Helping the uninsured by threatening them.

[DaShi]

Yes, but that was more out of luck in hiring than government policy. It used to be one of the worst managed systems.

[Ramo]

This isn't about helping the uninsured, MrFun. It's basically tax on healthy poor people.

That's ridiculous. In the HELP legislation, not only are people less than or equal to 150% of the federal poverty level eligible for Medicaid, not only are the subsidies for people up to 400% of the FPL, there are hardship exemptions.

[Ramo]

Yes, but that was more out of luck in hiring than government policy. It used to be one of the worst managed systems.

Part of it the change was good hiring practices. Part of it was adequate funding. But they also need a certain scale to carry out needed reforms. And all of that is affected by government policy. Clinton

[DaShi]

Well, Clinton is a god walking among mortals. Obama should aspire to such greatness.

[Ramo]

Here's a good article on the VHA.

How the system was reformed:

By the mid-1990s, the veterans health-care system was in deep crisis. A quarter of its hospital beds were empty. Government audits showed that many VHA surgeons had gone a year without picking up a scalpel. The population of veterans was falling sharply, as aging World War II and Korean War vets began to pass away. At the same time, a mass migration of veterans from the Snowbelt to the Sunbelt overwhelmed hospitals in places such as Tampa with new patients, while those in places such as Pittsburgh had wards of empty beds.

Serious voices called for simply dismantling the VA system. Richard Cogan, a senior fellow at the Center on Budget and Policy Priorities in Washington, told The New York Times in 1994: "The real question is whether there should be a veterans health care system at all." At a time when the other health-care systems were expanding outpatient clinics, the VHA still required hospital stays for routine operations like cataract surgery. A patient couldn't even receive a pair of crutches without checking in. Its management system was so ossified and top-down that permission for such trivial expenditures as $9.82 for a computer cable had to be approved in Washington at the highest levels of the bureaucracy.

Yet few politicians dared to go up against the powerful veterans lobby, or against the many unions that represented much of the VHA's workforce. Instead, members of Congress fought to have new veterans hospitals built in their districts, or to keep old ones from being shuttered. Three weeks before the 1996 presidential election, in part to keep pace with Bob Dole's promises to veterans, President Clinton signed a bill that planned, as he put it, to "furnish comprehensive medical services to all veterans," regardless of their income or whether they had service-related disabilities.

So, it may have been politics as usual that kept the floundering veterans health-care system going. Yet behind the scenes, a few key players within the VHA had begun to look at ways in which the system might heal itself. Chief among them was Kenneth W. Kizer, who in 1994 had become VHA's undersecretary for health, or, in effect, the system's CEO.

A physician trained in emergency medicine and public health, Kizer was an outsider who immediately started upending the VHA's entrenched bureaucracy. He oversaw a radical downsizing and decentralization of management power, implemented pay-for-performance contracts with top executives, and won the right to fire incompetent doctors. He and his team also began to transform the VHA from an acute care, hospital-based system into one that put far more resources into primary care and outpatient services for the growing number of aging veterans beset by chronic conditions.

By 1998, Kizer's shake-up of the VHA's operating system was already earning him management guru status in an era in which management gurus were practically demigods. His story appeared that year in a book titled Straight from the CEO: The World's Top Business Leaders Reveal Ideas That Every Manager Can Use published by Price Waterhouse and Simon & Schuster. Yet the most dramatic transformation of the VHA didn't just involve such trendy, 1990s ideas as downsizing and reengineering. It also involved an obsession with systematically improving quality and safety that to this day is still largely lacking throughout the rest of the private health-care system.

On the quality metrics:

And so it goes today. If the debate is over health-care reform, it won't be long before some free-market conservative will jump up and say that the sorry shape of the nation's veterans hospitals just proves what happens when government gets into the health-care business. And if he's a true believer, he'll then probably go on to suggest, quoting William Safire and other free marketers, that the government should just shut down the whole miserable system and provide veterans with health-care vouchers.

Yet here's a curious fact that few conservatives or liberals know. Who do you think receives higher-quality health care. Medicare patients who are free to pick their own doctors and specialists? Or aging veterans stuck in those presumably filthy VA hospitals with their antiquated equipment, uncaring administrators, and incompetent staff? An answer came in 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be "significantly better."

Here's another curious fact. The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care.

It gets stranger. Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose this year's winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.

[DinoDoc]

But then they're put into casts for free. And you get free crutches.

If you think health care is expensive now, wait until you see what it costs when it's free. - P.J. O'Rourke

Medicare Costs Have Risen Far More than the Costs of Private Health Care

[Ramo]

Find a non-bull**** source that claims that.

