Health Care Reform - Universal/Public Option

[JPhillips]

Originally Posted by Arles

Reducing profit margin for health-related companies in the US = lesser privately funded research. I'm all for eliminating redundancy, but I have a hard time believing the bureaucracy created to manage public health care will be any less expensive than the one currently used by private insurance companies. And I'm not a big fan of rationing health care services so that a small percentage of people not currently covered can be covered. Let's make 90% suffer so that 6% can get different coverage options. Why not just find a way to get those few without coverage into a plan that fits their needs (maybe that can be subsidized, instead of all 100%)?


That's what everyone said about social security. There is no way a political party will be able to "close the barn door" on a public health care system once it is instituted. They would be plastered as heartless bastards on every newspaper, network and internet page for years. Unless this becomes even more of a clusterf*ck than I think is possible, the political capital needed to undo it will never be there.


Well, if that's the case - why not go to a 50% tax rate like Sweden has to pay for it. It's just a few more percentage points and I'm sure we will see a much better health care system than we have now to justify that expense, right? I mean, the plan is so clear how a 50% tax rate gets us to health care Camelot. Well, that is if we could just pair down the US from $300 million people to around $9 million.

Well sure, if you eliminate every way of saving costs, it's going to be too expensive. At some point, though, costs are the issue. Even if you do nothing now the costs of Medicare are going to kill us in a couple of decades. How do you propose to reduce costs, especially in end of life and chronic care?

Who said SS was going to be temporary? FDR signed it as a solution to extreme poverty among the aged and disabled. Admittedly it didn't cover as many people as it does now, but I don't know where the idea that it was a temporary program comes from.

You're arguing tax rates and I'm not. I'm saying that it's possible to reduce overall spending on healthcare. Sure, taxes would have to go up under a single payer system, but if the costs are lower than in our current system that would still leave more money for individuals. To flip your example, what good would it do me to have my taxes lowered by 5% if that meant my medical expenses would go up by 1.5X that savings?

[RainMaker]

Originally Posted by Arles

A. They don't have quality of health care the US does.
B. They don't fit the bill for research and innovation like the US does.
C. They don't have the responsibility of being the military super power the US does.
D. They don't have the enormous expense (esp in the border states) that the US does in regards to covering illegal/non-tax payers.

Finally, the countries often cited (Canada, Sweden, other Europeans) don't have near the population of the US. Canada has a population of 30 million - the US is 300+ million. Just the sheer complexity in covering that number of people is immense. If Canada had 300 million people, there's no way they would have public health care. And, even with only 30 million, their quality is below what most have in the US.

A. The health care quality may not be better, but it's definitely not worse. I'd say health care is about the same in the U.S. and Canada for 99.9% of all health related issues.

B. That's because we don't allow citizens to purchase their drugs overseas. Removing that barrier would force drug companies to raise prices overseas and lower them in the U.S. If you truly want a free market, those restrictions must be removed and other countries will be forced to pitch in.

C. Our responsibility is to protect ourselves and our allies. We have gone beyond that and entered an unnecessary war that has cost us trillions of dollars. Iraq wasn't a responsibility of ours, and it's time our country started putting their money toward the citizens of this nation and not toward propping up other countries so political contributors can cash in on oil or hefty contracts.

D. Health care costs as a whole from illegals is still a ridiculously small percent of our overall spend. It's not bankrupting the system or causing the massive strain. Other countries (especially heavy tourist ones) cover everyone who comes into their country.

[lynchjm24]

Originally Posted by CamEdwards

House Panels Approve Health Legislation - NYTimes.com

This is from Chris Dodd:

"it eliminates annual and lifetime caps on coverage and ensures that your out-of-pocket costs will never exceed your ability to pay.”

The only thing missing is a "happy ending" with every annual physicial! And I still don't see how we're going to afford to add this new program on top of things like cap-and-trade.

Anyone who believes this nonsense is completely out of their mind. I'm sorry, but if you believe a lying scumbag moron like Chris Dodd and his ability to put together meaningful legislation that serves anyone but Chris Dodd you must be in a coma.

What are we going to have? Government means testing? People hiding assets?

[molson]

I just think it's reasonable to ask the administration to show me that it's possible, in our situation, to say, land on the moon before we land on pluto. Why should we risk the economy of the country and the program we have on a mission to pluto when we've never even accomplished getting to the moon?

What's the aversion to showing progress first? Is it just that we're in that much of a hurry? Doesn't small steps make sense here? If the small steps work, you'll have all the support to do whatever liberal schemes you want.

My guess is, there's a real doubt whether even small steps can work, so the strategy is just to spend an insane amount of money, then hope for any small amount of improvement, and try to brag about that. Then economists can fight it out over whether it was worthwhile or not. Any when there's more economic catastrophe, it will be too complicated to tie to any one particular spending blunder, so the health care plan can't be blamed.

[RainMaker]

Originally Posted by lynchjm24

The drug companies don't have any choice in those other countries. They are stuck with a single payer.

If you take away the American market from drug companies you'll pretty much end innovation in drugs. They get a single payer in the US and you'll get nothing, there will be no possible way to get an ROI on R&D. Already there is less R&D, just look at what Pfizer alone has been doing to their development staff.

The issue in price is between the company and the other country. If that country won't pay what the drug company needs to make a profit globally, then they don't get the drug. Their citizens can wonder why their doctors can't prescribe the newest drugs on the market.

