ObamaCare Implosion

[Jrr85]

This seems like wishful thinking.  With just seniors, between 5% and 6% of the federal budget goes to cover the difference between Medicare revenues and Medicare expenditures.  Health insurance companies have margins of around 3%, so that's not coming close to 5-6% of the federal budget, and I don't think you're going to get there by cutting "inefficiencies." 

If we implemented medicare for all, you could save a lot of money by using monopsony power to cut payments to providers.  But that comes with its own issues (although there is probably a decent amount of health provider compensation that could be cut before you really see negative impacts, although many hospitals probably require something close to what they are currently getting because of fixed costs).

If only someone had done a study on implementing something like this in the US. To see if there would be savings, and if it was feasible.
I wonder what their conclusion would have been?

http://archive.gao.gov/d20t9/144039.pdf

have you even read the executive summary of your link?  It doesn't say anything about medicare for all.  It compares the Canadian system to the U.S. system.  There is no doubt that if we just decide to spend less government money on healthcare, we could spend less money on healthcare.  That is a very different proposition from providing Medicare for all. 

[MustachianAccountant]

This seems like wishful thinking.  With just seniors, between 5% and 6% of the federal budget goes to cover the difference between Medicare revenues and Medicare expenditures.  Health insurance companies have margins of around 3%, so that's not coming close to 5-6% of the federal budget, and I don't think you're going to get there by cutting "inefficiencies." 

If we implemented medicare for all, you could save a lot of money by using monopsony power to cut payments to providers.  But that comes with its own issues (although there is probably a decent amount of health provider compensation that could be cut before you really see negative impacts, although many hospitals probably require something close to what they are currently getting because of fixed costs).

If only someone had done a study on implementing something like this in the US. To see if there would be savings, and if it was feasible.
I wonder what their conclusion would have been?

http://archive.gao.gov/d20t9/144039.pdf

have you even read the executive summary of your link?  It doesn't say anything about medicare for all.  It compares the Canadian system to the U.S. system.  There is no doubt that if we just decide to spend less government money on healthcare, we could spend less money on healthcare.  That is a very different proposition from providing Medicare for all.

Yes, I've read it. My apologies, I didn't catch that your comment was specifically about Medicare, and not a universal health care system generally.

[2buttons]

I enjoy it when people suggest that a number of other countries have it all figured out. Every single system has plusses and minuses, and it is entirely dependent on your population as well past programs/laws, and if your population will actually engage.  You don't think there are people in Canada that bitch about their healthcare?  This does not include our proud Canadian brethren on this board that hardly need convincing that they are better than the U.S. at something given a suggestion by a liberal here.  How about the doctors going on strike in the UK that brought the NHS to full on stoppage earlier this year?  Every system is flawed. 

I hate to break it to you, because people clearly love debating this issue to no end with super entrenched positions, but there is no miracle system. There never will be.  There will always be problems. There will always be sick people who don't engage the system. There will always be a free rider, and there will always be an injustice that someone will make a change to correct, and round and round we go. Make a change to the system? One person gets screwed and another benefits. 

My favorite is when people/media say their healthcare costs are on the rise...

What? Did someone think that as you get older and as your health slowly declines, that everything was going to cost the same or get cheaper?

[Telecaster]

This seems like wishful thinking.  With just seniors, between 5% and 6% of the federal budget goes to cover the difference between Medicare revenues and Medicare expenditures.  Health insurance companies have margins of around 3%, so that's not coming close to 5-6% of the federal budget, and I don't think you're going to get there by cutting "inefficiencies." 

With traditional health insurance, about 20% of each premium dollar is spent on overhead, marketing, and profit, and only 80% is returned in the form of payments. 

With Medicare, that number is closer to 1%.   That's a primary reason why all these studies show single-payer options as cheaper. 

[Jrr85]

This seems like wishful thinking.  With just seniors, between 5% and 6% of the federal budget goes to cover the difference between Medicare revenues and Medicare expenditures.  Health insurance companies have margins of around 3%, so that's not coming close to 5-6% of the federal budget, and I don't think you're going to get there by cutting "inefficiencies." 

If we implemented medicare for all, you could save a lot of money by using monopsony power to cut payments to providers.  But that comes with its own issues (although there is probably a decent amount of health provider compensation that could be cut before you really see negative impacts, although many hospitals probably require something close to what they are currently getting because of fixed costs).

If only someone had done a study on implementing something like this in the US. To see if there would be savings, and if it was feasible.
I wonder what their conclusion would have been?

http://archive.gao.gov/d20t9/144039.pdf

have you even read the executive summary of your link?  It doesn't say anything about medicare for all.  It compares the Canadian system to the U.S. system.  There is no doubt that if we just decide to spend less government money on healthcare, we could spend less money on healthcare.  That is a very different proposition from providing Medicare for all.

Yes, I've read it. My apologies, I didn't catch that your comment was specifically about Medicare, and not a universal health care system generally.

Sorry, my response was a little snarkier than necessary as people often use "medicare for all" as a synonym for single payer.  My point is that single payer in the U.S. won't look like current Medicare.   

To expand on my point, right now, Medicare doesn't pay the average cost of paying for care (I can't find the figures but it's something like 85-90% of average costs).  That uncovered cost is shifted to private parties.  They pay a higher percentage of the fixed/average costs.  But Medicare still pays more than the marginal cost of providing care to medicare recipients.  If we moved to Medicare for all (so Medicaid and private insureds and uninsureds now covered by Medicare), there would immediately be that difference between average and marginal care to adjust for.  Assuming we don't just increase payouts of Medicare (which I think would be a pretty safe assumption based on the budget impacts), that uncovered costs would ahve to be cut.  The most obvious place to cut would be compensation to healthcare providers.  Not sure how much that woudl cover of the short fall, but probably decent amount.  Doctors could certainly make less (in the long run, cutting physician pay could reduce the supply of doctors, but I really don't think this would happen until significant cuts were made).  Nurses and other providers I'm not so sure about; cuts there would probably more immediately impact quality.  There are other costs that are fixed in the short run but could be cut over time (primarily less investment in facilities). 

But even cutting that amount from healthcare immediately, Medicare for all still wouldn't work because there would be a huge shortfall to cover between the medicare taxes and medicare premiums and the amount spent.  At one extreme, they coudl keep Medicare premiums and taxes the same, and you'd end up with something that looks like Medicaid.  There would be a private market for physicians in addition to the Medicaid for all market (and probably a lot of under the table payments for access through medicaid).  At the other extreme, you could charge much more for premiums, in which case you end up with something approximating our current system.  Lots of access to care, high quality care, and at a cost that is also high.  You'd get some immediate benefits from reducing payments to providers, but over time the question is whether Medicare provides the right incentives for efficient care and for new types of care. 