The Pacific Research Institute (PRI) or officially the Pacific Research Institute for Public Policy, is a prominent California-based conservative think tank founded in 1979 whose stated vision is the promotion of "the principles of individual freedom and personal responsibility. The Institute believes these principles are best encouraged through policies that emphasize a free economy, private initiative, and limited government."[1] The Pacific Research Institute has associated with other think-tanks like the American Enterprise Institute, The Heritage Foundation, The Fraser Institute, and the Cato Institute.

http://en.wikipedia.org/wiki/Pacific_Research_Institute

Here's a Kaiser study which points out:

Comparing common benefits, changes in Medicare spending in the last three decades has largely tracked the growth rate in private health insurance premiums. Typically, Medicare increases have been lower than those of private health insurance, except during the mid-1970s, the early 1980s, and mid-1990s. Trends in Medicare spending are affected by legislative changes such as the Balanced Budget Act of 1997, which contributed to the drop-off in Medicare spending growth in 1998 and 1999, and the Balanced Budget Refinement Act of 1999 and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, which contributed to increases.

What makes this all the more remarkable is that the people in the private system form a relatively low risk pool (the poorest people, the elderly, and veterans are largely excluded). While Medicare covers a terrible risk pool (people over 65). You would expect Medicare cost growth to be wildly out of control. Yet it manages to be cheaper than the private system on a fairly consistent basis.

From 1970 to 2004, the average annual inflation of Medicare was 8.9%; for the private system, it was 9.9%. From 2000 to 2004, Medicare grew at 6.3%; the private system grew at 9%, almost 50% faster.

[Kuciwalker]

From 1970 to 2004, the average annual inflation of Medicare was 8.9%; for the private system, it was 9.9%. From 2000 to 2004, Medicare grew at 6.3%; the private system grew at 9%, almost 50% faster.

Did you actually pay any attention to DD's link? It brought up a fairly convincing point [to me] that you can't legitimately compare the growth of private insurance spending vs. Medicare spending, because that ignores the decrease in private out-of-pocket spending.

[KrazyHorse]

In economics this problem is called adverse selection. Sick people will always be willing to buy fairly priced insurance, while healthy people will tend to withdraw from such a plan. This eventually raises the cost of insurance to sick people, driving more healthy people out. Several small insurance plans have collapsed because of this. (e.g., Harvard University's employee health care plan a few years ago.) Requiring everyone to buy some insurance, or penalizing them for not buying, helps prevent this problem.

edit: spelling

Adverse selection/asymmetric information is just one of the problems in the health care market...

[Ramo]

Did you actually pay any attention to DD's link? It brought up a fairly convincing point [to me] that you can't legitimately compare the growth of private insurance spending vs. Medicare spending, because that ignores the decrease in private out-of-pocket spending.

You realize that people over 65 go to the doctor a hell of a lot more, and for more expensive procedures, than people under 65, right? That's an absurd metric. For example, the only reason why I have insurance is for catastrophic care.

[KrazyHorse]

That makes absolutely no sense, ramo. You're comparing growth rates, not absolute levels of per-patient spending.

[Kuciwalker]

You realize that people over 65 go to the doctor a hell of a lot more, and for more expensive procedures, than people under 65, right? That's an absurd metric. For example, the only reason why I have insurance is for catastrophic care.

You realize that KH is right and this makes no sense, right? Particularly since you were the one that started using the metric.

[Ramo]

I'm not sure which post you're referring to, but the Kaiser study looked at average premiums. I'd assume that Medicare spending is likewise normalized (but odd chance that it isn't, that makes Medicare look even better). I'm referring to growth rates because that's what Dino referred to.

[Kuciwalker]

From 1970 to 2004, the average annual inflation of Medicare was 8.9%; for the private system, it was 9.9%. From 2000 to 2004, Medicare grew at 6.3%; the private system grew at 9%, almost 50% faster.

[Kuciwalker]

I'm not sure which post you're referring to, but the Kaiser study looked at average premiums. I'd assume that Medicare spending is likewise normalized (but odd chance that it isn't, that makes Medicare look even better). I'm referring to growth rates because that's what Dino referred to.

Yes, and the way you referred to them made it obvious that you either didn't read or didn't understand his source. At all.

I'll repeat what I said before, and see if maybe you can actually understand it this time: "DD's source made the fairly convincing point [to me] that you can't legitimately compare the growth rate of private insurance and Medicare, because that ignores the the decrease in private out-of-pocket spending."