Drugs should be treated like any other item in the global economy. The current restrictions give a huge advantage to the drug companies and shit on consumers in the U.S. They are not in place to create better drugs, they are in place to bring in more profits to the drug companies. They play by a set of rules that no other industry has the benefits of playing by.

[lynchjm24]

Originally Posted by flere-imsaho

How, exactly? R&D costs are an operational budget item, not set by yearly (or quarterly) profit levels. And since these companies need new products and new innovations in order to keep making money why, exactly, would they stop trying to develop these?



How do you feel about HMOs?

HMOs barely exist anymore and the true HMOs that do exist like Kaiser get great reviews from their customers.

If you don't think R&D is a function of profit levels you've never worked for a public company. The first sign of missing a quarterly projection and every expense is cut across the board.

[lynchjm24]

Originally Posted by gstelmack

On the first question, yes. On the second, no idea.

Someone needs to track how well doctors and hospitals are doing. This should include transparent publication of things like infection rates.[*]Streamline the claims process. Better to have someone doing regular inspections to check for fraud than have the detailed breakdown and difficulty of submitting claims and having them paid that we do now.[*]Medical research should be included here and perhaps beefed up to cover the big issues that are resulting in claims.[*]Get rid of marketing departments at drug companies. Not only do we save money on ads, we get rid of all the freebies to doctors to prescribe certain medications that aren't necessarily in the best interests of the patient.[*]Now that everyone is covered, we don't have to worry about the price of meds at pharmacies being different depending on whether or not you have insurance or which provider you happen to be with. It's all government-subsidized anyway now, so much easier / simpler for both the patient and the pharmacy to fill a prescription.[*]Now that everyone is covered, we can turn folks away from emergency rooms for the sniffles. Or at the least the triage nurses can direct folks to appropriate places within the hospital to help true emergencies get emergency treatment in a timely manner.[/list]Now, given the issues at the VA and various mental health facilities (especially locally) I doubt government-run healthcare will really make any of this better, but the topics are worth discussing because we have real problems in all of those areas.

When you track how well patients do at hospitals, guess what happens. Nobody wants to treat high risk patients.

Fraud? There is no way in the world that the government could do a better job tracking fraud then private insurance. That's absurd.

Everyone got covered in Mass. ER visits still went up 41% over 2 years.

Doctors don't get freebees from drug companies anymore. You guys are living in the past on that one. That was all cracked down on. Drug companies can't even do things like buy lunch for the office staff to listen about a drug in some places.

[Arles]

Not to be overly redundant, but it comes back to the concept I talked about a few posts back. I think there are strategies/changes that could make real improvements in coverage (improving poverty options) and cost (looking at medical malpractice costs, partially subsidizing group plans for small business, improving on prescription drug options). Why not try these and see where the dust settles? Maybe the number of uninsured cuts by 2-3% and small business/lower wage workers see a decrease in cost. That seems like a pretty good start and would be worth doing before we toss out the entire system.

I'm back to this idea where if I can cover/improve coverage for 7 of 20 people, that's just not good enough for the congressional leadership and Obama. Unless we try and fix it for everyone (which is way too cumbersome to even understand at this point), we're just not going to do anything. That just seems silly to me.

[lynchjm24]

Originally Posted by RainMaker

The issue in price is between the company and the other country. If that country won't pay what the drug company needs to make a profit globally, then they don't get the drug. Their citizens can wonder why their doctors can't prescribe the newest drugs on the market.

Drugs should be treated like any other item in the global economy. The current restrictions give a huge advantage to the drug companies and shit on consumers in the U.S. They are not in place to create better drugs, they are in place to bring in more profits to the drug companies. They play by a set of rules that no other industry has the benefits of playing by.

Those problems come from having one payer in those areas. I don't disagree, it would be nice if the drug companies played hardball with the single payer nations. Moving us to a single payer causes as many problems as it solves though.

[RainMaker]

Originally Posted by lynchjm24

Doctors don't get freebees from drug companies anymore. You guys are living in the past on that one. That was all cracked down on. Drug companies can't even do things like buy lunch for the office staff to listen about a drug in some places.

Yes they do, althought it's not as brazen as it used to be. Now the money is just funneled through expensive speaking gigs, seeding trials, and paid surveys.

[lynchjm24]

Start with 5 things.

1. Get everyone who is eligible for Medicaid signed up. That's like 10 million people.

2. Limit the ability of Big Pharma to advertise. No more ridiculous commercials where you don't even know what the hell the drug does.

3. Extend tax credits to companies that provide HSA compliant plans and contribute a major part of the cost (75% single and 50% family). Larger credits for smaller employers.

4. Allow insurance companies to compete across state lines in the individual market.

5. Address the malpractice issue. Limit awards except in cases of gross negligence.

Give this 2 years. See where you are then.

The government couldn't even run Walter Reed. That was an embarrassment to this country. There is no way that the United States government is capable of running this system and saving money. They can run the system and costs will explode even faster, but it is in no way possible for them to run the system and lower the medical spend.

To believe differently flies in the face of history.

[RainMaker]

Originally Posted by lynchjm24

Those problems come from having one payer in those areas. I don't disagree, it would be nice if the drug companies played hardball with the single payer nations. Moving us to a single payer causes as many problems as it solves though.

I'm not talking about us moving to a single-payer here. I'm saying to reduce the cost of drugs in this country, opening the borders for trade is the best way to do it. We should not be forced to pay higher prices because the drug companies want to have their cake and eat it too.