I don't think it would be an option to simply raise taxes to pay for the difference between premiums and expenditures.  I'm not sure it's sustainable to keep doing that just for Medicare.  But certainly you could increase taxes some and then use the new tax revenues to offset some of the premium increases.

But all of these options are probably a little worse than what anybody would envision because Medicare is already on a pace that we can't sustain without significant tax increases.  I wouldn't be huge somes of money on it, but I think the political equilibrium would eventually work out to Medicaid for all, with a significant number of people paying for concierge type services just so they can have access when they want it, and rich people paying for additional insurance that insures they can get a hip replacement surgery or whatever when they want it. 

I'm not sure that's such a terrible result, but I don't think it's what people are envisioning when they say single payer.

 

[Northwestie]

Ummm, you don't think there is major cost shifting going on in the current, non-Medicare insurance business??   Hospitals are charging you and me and folks with insurance quite a bit more to deal with the uninsured.    If we went to some Medicare for all system we also would need some cost containment. 

Right now the cost of say, a hip replacement, varies widely for no apparent reason.   In other countries, even those that depend on a network of private insurers such as Germany, there are standards applied for procedure costs.   You, as a consumer, can't even find out how much most procedures will cost you prior to going into the hospital for crying out loud.  We have the crappiest health care system around - unless you have money.

[Jrr85]

This seems like wishful thinking.  With just seniors, between 5% and 6% of the federal budget goes to cover the difference between Medicare revenues and Medicare expenditures.  Health insurance companies have margins of around 3%, so that's not coming close to 5-6% of the federal budget, and I don't think you're going to get there by cutting "inefficiencies." 

With traditional health insurance, about 20% of each premium dollar is spent on overhead, marketing, and profit, and only 80% is returned in the form of payments. 

With Medicare, that number is closer to 1%.   That's a primary reason why all these studies show single-payer options as cheaper.

One, pretty sure that 1% number reflects the fact that a lot of overhead costs are off loaded onto different agencies. 

Two, if you follow that logic to the extreme, why shouldn't we have single provider of everything?  There's a reason that we don't do that, and it's because private providers and competition work vastly better, enough so that even having additional costs like marketing and losing economies of scale doesn't erase the difference.  We've pretty much used regulation to stamp out the vast majority of competition in health care and health insurance, so we may be at the point where we might as well bite the bullet and take the inefficiencies that come from lack of competition, but you don't want to go that route unless you believe we've already screwed up the market to the point that competition provides no benefits (I'm not sure if we're there or not) and that we can't fix it (if we are there, then I think as far as political reality goes, we're not going to improve things in the near to medium future and might as well make the jump).

ETA: left out the bolded 'not'; hopefully makes sense now.

[2buttons]

Ummm, you don't think there is major cost shifting going on in the current, non-Medicare insurance business??   Hospitals are charging you and me and folks with insurance quite a bit more to deal with the uninsured.    If we went to some Medicare for all system we also would need some cost containment. 

Right now the cost of say, a hip replacement, varies widely for no apparent reason.   In other countries, even those that depend on a network of private insurers such as Germany, there are standards applied for procedure costs.   You, as a consumer, can't even find out how much most procedures will cost you prior to going into the hospital for crying out loud.  We have the crappiest health care system around - unless you have money if you are poor/under or unemployed.

Exactly my point in your first paragraph.

Germany covers 89% of the population - 11% (the super rich) opt out of the crappy insurance scheme and pay for private insurance.

I agree with you, we should have much more transparency and competition, not one insurance plan for everyone that is government run.

Fixed your last sentence for you.

[Telecaster]

One, pretty sure that 1% number reflects the fact that a lot of overhead costs are off loaded onto different agencies. 

Pretty sure it doesn't.  Reimbursements to other Federal agencies are included as a line-item in the Medicare budget.

https://www.cms.gov/About-CMS/Agency-Information/PerformanceBudget/Downloads/FY2016-CJ-Final.pdf

Two, if you follow that logic to the extreme, why shouldn't we have single provider of everything?  There's a reason that we don't do that, and it's because private providers and competition work vastly better, enough so that even having additional costs like marketing and losing economies of scale doesn't erase the difference.  We've pretty much used regulation to stamp out the vast majority of competition in health care and health insurance, so we may be at the point where we might as well bite the bullet and take the inefficiencies that come from lack of competition, but you don't want to go that route unless you believe we've already screwed up the market to the point that competition provides no benefits (I'm not sure if we're there or not) and that we can't fix it (if we are there, then I think as far as political reality goes, we're going to improve things in the near to medium future and might as well make the jump).

Let's follow that logic to extreme the other way.   Why not have free market providers for everything?  Instead of public schools, we'll only have private schools and rely on the free market to educate everybody.  And instead of a police force hired by the city, if you're the victim of a crime you'll call up your favorite private detective and have him to go town.  And when he catches the perp, you'll arrange with a private court to do the trial, and then when he's convicted, you'll selected a nice private prison for him, based on the brochures the private prison company sends you.    Oh, if Canada decides to invade, we'll stop them with free market forces by using competing private armies.   

However, we don't have to look at hypothetical extreme cases,  we can look at this specific case.   Even if your claim that Medicare only pays about 90% of the cost of service is accurate, we could increase reimbursements and still save money.  That said, about 94% of physicians accept private insurance, and 93% accept Medicare.   I suspect those numbers would look a lot different if providers routinely lost money on Medicare patients. 

[randymarsh]

I enjoy it when people suggest that a number of other countries have it all figured out. Every single system has plusses and minuses, and it is entirely dependent on your population as well past programs/laws, and if your population will actually engage.  You don't think there are people in Canada that bitch about their healthcare?  This does not include our proud Canadian brethren on this board that hardly need convincing that they are better than the U.S. at something given a suggestion by a liberal here.  How about the doctors going on strike in the UK that brought the NHS to full on stoppage earlier this year?  Every system is flawed. 

I hate to break it to you, because people clearly love debating this issue to no end with super entrenched positions, but there is no miracle system. There never will be.  There will always be problems. There will always be sick people who don't engage the system. There will always be a free rider, and there will always be an injustice that someone will make a change to correct, and round and round we go. Make a change to the system? One person gets screwed and another

No one ever said that other countries' healthcare systems were perfect. They said they were better the than the US.  It's worth taking a look at how other countries do things because they routinely outscore us on healthcare while spending less money. When all those countries have some actual form of universal coverage and we don't, it's fair to suggest maybe that's the cause.

