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Post by mnhermit on Jul 7, 2009 9:49:40 GMT -5
I heard a report this morning on NPR (I was just waking up so I suppose I could be full-of-it), that the new 'health care bill' is out of committee in the Senate and one of the 'features' of it is that all individuals are required to buy insurance and all employers are required to assist in it's purchase. Not to pick nits or anything, but this seems to me to be an insurance company assistance program and NOT a health care program. And how does this address the spiraling costs associated with health care?
Like I said I'm probably full of it, and heard this in the daze between dreams and wakefulness, and it sounds so like the idiots in DC, But it couldn't really be true could it?
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Post by omaha on Jul 7, 2009 12:32:31 GMT -5
I haven't seen the details of the bill, yet. They were talking about it on the radio a little while ago. I'm not sure what to think.
But in general, the questions I am going to be asking about any attempt at reform are:
1) What, specifically, does this do to reconcile the commitments currently made (via Medicare and Medicaid) to the future with the fact that we simply can not afford what we have committed to do?
2) We are often told that the US spends something like 2x to 5x per person on medical care compared to other countries, and yet our outcomes are (as measured by societal averages) not significantly different. This is presented as evidence that there are vast amounts of money waiting to be "captured" if we can only improve our system. I want to know, specifically, what things that are happening today would not be happening if we captured these efficiencies.
3) Depending on who you talk to, there are something like 20 to 40 million uninsured people in the US. Most of the proposals being discussed are sold, at least in part, on the basis of providing universal coverage...which is to say, bringing those people into the system. I would like to know how we intend to bring 20 to 40 million new people into the system without creating massive new waiting lists or other dislocations. Round numbers, that is roughly the population of Canada. Can our current system simply absorb 30 million new patients? How many new doctors and nurses and other staff will it take to absorb 30 million new patients? How long will it take our medical schools and other institutions to train those people?
4) The inevitable public policy reality of the 21st century is demographics: Rapidly aging populations in an age of advanced welfare states are simply unsustainable. If we aren't talking demographics in this, we aren't being serious. How does the US intend to finance the health care system being proposed in 20, 30, 50 years and beyond?
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Post by loopysanchez on Jul 7, 2009 12:47:42 GMT -5
Great questions, Omaha. I doubt you'd get too many answers from your average American, other than, "Well, the current system doesn't have a solution for any of the problems you mentioned either!" I will attempt to answer #3, and I do so making some assumptions on the dems' logic of how the numbers will play out: 3) You're assuming that those 30 million people never go to a doctor in the current system. They do, but it's usually at a hospital ER, and usually after their condition has gotten worse and costs a lot more to fix. I don't know how the numbers will play out, but I think the dems are counting on the cost of treating the uninsured at ER's being cancelled out by the cost of giving them insurance that will allow them to get checkups and visit a doctor's office when they need to. As for how an extra 30 million people will be able to find family doctors, I figure capitalism will take care of that in due time--If there's money to be made, the occupational numbers will shift accordingly to fill the gap. That is, unless government sets an unrealistic limit on what they will pay to doctors for services provided so that there is no incentive for new doctors to enter the profession to tap into the enormous new customer base. In other words, Washington will probably screw this up like they do with every other business venture they attempt.  |
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Post by dickt on Jul 7, 2009 12:51:27 GMT -5
3) Depending on who you talk to, there are something like 20 to 40 million uninsured people in the US. Most of the proposals being discussed are sold, at least in part, on the basis of providing universal coverage...which is to say, bringing those people into the system. I would like to know how we intend to bring 20 to 40 million new people into the system without creating massive new waiting lists or other dislocations. Round numbers, that is roughly the population of Canada. Can our current system simply absorb 30 million new patients? How many new doctors and nurses and other staff will it take to absorb 30 million new patients? How long will it take our medical schools and other institutions to train those people? So what are these 20-40 million people not "in the system" doing for health care now? Visiting witch doctors? New patients? WTF are you talking about? These folks are either paying out of pocket w/o insurance, getting treated in emergency rooms and not paying (so we're all paying the cost), or postponing/forgoing treatment. What's your alternative--send them all to Canada? |
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Post by Russell Letson on Jul 7, 2009 13:02:22 GMT -5
Jeff's questions and concerns strike me as more than reasonable. Real reform means serious reallocation and realignment of resources (only some of which are simply monetary), which, when combined with the awesome lobbying influence of the insurance companies and for-profit health-care-corporations, makes me wonder whether we're up to the challenge. I'm willing to entertain the idea that a Euro-style single-payer system won't fly here, but even a hybrid system threatens the existing arrangements and income streams of powerful interest groups. If they can't be bought off, there won't be even a half-assed solution.