[lynchjm24]

Originally Posted by RainMaker

I'm not talking about us moving to a single-payer here. I'm saying to reduce the cost of drugs in this country, opening the borders for trade is the best way to do it. We should not be forced to pay higher prices because the drug companies want to have their cake and eat it too.

I can see giving that a try, but it's not without risk. It's pretty easy to get yourself killed taking counterfeit medication from another country.

[lynchjm24]

If you'd like to read about drug treatments in New Zealand.

http://www.theatlantic.com/doc/200903/postrel-drugs

In a public system, trade-offs don’t go away; if anything, they get harder.

The good thing about a decentralized, largely private system like ours is that health care constantly gets weighed against everything else in the economy. No single authority has to decide whether 15 percent or 20 percent or 25 percent is the “right” amount of GDP to spend on health care, just as no single authority has to decide how much to spend on food or clothing or entertainment. Different individuals and organizations can make different trade-offs. Centralized systems, by contrast, have one health budget. This treatment gets funded, and that one doesn’t.

[JPhillips]

Originally Posted by lynchjm24

Start with 5 things.

1. Get everyone who is eligible for Medicaid signed up. That's like 10 million people.

2. Limit the ability of Big Pharma to advertise. No more ridiculous commercials where you don't even know what the hell the drug does.

3. Extend tax credits to companies that provide HSA compliant plans and contribute a major part of the cost (75% single and 50% family). Larger credits for smaller employers.

4. Allow insurance companies to compete across state lines in the individual market.

5. Address the malpractice issue. Limit awards except in cases of gross negligence.

Give this 2 years. See where you are then.

The government couldn't even run Walter Reed. That was an embarrassment to this country. There is no way that the United States government is capable of running this system and saving money. They can run the system and costs will explode even faster, but it is in no way possible for them to run the system and lower the medical spend.

To believe differently flies in the face of history.

1 Increases taxpayer burden.

2 Is unlikely to lower consumer costs(although still a good idea)

3 Increases the burden on taxpayers or the deficit

4 Don't know much about this. May be the one area that cuts costs significantly

5 Lawsuits are grossly overstated as a cause for medical costs, but I'd trade a revamped drug/equipment approval process that is much more independent with lawsuit reform.

Why would you believe we'd be anywhere substantively different in two years when you aren't really addressing the problem, rising medical costs?

[JPhillips]

Originally Posted by lynchjm24

If you'd like to read about drug treatments in New Zealand.

http://www.theatlantic.com/doc/200903/postrel-drugs

In a public system, trade-offs don’t go away; if anything, they get harder.

The good thing about a decentralized, largely private system like ours is that health care constantly gets weighed against everything else in the economy. No single authority has to decide whether 15 percent or 20 percent or 25 percent is the “right” amount of GDP to spend on health care, just as no single authority has to decide how much to spend on food or clothing or entertainment. Different individuals and organizations can make different trade-offs. Centralized systems, by contrast, have one health budget. This treatment gets funded, and that one doesn’t.

In my insurance plan one treatment is covered and another isn't already.

[RainMaker]

Originally Posted by lynchjm24

Start with 5 things.

1. Get everyone who is eligible for Medicaid signed up. That's like 10 million people.

2. Limit the ability of Big Pharma to advertise. No more ridiculous commercials where you don't even know what the hell the drug does.

3. Extend tax credits to companies that provide HSA compliant plans and contribute a major part of the cost (75% single and 50% family). Larger credits for smaller employers.

4. Allow insurance companies to compete across state lines in the individual market.

5. Address the malpractice issue. Limit awards except in cases of gross negligence.

Give this 2 years. See where you are then.

The government couldn't even run Walter Reed. That was an embarrassment to this country. There is no way that the United States government is capable of running this system and saving money. They can run the system and costs will explode even faster, but it is in no way possible for them to run the system and lower the medical spend.

To believe differently flies in the face of history.

I think that's a start. I'd add a few more.

- Let Medicare use it's massive buying power to negotiate better rates on drugs (similar to what the VA does who pays 58% less for their drugs than Medicare).

- Force health insurance companies with over a certain percent market share in a region to split up. Also give incentives for other insurance companies to get started and create more competition.

- Marking certain procedures for elderly adults as elective surgery and not covered by Medicare. For instance, hip replacement surgery for someone over 85 should not be covered.

- Push better health education in students. Teach them about protiens, carbohydrates, and the different types of fats. What the glycemic index is. How to burn fat and build muscle. None of this 4 basic food groups shit anymore. A complete overhaul of what we are teaching our kids and make it a priority. Also push for more physical activity whether it be gym classes or funded after-school athletic activities (helps not only with health but crime). Start getting healthier foods into schools and eliminating these deals with fast food restaurants and soda makers. Get a kid healthy at 16 with good knowledge of what's good and bad and he has a better chance to be a healthy adult who needs less care.

- Create a government run plan for those who can't qualify for health insurance due to pre-existing conditions. Allow them to pay a monthly fee based on their annual income. For instance, if someone makes $35,000 a year, the government could say they should be able to afford $250/month for this plan. Not having insurance gets you turned away by a lot of doctors and we should not have a system based solely on who won the genetic lottery.

