Why the hell should we be concerned with keeping doctors' wages at the current inflated level of the US? It's the current system which has driven their wages up out of all proportion to their educational level. I see nothing wrong with a correction to this.

[Ned]

Just as a point of reference, over my entire life only one or two doctors appointments were made days in advance. This includes eye appointments. Whenever I have had to see a doctor, I just have to give a call and I get an appointment that same day. If my regular doctor is not available, I see another on staff.

I can hardly imagine a system that would force you to wait if you are sick or injured.

[Arrian]

That differs from my experience. Unless it's an emergency, often one has to plan an appointment (say, for a physical checkup) weeks or even months in advance. It varies depending on your doctor, of course.

The waiting while seriously sick/injured is something to worry about, for sure. Then again, what of those who will get no care at all, or only ER care (which we end up paying for anyway) and no preventative - because they're uninsured? Our system has major faults, Ned.

-Arrian

[Jon Miller]

My expereience is similiar to Ned. For dentists it has to be far an advance though.

JM

[Drake Tungsten]

From what I've seen of the two systems the difference in quality of service is not especially wide

There definitely seems to be differences in terms of timeliness of treatment and access to expensive machines like MRIs. And Americans simply aren't going to go for a system that restricts access to MRIs or asks patients to wait months for treatment when they are used to having prompt access to either with the current system.

Why the hell should we be concerned with keeping doctors' wages at the current inflated level of the US?

Because doctors are concerned about them? In addition to being a powerful lobbying force, they're also a highly-trained workforce that would be difficult to replace, so reducing their incentive to work would lead to shoddier health care across the board with no short-term option for replacing them with workers with lower wage standards.