On the other hand, if the public's nose gets rubbed hard enough in the hideous situation faced by a significant fraction of the population (e.g., laid-off workers diagnosed with cancer or diabetes and unable to get a foot in the door for treatment), maybe sufficient political energy will be liberated to counter the lobbyists. But as long as the pseudo-conservatives keep reading the scripts prepared by political strategists whose job is to carve out an opposition position, it will be impossible to talk rationally about the problems. If I hear one more Congresscritter mouthing the "there will be a bureaucrat between you and your doctor" meme, I'll puke. So pass the bucket and stand back.
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Post by omaha on Jul 7, 2009 13:09:38 GMT -5
If the 30 million (just to simplify and use a single number) are currently being treated, but it is just being done in an inefficient way, fine. But that still leaves the burden on the would-be reformers to explain why the entire system needs to be overhauled in order to change the way 30 million people who are being treated now and will continue to be treated in the future have their bills paid.
Take your scenarios:
- Paying out of pocket : Is there something inherently wrong with that? I mean, that's a choice that reasonable people can make, right?
- Getting treated in ER's and having the costs absorbed by the hospitals : Getting treated in ER's is obviously an inefficient process, but is it inherently bad to simply have the cost of indigent care pushed onto providers? I'm not saying one way or another, but it doesn't strike me as an inherently bad way for society to handle that. Just let the poor be served, and let those costs be spread across the rest of us paying customers. Society is going to be carrying the financial burden for the poor one way or another. This method seems to have the advantage of efficiency. Maybe the answer here is to make hospitals provide clinics for the indigent, to avoid the problem of them going to the ER for every little malady.
- Postponing/forgoing treatment - I think you're still begging the question here. Simply empowering the poor with money for health care (in whatever form) doesn't mean that health care will actually be available. The history of subsidy is plain enough : The more the government subsidizes something, the more it costs. Its Econ 101 : too many dollars chasing too few goods. Look at the cost of college tuition, after 40+ years of ever increasing government subsidy.
But, and this is the central point, if its the case that the 30 million are currently receiving care (just in inefficient ways), then the moral imperative for reform is largely neutralized, isn't it? Instead, it simply becomes a question of increasing net societal efficiency. And, contrary to your implication (eg "what's your alternative?"), there needs to be some connection between the identifiable problems with the current system and the solutions being promulgated.
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Post by omaha on Jul 7, 2009 13:11:51 GMT -5
ps : I should add that I am probably closer to thinking the only real answer, given the social and political realities we are facing, is a true, UK style single payer, government run solution. I think what is being tossed around congress right now is too much of an attempt to split the baby.
I think we will ultimately be very disappointed in such a system. And I think we will learn the hard way that we have given up a tremendous amount.
But I also think its the only way to achieve our core objectives.
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Post by TDR on Jul 7, 2009 13:14:31 GMT -5
This was Hillary's solution to health care, back when she was running. Lots of people aren't covered by health insurance? Simple pass a law that says they have to buy health insurance. Presto, problem solved.
I'm self employed. Therefore there is no pool I readily fit into to get the economy of scale most employees enjoy. An individual policy is ruinously expensive and covers squat. Deductibles are high, copays are high and everyday stuff like dental, vision and a visit to the GP aren't covered.