[radram]

Early on in the healthcare debate, I was at an anti Obamacare rally.
Of on one side was a young lady with a sign, some thing pro Obamacare phrase.
I stopped to talk to her, her husband was in the military and I paraphrase what she said, I don't know why everyone can't be on tricare, we only pay $22 a month.
 I didn't know what tricare was at the time. If I did, I would have pointed out that
there are 1 million people on tricare with 100 million taxpayers subsidizing the premium of those 1 million people.
 I'm not discussing the idea of tricare, I'm suggesting we don't have 3.5 billion people to subsidize the 350 million people in the US.
 I think some of these other government programs are the same way,
using out of pool peoples money to help those in the pool.

And yet, other countries seem to be able to do it. Need us to name a few?

How about instead we list the countries among the 25 wealthiest that do NOT offer BASIC HEALTH COVERAGE for its citizens :

United States of America

I'm not tired, I'm done with the list.

http://www.politifact.com/virginia/statements/2015/sep/01/dan-gecker/dan-gecker-says-us-only-wealth-nation-without-univ/

[Jrr85]

One, pretty sure that 1% number reflects the fact that a lot of overhead costs are off loaded onto different agencies. 

Pretty sure it doesn't.  Reimbursements to other Federal agencies are included as a line-item in the Medicare budget.

https://www.cms.gov/About-CMS/Agency-Information/PerformanceBudget/Downloads/FY2016-CJ-Final.pdf

What item are you looking at?  Just doing a 'control f' search and I apparently missed it.  But:  some additional differences:

http://www.forbes.com/sites/theapothecary/2011/06/30/the-myth-of-medicares-low-administrative-costs/[/quote]

Two, if you follow that logic to the extreme, why shouldn't we have single provider of everything?  There's a reason that we don't do that, and it's because private providers and competition work vastly better, enough so that even having additional costs like marketing and losing economies of scale doesn't erase the difference.  We've pretty much used regulation to stamp out the vast majority of competition in health care and health insurance, so we may be at the point where we might as well bite the bullet and take the inefficiencies that come from lack of competition, but you don't want to go that route unless you believe we've already screwed up the market to the point that competition provides no benefits (I'm not sure if we're there or not) and that we can't fix it (if we are there, then I think as far as political reality goes, we're going to improve things in the near to medium future and might as well make the jump).

Let's follow that logic to extreme the other way.   Why not have free market providers for everything?  Instead of public schools, we'll only have private schools and rely on the free market to educate everybody.  And instead of a police force hired by the city, if you're the victim of a crime you'll call up your favorite private detective and have him to go town.  And when he catches the perp, you'll arrange with a private court to do the trial, and then when he's convicted, you'll selected a nice private prison for him, based on the brochures the private prison company sends you.    Oh, if Canada decides to invade, we'll stop them with free market forces by using competing private armies. 

Well, there wouldn't be anything wrong with having the market provide education.  It would probably be better, although I would say it would be better to just subsidize or even pay for it outright and have it actually provided by private actors.  Law enforcement and national defense are pretty squarely within the parameters of a public good, so the same logic would not dictate private law enforcement, armies, or courts.  You're example doesn't follow "that logic to extreme the other way" because it's not following the logic of it at all.   


 

However, we don't have to look at hypothetical extreme cases,  we can look at this specific case.   Even if your claim that Medicare only pays about 90% of the cost of service is accurate, we could increase reimbursements and still save money. 

You are missing the point.  Medicare currently reimburses less than the average cost of care for medicare recipients, and it still requires huge subsidies from the tax payer.  Moving private insureds onto Medicare will massively increase the amount of taxpayer subsidies required.  And if you moved Medicaid recipients onto Medicare, you would increase the required subsidies and also add the costs of increasing reimbursement rates from Medicaid to Medicare levels. 

That said, about 94% of physicians accept private insurance, and 93% accept Medicare.   I suspect those numbers would look a lot different if providers routinely lost money on Medicare patients.

Providers don't routinely lose money on medicare patients.  They don't recover the average cost of care, which includes an allocation of overhead/fixed cost, but they do cover the marginal costs.  Essentially Insured patients pay for a greater percentage of fixed costs compared to their actual usage. 

[stoaX]

One, pretty sure that 1% number reflects the fact that a lot of overhead costs are off loaded onto different agencies. 

Pretty sure it doesn't.  Reimbursements to other Federal agencies are included as a line-item in the Medicare budget.

https://www.cms.gov/About-CMS/Agency-Information/PerformanceBudget/Downloads/FY2016-CJ-Final.pdf

What item are you looking at?  Just doing a 'control f' search and I apparently missed it.  But:  some additional differences:

http://www.forbes.com/sites/theapothecary/2011/06/30/the-myth-of-medicares-low-administrative-costs/

Two, if you follow that logic to the extreme, why shouldn't we have single provider of everything?  There's a reason that we don't do that, and it's because private providers and competition work vastly better, enough so that even having additional costs like marketing and losing economies of scale doesn't erase the difference.  We've pretty much used regulation to stamp out the vast majority of competition in health care and health insurance, so we may be at the point where we might as well bite the bullet and take the inefficiencies that come from lack of competition, but you don't want to go that route unless you believe we've already screwed up the market to the point that competition provides no benefits (I'm not sure if we're there or not) and that we can't fix it (if we are there, then I think as far as political reality goes, we're going to improve things in the near to medium future and might as well make the jump).

Let's follow that logic to extreme the other way.   Why not have free market providers for everything?  Instead of public schools, we'll only have private schools and rely on the free market to educate everybody.  And instead of a police force hired by the city, if you're the victim of a crime you'll call up your favorite private detective and have him to go town.  And when he catches the perp, you'll arrange with a private court to do the trial, and then when he's convicted, you'll selected a nice private prison for him, based on the brochures the private prison company sends you.    Oh, if Canada decides to invade, we'll stop them with free market forces by using competing private armies. 

Well, there wouldn't be anything wrong with having the market provide education.  It would probably be better, although I would say it would be better to just subsidize or even pay for it outright and have it actually provided by private actors.  Law enforcement and national defense are pretty squarely within the parameters of a public good, so the same logic would not dictate private law enforcement, armies, or courts.  You're example doesn't follow "that logic to extreme the other way" because it's not following the logic of it at all.   


 

However, we don't have to look at hypothetical extreme cases,  we can look at this specific case.   Even if your claim that Medicare only pays about 90% of the cost of service is accurate, we could increase reimbursements and still save money. 

You are missing the point.  Medicare currently reimburses less than the average cost of care for medicare recipients, and it still requires huge subsidies from the tax payer.  Moving private insureds onto Medicare will massively increase the amount of taxpayer subsidies required.  And if you moved Medicaid recipients onto Medicare, you would increase the required subsidies and also add the costs of increasing reimbursement rates from Medicaid to Medicare levels. 

That said, about 94% of physicians accept private insurance, and 93% accept Medicare.   I suspect those numbers would look a lot different if providers routinely lost money on Medicare patients.

