The American "Healthcare" thread

[Dinner]

Here's an interesting look at the Swedish Model done by the CBC.

[DirtyMartini]

About 12%

ACK!

That's good. A lot of hospitals, particularily inner city/underserved community hospitals, aren't in that kind of financial shape. I'd be curious to know your percentage of Medicare patients vs. private insurance patients.

[Dinner]

The Swiss and Germans allow people to get more medical services outside the primary (socialized) system, which Obamacare would criminalize.

What have you been smoking? Obama has said over and over he doesn't want single payer and that most people will retain private insurance. The current debate is if there should even be just a public option for people to choose if they want it.

The claim that Obama would criminalize private health providers is just Zaku levels of dumb.

[MrFun]

I saw in the news recently where there was discussion on the possibility of the health care system in Massachusetts being a really good model to reform our national health care system.

[Ogie Oglethorpe]

And thats a good thing how?

http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2009/03/02/mass_healthcare_reform_is_failing_us/

[Ogie Oglethorpe]

You're right. Let's factor in the availability of firearms.

Tasers, man. Lots of heart failure due to tasers.

[Ogie Oglethorpe]

This This This...

It's not supposed to be a market. It's supposed to be a public service.......

Easter bunny doesn't actually hide Easter eggs.

[DaShi]

July 25, 2009, 5:07 pm
Why markets can’t cure healthcare

Judging both from comments on this blog and from some of my mail, a significant number of Americans believe that the answer to our health care problems — indeed, the only answer — is to rely on the free market. Quite a few seem to believe that this view reflects the lessons of economic theory.

Not so. One of the most influential economic papers of the postwar era was Kenneth Arrow’s Uncertainty and the welfare economics of health care, which demonstrated — decisively, I and many others believe — that health care can’t be marketed like bread or TVs. Let me offer my own version of Arrow’s argument.

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

This problem is made worse by the fact that actually paying for your health care is a loss from an insurers’ point of view — they actually refer to it as “medical costs.” This means both that insurers try to deny as many claims as possible, and that they try to avoid covering people who are actually likely to need care. Both of these strategies use a lot of resources, which is why private insurance has much higher administrative costs than single-payer systems. And since there’s a widespread sense that our fellow citizens should get the care we need — not everyone agrees, but most do — this means that private insurance basically spends a lot of money on socially destructive activities.

The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping. (“I hear they’ve got a real deal on stents over at St. Mary’s!”) That’s why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.

You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people don’t trust them — they’re profit-making institutions, and your treatment is their cost.

Between those two factors, health care just doesn’t work as a standard market story.

All of this doesn’t necessarily mean that socialized medicine, or even single-payer, is the only way to go. There are a number of successful health-care systems, at least as measured by pretty good care much cheaper than here, and they are quite different from each other. There are, however, no examples of successful health care based on the principles of the free market, for one simple reason: in health care, the free market just doesn’t work. And people who say that the market is the answer are flying in the face of both theory and overwhelming evidence.

.

[DinoDoc]

In a post on healthcare, Paul Krugman makes this observation:

You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people don’t trust them — they’re profit-making institutions, and your treatment is their cost.

Paul's comment got me thinking. Perhaps a lot of the disagreement over healthcare reform, and maybe other policy issues as well, stems from the fundamental question of what kind of institutions a person trusts. Some people are naturally skeptical of profit-seeking firms; others are naturally skeptical of government. (There is, of course, the issue that an HMO can be run as a nonprofit organization. The one I use through Harvard is an example. But let's put that issue aside for another day.)

I tend to distrust power unchecked by competition. This makes me particularly suspicious of federal policies that take a strong role in directing private decisions. I am much more willing to have state and local governments exercise power in a variety of ways than for the federal government to undertake similar actions. I can more easily move to another state or town than to another nation. (I am not good with languages.)

Most private organizations have some competitors, and this fact makes me more comfortable interacting with them. If Harvard is a bad employer, I can move to Princeton or Yale, and this knowledge keeps Harvard in line. To be sure, we need a government-run court system to enforce contracts, prevent fraud, and preserve honest competition. But it is fundamentally competition among private organizations that I trust.

This philosophical inclination most likely influences my views of the healthcare debate. The more power a centralized government authority asserts, the more worried I am that the power will be misused either purposefully or, more likely, because of some well-intentioned but mistaken social theory. I prefer reforms that set up rules of the game but end up with power over key decisions as decentralized as possible.

What puzzles me is that Paul seems so ready to trust solutions that give a large role to the federal government. (In the past, for instance, he has advocated a single payer for healthcare.) I understand that trust of centralized authority is common among liberals. But here is the part that puzzles me: Over the past eight years, Paul has tried to convince his readers that Republicans are stupid and venal. History suggests that Republicans will run the government about half the time. Does he really want to turn control of healthcare half the time over to a group that he considers stupid and venal?