Its a ripoff and its not health care, why would I buy in? Now the government is going to make me buy in? What, fines and threat of jail if I don't? I'm not gonna get too excited till I see how it shakes out, but this one needs thought thru a little better.
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Post by omaha on Jul 7, 2009 13:15:10 GMT -5
" If I hear one more Congresscritter mouthing the "there will be a bureaucrat between you and your doctor" meme"
Indeed, there will always be something between you and your doctor.
We need to be honest about that.
Today, its your checkbook, or your insurance company, or something like that.
Under a single payer system, it will be a bureaucrat. That's just the hard reality of things. Any system has to account for the fact that demand (particularly if the incremental cost to the patient of treatment is effectively zero) will always outstrip supply. Therefore there must be some mechanism for throttling demand. In Canada, they have a system of managed waiting lists. In the US, we use money.
But its clear to me that our growing and evolving egalitarian impulse is destined to want to replace the checkbook with the waiting list. And single payer advocates shouldn't be shy about saying so.
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Post by millring on Jul 7, 2009 13:19:46 GMT -5
ps : I should add that I am probably closer to thinking the only real answer, given the social and political realities we are facing, is a true, UK style single payer, government run solution. Curiously, that was the basic campaign promise of those who are now in power. BUt now they want to compromise. And it makes one wonder....compromise? ...with who, and why? |
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Post by Supertramp78 on Jul 7, 2009 13:37:21 GMT -5
'I want to know, specifically, what things that are happening today would not be happening if we captured these efficiencies."
For one thing you might not see really large profits for insurance companies. One recent report stated, “profits at 10 of the country’s largest publicly-traded health insurance companies in 2007, rose 428 percent from 2000 to 2007, from $2.4 billion to $12.9 billion.” In 2007, the chief executive officers at these companies collected combined total compensation of $118.6 million — an average of $11.9 million each.”
The guy that used to run United Heath Care was pulling down a couple of hundred million bucks a year as CEO and when they fired him for back dating stock options, they paid him $1.1 billion in severance. The biggest golden parachute in corporate American history.
That is where some of that money is going to come from.
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Post by omaha on Jul 7, 2009 13:41:09 GMT -5
But Tramp, while that might seem satisfying, those numbers are a fart in a hurricane compared to the overall health care economy. Take all those profits to zero and the overall effect is still lost in the rounding error.
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Post by dickt on Jul 7, 2009 13:44:36 GMT -5
If someone can explain why having an insurance bureaucrat is somehow superior to having a government bureaucrat between you and your doctor then please do.
-- A bureaucrat
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Post by omaha on Jul 7, 2009 13:49:10 GMT -5
If someone can explain why having an insurance bureaucrat is somehow superior to having a government bureaucrat between you and your doctor then please do. I'm certainly not making that argument...although if I were, I would say that I have more control over an insurance bureaucrat than a government one. If my insurance company completely pisses me off, I at least have the theoretical prospect of changing companies (and therefore bureaucrats). With the government, I'm stuck, stuck, stuck. But that's not the point. What frustrates me is that Obamacare advocates are being dishonest in their response to the Newt Gingrich criticism that they would "put a Washington bureaucrat in charge of their health care". The fact is Newt is right. That is exactly what would happen. I wish the Obamacare folks would step up and make the case for why that is a good thing. |
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Post by dickt on Jul 7, 2009 13:54:38 GMT -5
If someone can explain why having an insurance bureaucrat is somehow superior to having a government bureaucrat between you and your doctor then please do. I'm certainly not making that argument...although if I were, I would say that I have more control over an insurance bureaucrat than a government one. If my insurance company completely pisses me off, I at least have the theoretical prospect of changing companies (and therefore bureaucrats). With the government, I'm stuck, stuck, stuck. But that's not the point. What frustrates me is that Obamacare advocates are being dishonest in their response to the Newt Gingrich criticism that they would "put a Washington bureaucrat in charge of their health care". The fact is Newt is right. That is exactly what would happen. I wish the Obamacare folks would step up and make the case for why that is a good thing. Not much worth discussing once folks start using phrases like "Obamacare" |
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Post by omaha on Jul 7, 2009 13:58:32 GMT -5
I thought that's what the Obama people were calling it. Its certainly not intended (on my part anyway) as a pejorative term.