Providers don't routinely lose money on medicare patients.  They don't recover the average cost of care, which includes an allocation of overhead/fixed cost, but they do cover the marginal costs.  Essentially Insured patients pay for a greater percentage of fixed costs compared to their actual usage.
[/quote]

Regarding the last sentence above:  When explaining escalating health care costs to employers purchasing group medical insurance, the "cost shifting" from Medicare and Medicaid patients to commercially insured patients is presented as one of the components of the increase by us underwriters.  I.e. doctors and hospitals have to negotiate higher fees with commercial medical insurance carriers to make up for the inadequate fees from Medicare and Medicaid.

[Heywood57]

$1306.64/month for a family of 6,  just over the subsidy line

Meaning your MAGI is over $94k?

   
KP CO Bronze 5000/30%/HSA

Decipher for me.

1306*12 = $15672/year post tax expense

About what I get, but with $72k income I get about a $9,000 subsidy.
 So again, your income is to high to get a subsidy?

My current employer subsidized plan for a family of 6 is $400/month as a pre-tax expense.

KP CO Bronze 5000/30%/HSA was the cheapest possible plan,
I don't care to dig into its details.

A plan that sorta approximates my employer subsidized plan is
$2251     Gold Compass 500
Deductible $500.00/Person/Year    Max $6850/Person/Year

The exchange will show you an estimated subsidy for a given income level.
I iterated thru the ones below, mid to upper 80s is either a sweet spot
or a calculation bug.


Income   Subsidy
-------  -------
 50000     1056
 60000      949
 75000      765
 80000      698
 82000      670
 85000     1045
 87000     1017
 90000      975
 95000      902
100000      842
110000      761
120000      681
130000      600
140000        0

[2buttons]

I enjoy it when people suggest that a number of other countries have it all figured out. Every single system has plusses and minuses, and it is entirely dependent on your population as well past programs/laws, and if your population will actually engage.  You don't think there are people in Canada that bitch about their healthcare?  This does not include our proud Canadian brethren on this board that hardly need convincing that they are better than the U.S. at something given a suggestion by a liberal here.  How about the doctors going on strike in the UK that brought the NHS to full on stoppage earlier this year?  Every system is flawed. 

I hate to break it to you, because people clearly love debating this issue to no end with super entrenched positions, but there is no miracle system. There never will be.  There will always be problems. There will always be sick people who don't engage the system. There will always be a free rider, and there will always be an injustice that someone will make a change to correct, and round and round we go. Make a change to the system? One person gets screwed and another

No one ever said that other countries' healthcare systems were perfect. They said they were better the than the US.  It's worth taking a look at how other countries do things because they routinely outscore us on healthcare while spending less money. When all those countries have some actual form of universal coverage and we don't, it's fair to suggest maybe that's the cause.

Yeah because the score is based on this health, health inequality, responsiveness-level, responsiveness-distribution, and fair-financing, which some of them definitely have socialist type indicators. And big surprise that because we are the wealthiest country in the world we have a lot of people who have access to a lot of things that make them unhealthy. Our fat people are dragging down our score.

Since we have such a thing as the diabetes belt, of course we are going to score poorly, although, apparently with all of that, we are still number 37 out of 191.  Canada beat us by 7 countries btw - they came in at 30.

[Northwestie]

 

However, we don't have to look at hypothetical extreme cases,  we can look at this specific case.   Even if your claim that Medicare only pays about 90% of the cost of service is accurate, we could increase reimbursements and still save money. 

You are missing the point.  Medicare currently reimburses less than the average cost of care for medicare recipients, and it still requires huge subsidies from the tax payer.  Moving private insureds onto Medicare will massively increase the amount of taxpayer subsidies required.  And if you moved Medicaid recipients onto Medicare, you would increase the required subsidies and also add the costs of increasing reimbursement rates from Medicaid to Medicare levels. 



Well, were is that proof??   This is simply a string of unsubstantiated statements.  In contrast, the previously cited GAO report discusses the massive SAVINGS that would be reaped with a single payer system - no profit and much more of an efficient system.  Funny isn't it?  All those other countries of the world have managed it but some dark cloud of ether exists over the US that it would just be IMPOSSIBLE here.   yea, roll eyes

[Jrr85]

 

However, we don't have to look at hypothetical extreme cases,  we can look at this specific case.   Even if your claim that Medicare only pays about 90% of the cost of service is accurate, we could increase reimbursements and still save money. 

You are missing the point.  Medicare currently reimburses less than the average cost of care for medicare recipients, and it still requires huge subsidies from the tax payer.  Moving private insureds onto Medicare will massively increase the amount of taxpayer subsidies required.  And if you moved Medicaid recipients onto Medicare, you would increase the required subsidies and also add the costs of increasing reimbursement rates from Medicaid to Medicare levels. 



Well, were is that proof??   This is simply a string of unsubstantiated statements.  In contrast, the previously cited GAO report discusses the massive SAVINGS that would be reaped with a single payer system - no profit and much more of an efficient system.  Funny isn't it?  All those other countries of the world have managed it but some dark cloud of ether exists over the US that it would just be IMPOSSIBLE here.   yea, roll eyes

Can't download the reports right now, but I think those stats are in the Medicare cost reports.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports/Cost-Reports-by-Fiscal-Year.html

rather than talk about what's funny, I'm just going to summarize our comments:

 Me:  "We can't feasibly do Medicare for in this country. We can do single layer, but it is not going to look like an expansion of the current Medicare."
You: "but look at all the countries doing single payer that doesn't look like Medicare for all.  If the can do that, why can't we do something that is not the same at all."
Me:* face palm *

[Bicycle_B]

Northwestie, Jrr85, 2buttons, thefinancialstudent:

Reading your posts - educational.  Thanks!  That is all.

[LeRainDrop]

At the risk of getting flooded:  I'm finding some of this hard to follow and keep up in this format.  Does anyone have a book or article that they would recommend I could read to explain what we "should" do in the US to fix our medical/insurance system?  I don't mean a partisan-hack thing or like a tip of the iceberg, 5-paragraph article, but a real solidly researched and supported article?  Preferably multiple articles.  I want to wrap my brain around this topic on which my knowledge is admittedly weak right now.  Thanks!

[MustachianAccountant]

At the risk of getting flooded:  I'm finding some of this hard to follow and keep up in this format.  Does anyone have a book or article that they would recommend I could read to explain what we "should" do in the US to fix our medical/insurance system?  I don't mean a partisan-hack thing or like a tip of the iceberg, 5-paragraph article, but a real solidly researched and supported article?  Preferably multiple articles.  I want to wrap my brain around this topic on which my knowledge is admittedly weak right now.  Thanks!