These thoughts, I appreciate, are broad generalizations. They don't immediately lead to a specific set of reform proposals. But I wanted to give Paul credit for a key insight: A central question in this and perhaps other debates is, Whom do you trust?

http://gregmankiw.blogspot.com/2009/07/trust.html

[DaShi]

He didn't really counter Paul's arguments. Rather he just made some assumptions about Paul and went from there. I can see why you like it, DD. There's no actual thought or understanding about healthcare in it.

[chequita guevara]

The proposed system will make it illegal for doctors to provide medical care outside the government system, and illegal for patients to pay for medical care outside the government system.

That's supposed to make health care better?

MORONS!

It has everywhere it's been tried.

[HalfLotus]

The free(ish) market hasn't done the job.

It's not the free(ish) part that makes our current system suck.

With Congress and the Executive in the front pocket of the Pharms, and with our enormous budget difficulties, and the all-around failure of our government in general, I can't support more government involvement in health care.

There is also the case that with Americans being fat, stupid, unhealthy in general, the socialist moral argument of "taking care of each other", doesn't hold as much water here in the goold ol U. S. o' Fatasses.

How about we stop invading other countries, stop giving 2/3 of our paychecks to the government, and allow the people to take care of themselves and each other?

I am loathe to enter the socialist/liberty debate here, because I know posters immediately put on the gloves before they respond, but the American tradition is for the people to innovate and associate with voluntary organizations in order to solve problems, not to lean on Big Brother and become lifetime dependents on a government system.

If other countries are doing well with a government system, that's great, but it's not the right system for America.

[DaShi]

Then what system is right? The market system doesn't work. No one trusts the government. Wasn't America founded on the ideals of a shared community? Ask not and all that rot?

[MrFun]

All the nay-sayers who are so 100 percent certain that government health care absolutely cannot co-exist with private health care providers should read this article.

By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer – 24 mins ago
WASHINGTON – A new government health insurance plan sought by President Barack Obama and congressional Democrats could coexist with private insurers without driving them out of business, an analysis by nonpartisan budget experts suggests.

The estimate by the nonpartisan Congressional Budget Office — seen as good news by Democrats — comes as leaders pushed Monday to make progress on health care overhaul before lawmakers go home for their August recess.

House Speaker Nancy Pelosi, D-Calif., says a floor vote is still possible in the next few days, and Democrats called a meeting of all their House members late Monday afternoon. In the Senate, a small group of lawmakers from both parties were resuming negotiations in search of an elusive compromise.

Obama's ambitious timetable for his top domestic priority has slipped as Democratic dissension has slowed the legislative work.

The White House and congressional Democrats were angered two weeks ago when the budget office director, Douglas Elmendorf, told Congress that the House bill lacked mechanisms to bring health care costs under control.

Now, Democrats are using the budget office's suggestion that a government-run insurance plan would not destroy private insurers to rebut one of the main charges against their proposal — that it would lead to a federal takeover of the private health insurance marketplace.

The controversy seems far from settled, given uncertainty over projections of how a revamped health care system would work.

Polls have shown that Americans support the idea of a public coverage option as part of health care overhaul. The insurance industry and employer groups say it could drive private insurers out of business, particularly if the government plan had the power to pay medical providers below-market rates.

More than 160 million workers and family members now get health insurance through an employer. A widely cited study by the Lewin Group, a private health research firm, estimated that more than 100 million people would sign up for the public plan proposed by House Democrats, making it the dominant insurer in the land.

But the budget office, in a letter Sunday to a senior Republican lawmaker, said its own estimate for the same legislation is "substantially smaller."

CBO estimates that only 11 million to 12 million people would sign up for the public plan — making it a much smaller player in the market. The government coverage would be available alongside private plans through a new kind of insurance purchasing pool called an exchange. CBO estimated about 6 million of those enrolled in the public plan would be workers and family members of employers that joined the exchange.

The reasons the estimates are so far apart have to do with different underlying assumptions.

The CBO estimated that the public plan would offer premiums about 10 percent lower than private plans; the Lewin analysis estimates the premiums would be at least 20 percent lower. The CBO estimates that only individuals and workers in companies with fewer than 50 employees would join the exchange, while Lewin estimated the exchange would eventually be open to all workers.

As if to underscore how such estimates can vary, the Urban Institute public policy center also ran calculations — and came up with different numbers. The Urban Institute estimated that about 47 million people would sign up for the public plan, if companies with fewer than 50 workers were allowed to join.

Non-Partisan Experts Say Gov. Health Care Can Coexist with Private Health Care

[DaShi]

I never trust non-partisan experts. What's their agenda?