[JPhillips]

Originally Posted by Arles

Not to be overly redundant, but it comes back to the concept I talked about a few posts back. I think there are strategies/changes that could make real improvements in coverage (improving poverty options) and cost (looking at medical malpractice costs, partially subsidizing group plans for small business, improving on prescription drug options). Why not try these and see where the dust settles? Maybe the number of uninsured cuts by 2-3% and small business/lower wage workers see a decrease in cost. That seems like a pretty good start and would be worth doing before we toss out the entire system.

I'm back to this idea where if I can cover/improve coverage for 7 of 20 people, that's just not good enough for the congressional leadership and Obama. Unless we try and fix it for everyone (which is way too cumbersome to even understand at this point), we're just not going to do anything. That just seems silly to me.

People see the House plan as far more radical than it is. There's the public option and some small tax increases. There isn't any discussion of tossing out the entire system.

[lynchjm24]

Originally Posted by JPhillips

Why would you believe we'd be anywhere substantively different in two years when you aren't really addressing the problem, rising medical costs?

As someone who does this everyday and is immersed in it I believe there is no way to lower rising medical costs in the short term.

The only way to lower medical costs is to put people's long term financial situation at stake and teach them how to be healthier starting at an early age.

Something like a health IRA or health 401k could be created and people are going to have to understand they need to fund their health care and it's going to be very expensive.

Giving health care as an entitlement cannot lower costs. It's the ultimate embodiment of a moral hazard. Give people access to cutting edge medicine for free, and some will end up needing it who shouldn't have, just because it was available.

[RainMaker]

Originally Posted by lynchjm24

I can see giving that a try, but it's not without risk. It's pretty easy to get yourself killed taking counterfeit medication from another country.

I think regulating what countries can sell along with which manufactuerers are allowed to ship here. We do this with food which can be just as lethal if not done right.

[lynchjm24]

Originally Posted by JPhillips

In my insurance plan one treatment is covered and another isn't already.

Right, and that's generally decided by the company you work for, not the insurance company. Insurance companies generally cover things that have been proven to be medically necessary.

Most of the issues on coverage are on emerging issues like Autism where A) there is no history of coverage as the conditions are really just starting to hit a critical mass and B) there is no consensus on the best way to treat.

[JPhillips]

Giving health care as an entitlement cannot lower costs.

I still don't understand how you can make a blanket statement like this when, in other countries, it has lowered costs.

[JPhillips]

Originally Posted by lynchjm24

Right, and that's generally decided by the company you work for, not the insurance company. Insurance companies generally cover things that have been proven to be medically necessary.

Most of the issues on coverage are on emerging issues like Autism where A) there is no history of coverage as the conditions are really just starting to hit a critical mass and B) there is no consensus on the best way to treat.

For the end user who makes the decision doesn't matter a whole lot. What's important is that I can have treatment A but not treatment B. Almost all of us already have insurance where that's the case.

[lynchjm24]

Originally Posted by JPhillips

1 Increases taxpayer burden.

2 Is unlikely to lower consumer costs(although still a good idea)

3 Increases the burden on taxpayers or the deficit

4 Don't know much about this. May be the one area that cuts costs significantly

5 Lawsuits are grossly overstated as a cause for medical costs, but I'd trade a revamped drug/equipment approval process that is much more independent with lawsuit reform.

Why would you believe we'd be anywhere substantively different in two years when you aren't really addressing the problem, rising medical costs?

The cry is that there are too many uninsured. Well starting with signing up those who are already eligible seems to make sense to me. Of course it won't save money, neither will the house plan.

I'm just trying to take a step in the right direction. I do think that 2 would lower costs. They must pay for that advertising somehow and it leads to people taking a lot of drugs they really don't need.

#3 might not save money but it might be a wash. As those companies drop coverage that burden is getting shifted anyway.

It's hard to say how much malpractice adds to the cost. The providers certainly seem to think it does, especially in certain areas.

[lynchjm24]

Originally Posted by JPhillips

I still don't understand how you can make a blanket statement like this when, in other countries, it has lowered costs.

It hasn't. Their costs are lower then ours for a number of reasons. Many of them are because of rationing, which Americans are not going to stand for.

[lynchjm24]

Originally Posted by JPhillips

For the end user who makes the decision doesn't matter a whole lot. What's important is that I can have treatment A but not treatment B. Almost all of us already have insurance where that's the case.

So a system where everyone gets what they want whenever they want you think is something to strive for? You might need to add some zeros to the trillions.

[JPhillips]

Originally Posted by lynchjm24

It hasn't. Their costs are lower then ours for a number of reasons. Many of them are because of rationing, which Americans are not going to stand for.

That's just playing with semantics. If you say all cost cutting measures can't be counted, it's pretty easy to say there are no savings.

[RainMaker]

Originally Posted by lynchjm24

It hasn't. Their costs are lower then ours for a number of reasons. Many of them are because of rationing, which Americans are not going to stand for.

Which countries ration? I would say if anything that they are just more realistic with their approach. You don't get an MRI everytime you have a headache in Canada nor a CT scan because you have tennis elbow. The problem here is that our doctors treat everything as if it's that .001% case where it is something more serious.

I never remember reading about them running out of some supply or drug in Canada.

[JPhillips]

Originally Posted by lynchjm24

So a system where everyone gets what they want whenever they want you think is something to strive for? You might need to add some zeros to the trillions.

No, I'm saying the fear of government deciding treatment is way overblown. In your post you highlighted, This treatment gets funded, and that one doesn’t, presumably as one of the problems with a single payer system. I'm saying that for me and most Americans we already live in a system where that's true.