You could start with the 91 page report that the Governmental Accountability Office did in 1991. I've linked it a few times in this thread, and it is basically a report on what would happen if we implemented something similar to what Canada has.

http://archive.gao.gov/d20t9/144039.pdf

I'm not saying this is the best plan, but it is in-depth and non-partisan, as you requested.

[MustachianAccountant]

Well, there wouldn't be anything wrong with having the market provide education.  It would probably be better, although I would say it would be better to just subsidize or even pay for it outright and have it actually provided by private actors.  Law enforcement and national defense are pretty squarely within the parameters of a public good, so the same logic would not dictate private law enforcement, armies, or courts.  You're example doesn't follow "that logic to extreme the other way" because it's not following the logic of it at all.   

I don't want to get off topic here, but the market already provides college education, with government subsidies, as you suggest, and that's not working out too well for most college students. I can't imagine how it would go if I had to take out loans to send my children to elementary school and high school as well.

To me, the government is a big, blunt tool. There are some things you should employ this big blunt tool against, and some things that require a more precise instrument. For me, health care (which is something EVERY SINGLE PERSON needs at some point in their lives) is a big, blunt problem.

[LeRainDrop]

You could start with the 91 page report that the Governmental Accountability Office did in 1991. . . .

Thanks, MA.

[MustachianAccountant]

I enjoy it when people suggest that a number of other countries have it all figured out. Every single system has plusses and minuses, and it is entirely dependent on your population as well past programs/laws, and if your population will actually engage.  You don't think there are people in Canada that bitch about their healthcare?  This does not include our proud Canadian brethren on this board that hardly need convincing that they are better than the U.S. at something given a suggestion by a liberal here.  How about the doctors going on strike in the UK that brought the NHS to full on stoppage earlier this year?  Every system is flawed. 

I hate to break it to you, because people clearly love debating this issue to no end with super entrenched positions, but there is no miracle system. There never will be.  There will always be problems. There will always be sick people who don't engage the system. There will always be a free rider, and there will always be an injustice that someone will make a change to correct, and round and round we go. Make a change to the system? One person gets screwed and another

No one ever said that other countries' healthcare systems were perfect. They said they were better the than the US.  It's worth taking a look at how other countries do things because they routinely outscore us on healthcare while spending less money. When all those countries have some actual form of universal coverage and we don't, it's fair to suggest maybe that's the cause.

Yeah because the score is based on this health, health inequality, responsiveness-level, responsiveness-distribution, and fair-financing, which some of them definitely have socialist type indicators. And big surprise that because we are the wealthiest country in the world we have a lot of people who have access to a lot of things that make them unhealthy. Our fat people are dragging down our score.

Since we have such a thing as the diabetes belt, of course we are going to score poorly, although, apparently with all of that, we are still number 37 out of 191.  Canada beat us by 7 countries btw - they came in at 30.

So you're saying that the US's poor score in these reports is entirely due to "our fat people"??
When you look at this graph (which charts life expectancy vs. yearly spending per person), we spend a lot (about DOUBLE of Western Europe) because we're such unhealthy eaters?

That's it. That's the entire reason the US is such an outlier.
I can't even.
EVEN IF that were true, countries with "socialized" health care spend more money on PREVENTION than we do, because when you spend money on prevention, the costs are less down the road - and since the taxpayers are footing the bill, there is an incentive to spend less on preventable issues. There is no incentive for prevention in our current system.

[Jrr85]

I enjoy it when people suggest that a number of other countries have it all figured out. Every single system has plusses and minuses, and it is entirely dependent on your population as well past programs/laws, and if your population will actually engage.  You don't think there are people in Canada that bitch about their healthcare?  This does not include our proud Canadian brethren on this board that hardly need convincing that they are better than the U.S. at something given a suggestion by a liberal here.  How about the doctors going on strike in the UK that brought the NHS to full on stoppage earlier this year?  Every system is flawed. 

I hate to break it to you, because people clearly love debating this issue to no end with super entrenched positions, but there is no miracle system. There never will be.  There will always be problems. There will always be sick people who don't engage the system. There will always be a free rider, and there will always be an injustice that someone will make a change to correct, and round and round we go. Make a change to the system? One person gets screwed and another

No one ever said that other countries' healthcare systems were perfect. They said they were better the than the US.  It's worth taking a look at how other countries do things because they routinely outscore us on healthcare while spending less money. When all those countries have some actual form of universal coverage and we don't, it's fair to suggest maybe that's the cause.

Yeah because the score is based on this health, health inequality, responsiveness-level, responsiveness-distribution, and fair-financing, which some of them definitely have socialist type indicators. And big surprise that because we are the wealthiest country in the world we have a lot of people who have access to a lot of things that make them unhealthy. Our fat people are dragging down our score.

Since we have such a thing as the diabetes belt, of course we are going to score poorly, although, apparently with all of that, we are still number 37 out of 191.  Canada beat us by 7 countries btw - they came in at 30.

So you're saying that the US's poor score in these reports is entirely due to "our fat people"??
When you look at this graph (which charts life expectancy vs. yearly spending per person), we spend a lot (about DOUBLE of Western Europe) because we're such unhealthy eaters?

That's it. That's the entire reason the US is such an outlier.
I can't even.
EVEN IF that were true, countries with "socialized" health care spend more money on PREVENTION than we do, because when you spend money on prevention, the costs are less down the road - and since the taxpayers are footing the bill, there is an incentive to spend less on preventable issues. There is no incentive for prevention in our current system.

There are a number of reasons us life expectancy is lower. Probably the primary driver is out ethnic makeup. Comparing population subsets, the US generally does well. Japanese Americans have longer life spans than Japanese. But we have a nigh higher percentage of groups, such as African Americans, that tend to have shorter life expectancies. Some of the difference is driven by higher rates of car wreck fatalities. The us is more rural, so we drive more at higher speed and are more likely to have fatalities before receiving any medical treatment. We have more homicides. then we have more lifestyle issues. More obesity (partially due to being more rural, partially due to ethnic makeup).  We measure infant mortality differently than many countries, and so include in life expectancy a it of infant deaths that would be classified as still born in other countries. All of these factors drive down life expectancy without implicating healthcare, or at least not directly implicating healthcare.

[2buttons]

You do realize that we get tens of thousands of people coming to the U.S. for medical tourism and the reason is advancements and extensive medical training on things like heart disease and cancer, unparalleled to any other country in the world.  Here is a hint, because we are the most advanced in terms of specialities, which in turn costs a ton of money, we spend a lot more on healthcare. 

[MustachianAccountant]

I enjoy it when people suggest that a number of other countries have it all figured out. Every single system has plusses and minuses, and it is entirely dependent on your population as well past programs/laws, and if your population will actually engage.  You don't think there are people in Canada that bitch about their healthcare?  This does not include our proud Canadian brethren on this board that hardly need convincing that they are better than the U.S. at something given a suggestion by a liberal here.  How about the doctors going on strike in the UK that brought the NHS to full on stoppage earlier this year?  Every system is flawed. 

