Healthcare Reform Thread II

[Dinner]

Getting the health insurance exchange up and properly running, paying for comparative effectiveness research,

And when we're done paying these the system will be so much cheaper?

One would guess that guess that setting up a new program would have start up costs but that once things are set up maintaining it would be cheaper then building new from scratch. Example: It is more expensive to build a new building then it is to maintain an existing one. I.E. the start up cost on the new building is high but maintenance is much cheaper.

[KrazyHorse]

I was making the point that there are cost savings here that are not likely to be realized over a short time period.

No, you said:

There are large up front costs in setting the system up. Getting the [...] uninsured poor coverage is going to cost money.

Huh? What exactly do you think is stopping Medicare from telling doctors to pay for procedure x with marginal benefit? We're talking about a HUGE portion of the market that comparative effectiveness research has immediate applicability.

I have no idea why you think that Medicare will actually restrict treatments based on comparative effectiveness research. They've proven EXTRAORDINARILY unwilling to do so in the past. In order to claim cost savings from this you have to demonstrate that the research will lead to ACTION to restrict care.

The health insurance exchange is a regulated marketplace. It provides an avenue for imposing these kinds of controls. But the hope is that the private sector would follow Medicare's lead.

You have to actually explain yourself here. You can't just say "regulated marketplace" and expect anybody to understand you.

IIRC, the Stevens appropriation was an increase in aggregate disbursement. And yes:

http://www.dartmouthatlas.org/interactive_map.shtm

How far from ideal? Dunno, but you can look at a more micro comparison (similar demographic towns), and see the same thing. McAllen and El Paso, TX for example.

I have no idea what a change in "aggregate disbursements" means. A quick google search suggests that what you're referring to was an increase to the payments made to Alaskan physicians PER PROCEDURE. How, exactly, do you think that Medicare is disbursed? AFAIK it is not that the federal government gives X$ to each state to use for provision of medical services. It is a payment per procedure directly from the federal government to the provider. The amount of the payment depends on location.

That map is of disbursements PER ENROLEE. Not of disbursements per procedure. All the map tells me is that some places provide patients with a lot of high cost care and other places provide patients with less high cost care. It does NOT tell me how widely the disbursement rates for a given procedure vary geographically, which is the part you appear to be referring to with the Stevens incident.

If the government makes efforts at limiting disbursements for a certain class of procedures, private insurers have that leverage when negotiating with providers.

The government ALREADY pays significantly less than private insurers do for any given procedure. What additional "leverage" do the private insurers gain, exactly?

[DaShi]

KH, what do you think are the reasons why other countries pay less for their health care, but have a more cared for populace compared to the US?

Other countries have less of a fetish for specialists as well as simply paying all doctors less.

[Jon Miller]

Most doctors are middle class though. I could beleive an extra ~10k per doctor per year for extra costs due to training, but that isn't much on a per patient basis.

And people were just arguing that malpractice isn't big enough to make up the difference.

So I am going to have to disagree with you.

JM

[Arrian]

Tort reform would yield tens of billions in savings.

It seems very few people (not just the GOP, before anyone assumes I mean that) are serious about cost control. Tort reform! The magic bullet!

-Arrian

[Guynemer]

Other countries have less of a fetish for specialists as well as simply paying all doctors less.

And part of that is related to the relative costs of medical school. Med school is prohibitively expensive here in the US, so doctors make relatively more money.

Any plan to decrease compensation for doctors, therefore, must be accompanied by tort reform (to reduce malpractice costs), a decrease in medical school costs, and some degree of forgiveness for medical school loans currently in repayment.

[Jon Miller]

http://www.cato.org/pubs/pas/pa527.pdf

It's definitely biased, but at least is a study of some sort.

JM

[DaShi]

Most doctors are middle class though. I could beleive an extra ~10k per doctor per year for extra costs due to training, but that isn't much on a per patient basis.

And people were just arguing that malpractice isn't big enough to make up the difference.

So I am going to have to disagree with you.

JM

Fine, screw you then!

[KrazyHorse]

KH, what do you think are the reasons why other countries pay less for their health care, but have a more cared for populace compared to the US?

a) I have no idea what you mean by "more cared for". Please elaborate what metric you are using

b) In other countries the government purchaser of health care might exercise monopsony power, which the US gov't will not, even under a plan that includes a new gov't competitor

c) In other countries the gov't has proved willing to control costs by restricting care choices, something the US gov't has not done effectively

d) Magic. This is not the only area in which American exceptionalism has shown itself.

I know one is doctors education. But that is a one time cost that should just increase costs just slightly on a per service basis over the course fo the doctors life time.
JM

300000$ present value = small?

(private undergrad + private med school)

[KrazyHorse]

Most doctors are middle class though. I could beleive an extra ~10k per doctor per year for extra costs due to training, but that isn't much on a per patient basis.

You could probably at LEAST triple that. Remember that you have to include all the people who went to a fancy private school because they wanted to become doctors and yet still didn't end up doing so.

[Jon Miller]

Divided among all their patients and over the course of their professional lives... yeah?

JM

[Jon Miller]

You could probably at LEAST triple that. Remember that you have to include all the people who went to a fancy private school because they wanted to become doctors and yet still didn't end up doing so.

Why would that cause doctors to ask patients to pay more?

I agree that it is part of the costs with educating medical people in the US. But it isn't part of what patients pay, I think.

Despite all of that, I know many incompetent doctors in the US.

JM

[KrazyHorse]

Divided among all their patients and over the course of their professional lives... yeah?

JM

Now double it because it's posttax money....

[KrazyHorse]

Why would that cause doctors to ask patients to pay more?

Laugh out ****ing loud.

[Jon Miller]

http://www.bls.gov/oes/2003/may/oes_29He.htm

In 2003 there was something like 300k doctors in the US.

300k \times 2 \times 300k (number of doctors) / 300kk (US population) / 20 (prof lives) = 30$ per capita.

It isn't a major factor, from this estimate.

JM