[CamEdwards]

Originally Posted by JPhillips

No, I'm saying the fear of government deciding treatment is way overblown. In your post you highlighted, This treatment gets funded, and that one doesn’t, presumably as one of the problems with a single payer system. I'm saying that for me and most Americans we already live in a system where that's true.

It's a helluva lot easier to fight your insurance company (or switch) than it is to fight the federal government if it decides you don't need treatment.

[RainMaker]

Originally Posted by CamEdwards

It's a helluva lot easier to fight your insurance company (or switch) than it is to fight the federal government if it decides you don't need treatment.

Not if you're poor. In any event, the insurance company is much more likely to fight you than the federal government.

[flere-imsaho]

Originally Posted by lynchjm24

If you don't think R&D is a function of profit levels you've never worked for a public company.

Oh really? Tell me, do you think Apple cuts R&D when they have a bad quarter? How about Toyota? Sony? Nokia? BP?

We're not talking about Wal-Mart here.

The first sign of missing a quarterly projection and every expense is cut across the board.

I'd love to see some evidence for this claim. Despite the hyperbole bandied about concerning corporate executives who slash and burn, I can assure you that the typical response to a bad quarter is not to cut all expenses across the board.

If I didn't know better, I'd think you were the one without corporate experience....

Originally Posted by lynchjm24

I don't disagree, it would be nice if the drug companies played hardball with the single payer nations.

They don't because they still make a profit from their sales to countries such as Germany, France, UK, Japan, etc.... That's not even to mention the better R&D & clinical trial support they get from those countries as opposed to the United States.

Big Pharma's a business. They don't give drugs away for free, at least to first world nations. What, possibly, could be the motivation for them to do so?

[flere-imsaho]

Originally Posted by lynchjm24

As someone who does this everyday and is immersed in it I believe there is no way to lower rising medical costs in the short term.

The only way to lower medical costs is to put people's long term financial situation at stake and teach them how to be healthier starting at an early age.

Look, I mean this in the nicest way possible, but I think you're biased here. You may have immersed yourself in the details, but as an unintended consequence you've also put yourself in a position where you're not seeing the forest for the trees. You've drunk the Kool-Aid, my friend, and it shows when you dismiss, out of hand, the stated facts that others are putting to you in this discussion.

Originally Posted by lynchjm24

Right, and that's generally decided by the company you work for, not the insurance company. Insurance companies generally cover things that have been proven to be medically necessary.

...and not too expensive. I mean, let's be honest here.

Originally Posted by lynchjm24

It hasn't. Their costs are lower then ours for a number of reasons. Many of them are because of rationing, which Americans are not going to stand for.

Americans already stand for quite a lot of rationing of health care, but many don't realize it because of the good marketing the industry does, and our politicians certainly don't understand it because their health care system doesn't ration in the slightest.

[CamEdwards]

Originally Posted by RainMaker

Not if you're poor. In any event, the insurance company is much more likely to fight you than the federal government.

My comment was about the insured, not the poor Americans without insurance. As to your second comment, I don't see how there's any possible way you could know that, given the huge influx of people who would be under the federal umbrella.

[CamEdwards]

Originally Posted by flere-imsaho

Look, I mean this in the nicest way possible, but I think you're biased here. You may have immersed yourself in the details, but as an unintended consequence you've also put yourself in a position where you're not seeing the forest for the trees. You've drunk the Kool-Aid, my friend, and it shows when you dismiss, out of hand, the stated facts that others are putting to you in this discussion.

I've yet, in seven pages of this thread, seen any stated fact about being able to reduce costs and increase service, other than some generic statement about "reducing waste", which is nonsense.

To me, it's simple. The American people want something we can't afford, and we're completely unwilling to bend to reality. We're behaving like a bunch of Californians!

[Arles]

Originally Posted by RainMaker

Which countries ration? I would say if anything that they are just more realistic with their approach. You don't get an MRI everytime you have a headache in Canada nor a CT scan because you have tennis elbow. The problem here is that our doctors treat everything as if it's that .001% case where it is something more serious.

I never remember reading about them running out of some supply or drug in Canada.

This is one of my main concerns when it comes to services under a universal plan:

Wait times for surgery in Canada at all-time high: study

A typical Canadian seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high, according to new research published Monday by independent research organization the Fraser Institute.

"Despite government promises and the billions of dollars funnelled into the Canadian health-care system, the average patient waited more than 18 weeks in 2007 between seeing their family doctor and receiving the surgery or treatment they required," said Nadeem Esmail, director of Health System Performance Studies at the Fraser Institute and co-author of the 17th annual edition of Waiting Your Turn: Hospital Waiting Lists in Canada.

The survey measures median waiting times to document the extent to which queues for visits to specialists and for diagnostic and surgical procedures are used to control health-care expenditures.

"It's becoming clearer that Canada's current health-care system cannot meet the needs of Canadians in a timely and efficient manner, unless you consider access to a waiting list timely and efficient," Esmail added.

The 2007 survey found the total median waiting time for patients between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, increased to 18.3 weeks from 17.8 weeks observed in 2006. This was primarily due to an increase in the first waiting period, between seeing the general practitioner and attending a consultation with a specialist.

Rarely do you wait more than 3 weeks in the US for most surgeries. So, adding three months of wait time for surgery isn't something that counts as "improvement" to me.