I hate to break it to you, because people clearly love debating this issue to no end with super entrenched positions, but there is no miracle system. There never will be.  There will always be problems. There will always be sick people who don't engage the system. There will always be a free rider, and there will always be an injustice that someone will make a change to correct, and round and round we go. Make a change to the system? One person gets screwed and another

No one ever said that other countries' healthcare systems were perfect. They said they were better the than the US.  It's worth taking a look at how other countries do things because they routinely outscore us on healthcare while spending less money. When all those countries have some actual form of universal coverage and we don't, it's fair to suggest maybe that's the cause.

Yeah because the score is based on this health, health inequality, responsiveness-level, responsiveness-distribution, and fair-financing, which some of them definitely have socialist type indicators. And big surprise that because we are the wealthiest country in the world we have a lot of people who have access to a lot of things that make them unhealthy. Our fat people are dragging down our score.

Since we have such a thing as the diabetes belt, of course we are going to score poorly, although, apparently with all of that, we are still number 37 out of 191.  Canada beat us by 7 countries btw - they came in at 30.

So you're saying that the US's poor score in these reports is entirely due to "our fat people"??
When you look at this graph (which charts life expectancy vs. yearly spending per person), we spend a lot (about DOUBLE of Western Europe) because we're such unhealthy eaters?

That's it. That's the entire reason the US is such an outlier.
I can't even.
EVEN IF that were true, countries with "socialized" health care spend more money on PREVENTION than we do, because when you spend money on prevention, the costs are less down the road - and since the taxpayers are footing the bill, there is an incentive to spend less on preventable issues. There is no incentive for prevention in our current system.

There are a number of reasons us life expectancy is lower. Probably the primary driver is out ethnic makeup. Comparing population subsets, the US generally does well. Japanese Americans have longer life spans than Japanese. But we have a nigh higher percentage of groups, such as African Americans, that tend to have shorter life expectancies. Some of the difference is driven by higher rates of car wreck fatalities. The us is more rural, so we drive more at higher speed and are more likely to have fatalities before receiving any medical treatment. We have more homicides. then we have more lifestyle issues. More obesity (partially due to being more rural, partially due to ethnic makeup).  We measure infant mortality differently than many countries, and so include in life expectancy a it of infant deaths that would be classified as still born in other countries. All of these factors drive down life expectancy without implicating healthcare, or at least not directly implicating healthcare.

Yes, I agree that there are many factors that figure into whether a population is "healthy" or not, but it sure looks like we're just throwing healthcare dollars at the problem of an unhealthy population to no effect. I'd rather see us somewhere along the continuum - either Mexico/Eastern Europe levels of "money isn't going to fix this so we'll just accept our low life expectancy" or the Western Europe/developed Asia/Australia/Canada level of smart spending that  has them all clustered at slightly higher spending with better life expectancy.
I don't accept that health care spending has *nothing* to do with life expectancy, but I do admit that there are other factors to be considered.
But at $7,500-8,000 per capita per year, there must be SOME indicator that we're doing better than the rest of the world - that we're, in some way, 2x more healthy for our 2x more spending. I can't seem to find one though.

[MustachianAccountant]

You do realize that we get tens of thousands of people coming to the U.S. for medical tourism and the reason is advancements and extensive medical training on things like heart disease and cancer, unparalleled to any other country in the world.  Here is a hint, because we are the most advanced in terms of specialities, which in turn costs a ton of money, we spend a lot more on healthcare.

Unfortunately, those tens of thousands of people aren't driving down the costs of my healthcare. I don't see why American spending should subsidize the rest of the world's medical advancements.
(Also, Merck Group is a German company and Novo Nordisk is a Danish one. As a couple of counter examples of innovation in the medical arena.)

[Psychstache]

At the risk of getting flooded:  I'm finding some of this hard to follow and keep up in this format.  Does anyone have a book or article that they would recommend I could read to explain what we "should" do in the US to fix our medical/insurance system?  I don't mean a partisan-hack thing or like a tip of the iceberg, 5-paragraph article, but a real solidly researched and supported article?  Preferably multiple articles.  I want to wrap my brain around this topic on which my knowledge is admittedly weak right now.  Thanks!

While not quite what you are asking for, Time has a great article a few years so called 'The Bitter Pill' that I think does an awesome job of laying out the all of the challenges of the Healthcare system in a nonpartisan way. Might be helpful as a way to think about the problem so you can consider the merits of solutions proposed.

A quick Google search should get you a free PDF of it.

Sent from my SM-G930V using Tapatalk

[GuitarStv]

You do realize that we get tens of thousands of people coming to the U.S. for medical tourism and the reason is advancements and extensive medical training on things like heart disease and cancer, unparalleled to any other country in the world.  Here is a hint, because we are the most advanced in terms of specialities, which in turn costs a ton of money, we spend a lot more on healthcare.

If medical tourism is some sort of magic indicator of health care quality, then the US must be in dire straits . . . given that six million Americans leave the US for health care each year (http://news.health.com/2009/04/08/traveling-treatment/).  A quick google search shows plenty of:

* American medical tourism in Canada -  http://www.nytimes.com/1993/12/20/world/americans-filching-free-health-care-in-canada.html?pagewanted=all

* American medical tourism in China -  https://www.healthstatus.com/health_blog/wellness/reasons-behind-the-booming-medical-tourism-in-china/

*American medical tourism in Mexico -  http://www.washingtonpost.com/wp-dyn/content/article/2007/06/17/AR2007061701297.html

* American medical tourism in Cuba -  http://www.nytimes.com/2015/02/18/world/americas/americans-may-see-appeal-of-medical-tourism-in-cuba.html?_r=0

* American medical tourism in South Korea -  http://www.asiamattersforamerica.org/korea/americans-increasingly-pursuing-medical-tourism-in-south-korea

* American medical tourism in Germany -  https://german-medicalgroup.com/page/for_patients/dear_patients_from_the_usa/

[2buttons]

You do realize that we get tens of thousands of people coming to the U.S. for medical tourism and the reason is advancements and extensive medical training on things like heart disease and cancer, unparalleled to any other country in the world.  Here is a hint, because we are the most advanced in terms of specialities, which in turn costs a ton of money, we spend a lot more on healthcare.

Unfortunately, those tens of thousands of people aren't driving down the costs of my healthcare. I don't see why American spending should subsidize the rest of the world's medical advancements.
(Also, Merck Group is a German company and Novo Nordisk is a Danish one. As a couple of counter examples of innovation in the medical arena.)

With huge US subsidiaries doing bench science domestically here in the US.