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Post by Supertramp78 on Jul 7, 2009 14:04:54 GMT -5
"I wish the Obamacare folks would step up and make the case for why that is a good thing."
for the reason I pointed out. That Wachinton bureaucrat isn't having to make a profit large enough to pay someone a few hundred million a year in salary. This makes it cheaper. Plus if everyone is covered, you will need a lot less of these guys because right now their main job is to say no. With 'no' off the table, you won't have to hire a few hundred thousand people to do that job.
One of the people we listen in on is a health care provider. We listen to sales calls most of the time. Cold calls to people with no insurance seeing if they would like to buy insurance. One of the most commonly asked questions is "Are you currently suffering from end state renal disease?" Translate that, "Do you have kidney failure?" If the answer is yes, the call ends. Buh by. So on one end of the process you have a lot of people who work really hard to make sure some people never get health insurance and another group of people working very hard on the other end making sure that if you do have health insurance you can't always get it to pay for something. This is the system we claim is the best in the world. ALL of those people would go away under any single payer plan. You don't need them. Nobody is refused health care and no treatment is refused.
If this puts a strain on the health care industry I'm pretty sure it will expand to fill the void. Businesses do that. But that is why the bureaucrat is far better than the insurance call center agent. The job of the bureaucrat is to make sure you get coverage. The call center agent is comped on preventing you from getting it.
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Post by Russell Letson on Jul 7, 2009 14:05:19 GMT -5
The meme is annoying, but even more annoying is that it issues unedited, undigested, unprocessed in any way from the mouths of multiple Republicans. Push the button, out comes the line. If I thought that they had independently reached a conclusion and fortuitously come up with the same optimal phrase to express it, I might pay some attention. Instead, they repeat the PR product that's been given them with miminal intervention from whatever rudimentary central nervous systems they might possess. I sometime wonder whether new Congress-entities get their data by being fed the ground-up bodies of their predecessors.
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Post by aquaduct on Jul 7, 2009 14:07:45 GMT -5
This was Hillary's solution to health care, back when she was running. Lots of people aren't covered by health insurance? Simple pass a law that says they have to buy health insurance. Presto, problem solved. I'm self employed. Therefore there is no pool I readily fit into to get the economy of scale most employees enjoy. An individual policy is ruinously expensive and covers squat. Deductibles are high, copays are high and everyday stuff like dental, vision and a visit to the GP aren't covered. Its a ripoff and its not health care, why would I buy in? Now the government is going to make me buy in? What, fines and threat of jail if I don't? I'm not gonna get too excited till I see how it shakes out, but this one needs thought thru a little better. No silly, you've been watching too much FOX News. The government is going to offer a government health plan that we can all get into. To control costs however, they're going to fine employers if too many of thier employees sign up for the government program. Sheesh. Try listening to someone besides Rush. |
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Post by omaha on Jul 7, 2009 14:10:07 GMT -5
The meme is annoying, but even more annoying is that it issues unedited, undigested, unprocessed in any way from the mouths of multiple Republicans. Push the button, out comes the line. If I thought that they had independently reached a conclusion and fortuitously come up with the same optimal phrase to express it, I might pay some attention. Instead, they repeat the PR product that's been given them with miminal intervention from whatever rudimentary central nervous systems they might possess. I sometime wonder whether new Congress-entities get their data by being fed the ground-up bodies of their predecessors. So let me get all "millring" on you and ask "what difference does it make what Republicans say, do or think"? Particularly with Franken finally taking his seat, the democrats can do absolutely anything they want. Forget the republicans. |
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