[RainMaker]

Originally Posted by Arles

This is one of my main concerns when it comes to services under a universal plan:

Wait times for surgery in Canada at all-time high: study


Rarely do you wait more than 3 weeks in the US for most surgeries. So, adding three months of wait time for surgery isn't something that counts as "improvement" to me.

It's based on necessity though. If you needed immediate brain surgery to stop a clot, you'd get it. If you have a bum shoulder that you need a minor surgery for, you're going to wait a few months (depending on where you live). It sucks, but it's also the price you pay to have everyone covered and not have to deal with begging your insurance company to pay their share months down the road.

Does anyone have a definitive wait time on US and surgeries? The study is from the first doctor visit till the procedure. In the U.S, minor issues can take a long time too between initial visit, testing, some less invasive options, and finally the surgery. I'd be curious to see how it compares to our time table (which I'm guessing is shorter on average, though much more expensive).

It's also worth noting that if you have the money, you can get the procedure done privately. You are in now way forced to go the government route. I'm a fan of the public/private hybrid.

[RainMaker]

Originally Posted by lynchjm24

Right, and that's generally decided by the company you work for, not the insurance company. Insurance companies generally cover things that have been proven to be medically necessary.

Most of the issues on coverage are on emerging issues like Autism where A) there is no history of coverage as the conditions are really just starting to hit a critical mass and B) there is no consensus on the best way to treat.

That's not necessarily true. If you stay at a hospital for an extended period of time, the insurance company will try to get you out faster. They will threaten to not pay for extra days or set a predetermined number. I dealt with this on my own when my insurance company stated they wanted me out on a certain date while the surgeon wanted me to wait since he was worried about an infection. New Mothers are being pushed out of the hospital much faster than they ever have been against the advice of doctors.

My Mom was on a regular dose of Humira every month which costs around $1500. Her doctor who is one of the leading voices in the entire world on Psoriatic Arthritis wanted her to double the dose as he had had exceptional results with it with other patients. The insurance company refused to pay for the second dose and we had to cover it out of pocket for about 4 months until upon numerous appeals and calls, they reversed their decision. She never got reimbursed on the $6000 dished out for a treatment a top doctor in that profession prescribed that worked wonders on her.

Now maybe I've just had bad luck, but I do know this happens a lot. There are stories everywhere about insurance companies pushing for shorter stays, less drugs, and less tests. It's a completely fucked up industry as it's not in the best interest of your insurance company for you to get the best treatment possible. They are better off if you go home early from the hospital and die than to stay an extra two days under supervision of medical professionals. That has to be an area of the insurance industry that must be fixed. The doctors are in charge, not the insurance companies.

In the same vain, doctors do take advantage often times and do unnecessary tests. As I stated earlier, a doctor who owns his own MRI machine is 4 times more likely to use it. There has to be some enforcement of doctors as well.

[gstelmack]

Originally Posted by RainMaker

- Push better health education in students. Teach them about protiens, carbohydrates, and the different types of fats. What the glycemic index is. How to burn fat and build muscle. None of this 4 basic food groups shit anymore. A complete overhaul of what we are teaching our kids and make it a priority. Also push for more physical activity whether it be gym classes or funded after-school athletic activities (helps not only with health but crime). Start getting healthier foods into schools and eliminating these deals with fast food restaurants and soda makers. Get a kid healthy at 16 with good knowledge of what's good and bad and he has a better chance to be a healthy adult who needs less care.

My problem with this is two-fold:

1. That advice changes every couple of years. Since I graduated from high school it's gone from "avoid protein!" to "avoid fat!" to "avoid carbs!".
2. Kids are already taught physical fitness and the food pyramid and it's not working...

[SportsDino]

EDIT: I don't intend to slow the overall discussion, my intent is to build up a collection of bolded statements that I think makes for good public policy, a bit at a time so it's easy to digest or tear apart in detail.

Okay, well we're starting to see some more specific statements, so I'll go ahead and interject on a few of the 'easier' ones from my point of view.

1. Opening up the drug trade to an international market
This makes total sense from an economics standpoint. The whole notion that it is necessary for the U.S. to be an inefficient market is the biggest pile of nonsense ever rolled out.

Other countries do not have total power to negotiate rates. If they go full 'unethical' and outright steal the drug and produce it generically then they run the risk of retaliation from the U.S. trading partner. I would be perfectly fine with the U.S. imposing trade tariffs in response to legitimate complaints of patent infringement by nations on drug companies products.

The two price system (U.S. and otherwise) is a purely obvious market inefficiency supported by government interference. The worldwide price is the true one, if it is insufficient for their budget they need to increase the overall price, not rely on a strangled market (the US). There is zero positive incentive for our government or consumers to support this system... it does not even provide lower costs to other nations. Other nations are just paying the true price, and we are paying more... to say otherwise is to insist that our drug companies are making an entirely illogical pricing decision. I'll go into the economics 101 course if its not obvious.

So lets get rid of the unequal market. If the companies do not adjust their local prices than shipping services will do it for them. Now thats some basic capitalism that will help attack the cost problem. I do have a defense ready in case people want to go along the scenario of drug companies raising the world wide price to negate the net impact on costs, but I think everyone can agree once the government imposed barrier is out of the way there is not much for those companies to do.