[2buttons]

You do realize that we get tens of thousands of people coming to the U.S. for medical tourism and the reason is advancements and extensive medical training on things like heart disease and cancer, unparalleled to any other country in the world.  Here is a hint, because we are the most advanced in terms of specialities, which in turn costs a ton of money, we spend a lot more on healthcare.

If medical tourism is some sort of magic indicator of health care quality, then the US must be in dire straits . . . given that six million Americans leave the US for health care each year (http://news.health.com/2009/04/08/traveling-treatment/).  A quick google search shows plenty of:

* American medical tourism in Canada -  http://www.nytimes.com/1993/12/20/world/americans-filching-free-health-care-in-canada.html?pagewanted=all

* American medical tourism in China -  https://www.healthstatus.com/health_blog/wellness/reasons-behind-the-booming-medical-tourism-in-china/

*American medical tourism in Mexico -  http://www.washingtonpost.com/wp-dyn/content/article/2007/06/17/AR2007061701297.html

* American medical tourism in Cuba -  http://www.nytimes.com/2015/02/18/world/americas/americans-may-see-appeal-of-medical-tourism-in-cuba.html?_r=0

* American medical tourism in South Korea -  http://www.asiamattersforamerica.org/korea/americans-increasingly-pursuing-medical-tourism-in-south-korea

* American medical tourism in Germany -  https://german-medicalgroup.com/page/for_patients/dear_patients_from_the_usa/

Fair point, but the reasons the Americans are leaving the US for medical treatment are very different than the reasons why tens of thousands, Canadians included, come to the US for expert care and treatment.

[deadlymonkey]

You do realize that we get tens of thousands of people coming to the U.S. for medical tourism and the reason is advancements and extensive medical training on things like heart disease and cancer, unparalleled to any other country in the world.  Here is a hint, because we are the most advanced in terms of specialities, which in turn costs a ton of money, we spend a lot more on healthcare.

If medical tourism is some sort of magic indicator of health care quality, then the US must be in dire straits . . . given that six million Americans leave the US for health care each year (http://news.health.com/2009/04/08/traveling-treatment/).  A quick google search shows plenty of:

* American medical tourism in Canada -  http://www.nytimes.com/1993/12/20/world/americans-filching-free-health-care-in-canada.html?pagewanted=all

* American medical tourism in China -  https://www.healthstatus.com/health_blog/wellness/reasons-behind-the-booming-medical-tourism-in-china/

*American medical tourism in Mexico -  http://www.washingtonpost.com/wp-dyn/content/article/2007/06/17/AR2007061701297.html

* American medical tourism in Cuba -  http://www.nytimes.com/2015/02/18/world/americas/americans-may-see-appeal-of-medical-tourism-in-cuba.html?_r=0

* American medical tourism in South Korea -  http://www.asiamattersforamerica.org/korea/americans-increasingly-pursuing-medical-tourism-in-south-korea

* American medical tourism in Germany -  https://german-medicalgroup.com/page/for_patients/dear_patients_from_the_usa/

Fair point, but the reasons the Americans are leaving the US for medical treatment are very different than the reasons why tens of thousands, Canadians included, come to the US for expert care and treatment.

People come to the US form medical care if they have a lot of money (or really good insurance) and have some very extreme medical condition that can't be treated elsewhere.  People leave the US for medical care if they don't have a lot of money and have serious medical issues that can be completed by US trained doctors at a fraction of the price.

Not to derail into dentistry as that is a major lurking American health crisis (who has good dental insurance?).  Thailand is a major Dentistry tourist location.  Entire offices in Bangkok that only serve Europeans and Americans.  US trained dentists and surgeons and flying to Thailand, food, hotel medical care is cheaper than getting it done in the US.  All the while in a really nice high end office that wouldn't look out of place in Beverly Hills.

[Jrr85]

Yes, I agree that there are many factors that figure into whether a population is "healthy" or not, but it sure looks like we're just throwing healthcare dollars at the problem of an unhealthy population to no effect. I'd rather see us somewhere along the continuum - either Mexico/Eastern Europe levels of "money isn't going to fix this so we'll just accept our low life expectancy" or the Western Europe/developed Asia/Australia/Canada level of smart spending that  has them all clustered at slightly higher spending with better life expectancy.
I don't accept that health care spending has *nothing* to do with life expectancy, but I do admit that there are other factors to be considered.
But at $7,500-8,000 per capita per year, there must be SOME indicator that we're doing better than the rest of the world - that we're, in some way, 2x more healthy for our 2x more spending. I can't seem to find one though.

A lot of studies claim that most healthcare basically does nothing as far as life expectancy is concerned.  There are some areas like heart disease where it makes a big difference, and some pills that make a big difference, but for most healthcare, we spend a lot of money to marginally improve life expectancy. 

As far as what we're doing better than the rest of the world, it is basically just cutting edge care.  We do a little bit better when it deals to life expectancy after most cancers.  We do better (or at least have more access) for most "lifestyle" surgical procedures that improve quality of life (e.g., hip replacement), and I think that's about it. 

The main problem with U.S. healthcare is that we have an insane amount of healthcare cost paid by third party payers, either government or insurance, without having the political will to ration care.  If people were spending their own money, it wouldn't be a big deal if the richest country in the world chose to spend more on healthcare; it would be what's expected.  Alternatively, if we're going to continue to have a lot of third party payments and increase the amount paid by government, we should do what other countries do and ration care, both by restricting access and by refusing to pay for beneficial but expensive procedures. 

I'd much prefer that we just give people more control over what they spend on healthcare rather than implement a bunch of taxes and huge bureaucracy just so people don't have to face tough decisions, but if we can't do that, we need to get away from this delusional stance that everybody can have the best health care available and it will all be paid for by somebody else.  Just implement single payer, ration the shit out of care, and get on with it.  There will be some heartbreaking individual stories from the rationing, but overall, you probably won't see more than a blip in statistics broadly measuring "health". 

[GuitarStv]

You do realize that we get tens of thousands of people coming to the U.S. for medical tourism and the reason is advancements and extensive medical training on things like heart disease and cancer, unparalleled to any other country in the world.  Here is a hint, because we are the most advanced in terms of specialities, which in turn costs a ton of money, we spend a lot more on healthcare.