2. We don't need Big Pharma advertisements.
If Joe Schmoe watching television needs to tell his doctor anything then we have some damn useless shlubs for doctors who need to be fired. The entire notion of these advertisements is to drive waste in the system... to create a notion in the consumer that they need something they really do not. If they do need it, the doctor is ethically obligated to tell them so. Never, ever, ever, should we assume that a drug commercial has a purpose.

Instead, some far smaller share of resources should be set towards increasing the ability to freely and rapidly acquire information (in many forms) about any drug that may be related to your condition. Promote information access and alert doctors, commercials promote waste, and I can't see any positive benefit to them (for consumers or health care costs overall, oh yes I can see the greed monster benefits quite well).

Again, some impact on costs... heavy advertising is a far more expensive use of money than any other way to provide the same information, and you eliminate waste being caused by hype more than need for a drug (in fact that is the only reason to advertise).

3. Tax credits for employers that purchase some sort of standard compliant plan.
I'm not sure what standards level should be set for this... I personally think to get a credit it needs to actually follow a standard that probably has not been created yet (higher than 'just the minimum').

I personally am for just about any tax credit that is directly based on providing essential benefits to employees. If it encourages a company to employ more people because the tax credit nudges its income statement in the right direction, more power to them. I am aware this will be a subsidy to already wealthy companies at first.

This actually could increase costs, the notion of how subsidies interact with prices in many ways can be a factor to jump things up (basically inject more dollars into the system for the same set of services, why not raise the prices to capture more of the dollars, without no need to increase services). However, I think it could help attack costs if you create a new standard of health plan to qualify for the credit, and that standard must involve reforms directly targeted towards overall cost reduction (for instance more prevention support, health incentives, and so on). I think the insurance being sold these days is a substandard product, so just handing out government dollars to them encourages stupidity (like with banks!).


-----

All right, so my question at the moment is do these three on their own have significant objection? I pulled some that I think are not so contested just to get a start towards some notion of common sense on this topic. It is obvious universal versus private versus hybrids is a very large topic, and I always think debates get less 'religious' the more you subtract some of the noise off them.

If that is cool, I think the next topic I'd like to bring up is sources of waste and substandard service in the private health care system (note they may exist in the foreign universal situation as well, I personally am a hybrid'er because I think both have their ugly sides or lack of practical implementation speed for the US situation).

[Eaglesfan27]

Originally Posted by Swaggs

As an aside, I know my wife was offered a job where she could essentially sit at her desk, write Rxs, and duck her head into a room to "see" a patient (so that insurance would pay). She could have made about $70K more than she makes at the job she ended up taking, but she wanted to actually work with patients, rather than using her 9-years of training to write prescriptions for patients that nurses or social workers saw. Again, there was an administrator at that particular clinic that was a great businessman (who knew how to work the system), but I'm not sure that I would consider the level of care to be very good there.

I'm trying to remember, is your wife a psychiatrist? I was offered a very similar deal when I first finished residency, but it did not appeal to me either. One of the most satisfying things for me is that patients come to the public clinic I work at and almost always say, "I can't believe how much more time you spent with me than Dr. [on of a few local private child psychiatrists] and how much better you are getting to know my child." I don't trust myself not to fall to the pressure of constantly trying to see more patients if I wasn't working at a state clinic, which makes me hope that this system doesn't get screwed up any time soon. Oh yeah, almost every single child psychiatrist in this area doesn't take any insurance and they are all generally thriving. However, as others have mentioned, many doctors make an amount that is low and would surprise people. I haven't looked at the numbers recently, but I think the average pediatrician still makes under 6 figures or in the very low 6 figures.

[JPhillips]

Dino: I think three would be very hard to implement. What about hourly employees? Part-time? What about differing levels of insurance for executives? Do you keep the tax-free nature of health benefits as it currently stands? Is the credit based on how many individuals are covered? A raw number or brackets?

I'm also not quite sure what the credit is supposed to accomplish. Will it be large enough to cover the costs of healthcare or a significant portion of it? If not is it really much of an incentive? Won't it also likely help inflate insurance costs as they'll initially seem much lower?

[miked]

Originally Posted by lynchjm24

Doctors don't get freebees from drug companies anymore. You guys are living in the past on that one. That was all cracked down on. Drug companies can't even do things like buy lunch for the office staff to listen about a drug in some places.

You are very uninformed. I know Grassley has just come down rather hard (especially on my University) but this is laughable. I have a friend who is in private practice that makes an extra year's worth of salaries by giving "talks" and hosting dinners for 2 weekends a month or so. In academia, it's been tightly regulated (especially lately) but not really in private practice. Also, if you'd like, you can accompany me to the next major conference, we can have a drink in Merck's suite (after getting a nice steak dinner for listening to their "studies" showing efficacy of their statin) and talk all about it.

[Arles]

Originally Posted by RainMaker

It's based on necessity though. If you needed immediate brain surgery to stop a clot, you'd get it. If you have a bum shoulder that you need a minor surgery for, you're going to wait a few months (depending on where you live). It sucks, but it's also the price you pay to have everyone covered and not have to deal with begging your insurance company to pay their share months down the road.

I don't want to pay that price. I play soccer year round and am 33 years old. If I tear up my knee or shoulder and need surgery, waiting three months could severely impact my ability to keep playing and risk further damage. Not to mention going three months without exercise isn't going to do me any favors.

And, to play devil's advocate, what do other people get for my "sacrifice"? If someone goes to the ER, they are going to be treated right now (regardless of what kind of insurance they have). My 3 month wait is basically going to allow a handful of people to have access to better treatment on non-life threatening ailments. Instead of making me suffer, why not try to find who these people are who would benefit and start chipping away without massive changes that cause the quality of life for the 90+% with good coverage to suffer?

Does anyone have a definitive wait time on US and surgeries? The study is from the first doctor visit till the procedure. In the U.S, minor issues can take a long time too between initial visit, testing, some less invasive options, and finally the surgery. I'd be curious to see how it compares to our time table (which I'm guessing is shorter on average, though much more expensive).

The story I referenced had a link that said 2 weeks is the norm for surgery in the US. Heck, most cosmetic surgeries are scheduled and completed within 3 weeks per their data. That same study above linked to an article stating that some procedures have well over a 1-year waiting period in Canada. Here's a quote on bariatric surgery (ie, for obesity):

According to the study, the average waiting time for bariatric surgery in Canada is 5 years, a timeframe that is long compared with the 8-week average for cancer surgery or the 18-month average for cosmetic surgery. Yet many studies have shown that this type of procedure reduces the risk of death over 5 years from 40% to 85%: bariatric surgery can therefore save lives.

I'm not sure I want to be waiting 2 months for Cancer surgery either.
There are a lot of risks and downsides with Canada's plan that no one seems to be informing the public about. I'm pretty sure a lot of people in favor of national health care might have a different tune if they knew it could lead to 2-month waits for cancer surgery, 3-4 months for orthopedic surgery, 18 months for cosmetic surgery (which often isn't superficial when it comes as the result of an illness or accident) and 5 years for some more specialized procedures (many which may be needed for cases of diabetes and others).

Imagine getting in a car wreck, having damage to your neck, shoulder and cheek - only to find out you need to wait 3 months for neck surgery, 4 months for shoulder surgery and almost 2 years to repair your messed up cheek - Sign me up for that! As of right now, all 3 procedures would be done in the US within 2-3 weeks (according to the average numbers in the story for orthopedic and cosmetic surgery). Why risk that for something that we don't even know will solve the main problems with health care?

[JPhillips]

We're not risking that because no bill is proposing a single payer system.

[Arles]

Originally Posted by JPhillips

We're not risking that because no bill is proposing a single payer system.

OK, if people in this thread are abandoning the idea of a Europe/Canada universal coverage plan, then I feel a lot better about the prospects of finding a good solution. I didn't know that was the case, but if it is I will shift the focus to non-full public coverage solutions.

[RainMaker]

Originally Posted by Arles

I don't want to pay that price. I play soccer year round and am 33 years old. If I tear up my knee or shoulder and need surgery, waiting three months could severely impact my ability to keep playing and risk further damage. Not to mention going three months without exercise isn't going to do me any favors.

And, to play devil's advocate, what do other people get for my "sacrifice"? If someone goes to the ER, they are going to be treated right now (regardless of what kind of insurance they have). My 3 month wait is basically going to allow a handful of people to have access to better treatment on non-life threatening ailments. Instead of making me suffer, why not try to find who these people are who would benefit and start chipping away without massive changes that cause the quality of life for the 90+% with good coverage to suffer?

The story I referenced had a link that said 2 weeks is the norm for surgery in the US. Heck, most cosmetic surgeries are scheduled and completed within 3 weeks per their data. That same study above linked to an article stating that some procedures have well over a 1-year waiting period in Canada. Here's a quote on bariatric surgery (ie, for obesity):

I'm not sure I want to be waiting 2 months for Cancer surgery either.
There are a lot of risks and downsides with Canada's plan that no one seems to be informing the public about. I'm pretty sure a lot of people in favor of national health care might have a different tune if they knew it could lead to 2-month waits for cancer surgery, 3-4 months for orthopedic surgery, 18 months for cosmetic surgery (which often isn't superficial when it comes as the result of an illness or accident) and 5 years for some more specialized procedures (many which may be needed for cases of diabetes and others).

Imagine getting in a car wreck, having damage to your neck, shoulder and cheek - only to find out you need to wait 3 months for neck surgery, 4 months for shoulder surgery and almost 2 years to repair your messed up cheek - Sign me up for that! As of right now, all 3 procedures would be done in the US within 2-3 weeks (according to the average numbers in the story for orthopedic and cosmetic surgery). Why risk that for something that we don't even know will solve the main problems with health care?

But you don't have to wait. You would be free to choose a private option if you felt the wait was too long for your liking.

[Arles]

Originally Posted by RainMaker

But you don't have to wait. You would be free to choose a private option if you felt the wait was too long for your liking.

So, I'll have to pay a higher tax rate to get "public health care". Then, I will find the quality of care is much lower than I am used to so I will have to hope my company continues to offer a private option so I can pay for that as well. If they don't, not only will I be paying higher taxes, but I will be paying more in premiums to find an independent broker to get me private insurance like I was self employed.

Hard to find fault in this plan...

[CamEdwards]

BTW, Peter Singer says we "Must Ration Health Care".

hxxp://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?em

It's an interesting column, but the fact remains that the phrase "rationing your health care" sounds like a bad freaking idea to the tens of millions of Americans who are already insured. It may be cold-hearted of them, or short-sighted of them, but it's also a fact.

[Arles]

If not wanting to wait 2 months for cancer surgery and 4 months for orthopedic surgery makes me a cold-hearted ass, guilty as charged.