If medical tourism is some sort of magic indicator of health care quality, then the US must be in dire straits . . . given that six million Americans leave the US for health care each year (http://news.health.com/2009/04/08/traveling-treatment/).  A quick google search shows plenty of:

* American medical tourism in Canada -  http://www.nytimes.com/1993/12/20/world/americans-filching-free-health-care-in-canada.html?pagewanted=all

* American medical tourism in China -  https://www.healthstatus.com/health_blog/wellness/reasons-behind-the-booming-medical-tourism-in-china/

*American medical tourism in Mexico -  http://www.washingtonpost.com/wp-dyn/content/article/2007/06/17/AR2007061701297.html

* American medical tourism in Cuba -  http://www.nytimes.com/2015/02/18/world/americas/americans-may-see-appeal-of-medical-tourism-in-cuba.html?_r=0

* American medical tourism in South Korea -  http://www.asiamattersforamerica.org/korea/americans-increasingly-pursuing-medical-tourism-in-south-korea

* American medical tourism in Germany -  https://german-medicalgroup.com/page/for_patients/dear_patients_from_the_usa/

Fair point, but the reasons the Americans are leaving the US for medical treatment are very different than the reasons why tens of thousands, Canadians included, come to the US for expert care and treatment.

The most common reason given for Americans leaving the US for medical treatment is cost.  Does quality of care matter at all if you can't afford the treatment you need?

[deadlymonkey]

Yes, I agree that there are many factors that figure into whether a population is "healthy" or not, but it sure looks like we're just throwing healthcare dollars at the problem of an unhealthy population to no effect. I'd rather see us somewhere along the continuum - either Mexico/Eastern Europe levels of "money isn't going to fix this so we'll just accept our low life expectancy" or the Western Europe/developed Asia/Australia/Canada level of smart spending that  has them all clustered at slightly higher spending with better life expectancy.
I don't accept that health care spending has *nothing* to do with life expectancy, but I do admit that there are other factors to be considered.
But at $7,500-8,000 per capita per year, there must be SOME indicator that we're doing better than the rest of the world - that we're, in some way, 2x more healthy for our 2x more spending. I can't seem to find one though.

A lot of studies claim that most healthcare basically does nothing as far as life expectancy is concerned.  There are some areas like heart disease where it makes a big difference, and some pills that make a big difference, but for most healthcare, we spend a lot of money to marginally improve life expectancy. 

As far as what we're doing better than the rest of the world, it is basically just cutting edge care.  We do a little bit better when it deals to life expectancy after most cancers.  We do better (or at least have more access) for most "lifestyle" surgical procedures that improve quality of life (e.g., hip replacement), and I think that's about it. 

The main problem with U.S. healthcare is that we have an insane amount of healthcare cost paid by third party payers, either government or insurance, without having the political will to ration care.  If people were spending their own money, it wouldn't be a big deal if the richest country in the world chose to spend more on healthcare; it would be what's expected.  Alternatively, if we're going to continue to have a lot of third party payments and increase the amount paid by government, we should do what other countries do and ration care, both by restricting access and by refusing to pay for beneficial but expensive procedures. 

I'd much prefer that we just give people more control over what they spend on healthcare rather than implement a bunch of taxes and huge bureaucracy just so people don't have to face tough decisions, but if we can't do that, we need to get away from this delusional stance that everybody can have the best health care available and it will all be paid for by somebody else.  Just implement single payer, ration the shit out of care, and get on with it.  There will be some heartbreaking individual stories from the rationing, but overall, you probably won't see more than a blip in statistics broadly measuring "health".

That all makes sense in an emotionally detached worldview.  But as soon as you or your child is one of the heartbreaking individual stories, the tune will change.  When you see that the nation has the ability to fix you or your loved ones, but won't because of the budget or you exceeded your lifetime medical care quota, your entire worldview will change.

[Northwestie]

Oh - we ration health care in the US.  By financial ability.  Don't kid yourself.

[MustachianAccountant]

Freakonomics recently did a podcast on end of life care, which is the most expensive health event in many people's lives and a big driver of health care costs. Plus an interesting insurance idea. Worth a listen.

http://freakonomics.com/podcast/are-you-ready-for-a-glorious-sunset-a-new-freakonomics-radio-episode/

[Jrr85]

Oh - we ration health care in the US.  By financial ability.  Don't kid yourself.

Why would you ever think that is a meaningful statement?  First, it's not technically true under most definitions of rationing.  Rationing at least carries the connotation that a fixed amount is provided.  But ignoring that, do you think there are people in the U.S. that are not familiar with the concept of paying for goods and services? 

If we're going to state the obvious, then yes, we "ration" healthcare to roughly the same extent we ration food and most other goods.  The difference is that when you use a pricing mechanism to allocate resources, the spending on those resources generally reflect what people value, and also encourages more people to provide what people value.  When you have government simply ration resources, you get at best spending with no reflection of who values what most, and at worst spending that reflects who is politically connected.   

[GuitarStv]

Oh - we ration health care in the US.  By financial ability.  Don't kid yourself.

Why would you ever think that is a meaningful statement?  First, it's not technically true under most definitions of rationing.  Rationing at least carries the connotation that a fixed amount is provided.  But ignoring that, do you think there are people in the U.S. that are not familiar with the concept of paying for goods and services? 

If we're going to state the obvious, then yes, we "ration" healthcare to roughly the same extent we ration food and most other goods.  The difference is that when you use a pricing mechanism to allocate resources, the spending on those resources generally reflect what people value, and also encourages more people to provide what people value.  When you have government simply ration resources, you get at best spending with no reflection of who values what most, and at worst spending that reflects who is politically connected.

The bolded part is only true if the people have no say in what the government does, and no control over who makes up the government.

Government spending is finite.  All government resources are rationed.  Ideally, in a democracy they are rationed in a way that reflects what the majority of the people who make up a country want and value.

[Northwestie]

Oh - we ration health care in the US.  By financial ability.  Don't kid yourself.

Why would you ever think that is a meaningful statement?  First, it's not technically true under most definitions of rationing.  Rationing at least carries the connotation that a fixed amount is provided.  But ignoring that, do you think there are people in the U.S. that are not familiar with the concept of paying for goods and services? 

If we're going to state the obvious, then yes, we "ration" healthcare to roughly the same extent we ration food and most other goods.  The difference is that when you use a pricing mechanism to allocate resources, the spending on those resources generally reflect what people value, and also encourages more people to provide what people value.  When you have government simply ration resources, you get at best spending with no reflection of who values what most, and at worst spending that reflects who is politically connected.

Huh?   Let's see.  If you are on the lower rungs of the financial ladder and have a near-minimum wage job with no benefits you likely are not going to spend money on preventive care rather than food for the kids.  Meanwhile - a typical middle class person has benefits along with a better paying job and can manage to take the kids to the doc for checkups, etc., and can manage the co-pay.

So while not willful rationing it is defacto rationing - particularly compared to any other first world country. 

I'm not a health policy analyst.  And I'll admit my take on things is affected from some of my world travels.  I have relatives in England.  One of them is a plumber and took a bad fall off a ladder - broken pelvis, internal injuries.  I asked about the costs for him and he looked at me as if I were crazy -- zero cost to him and he spent two weeks in the hospital.  They think we're weird here.

Even in travels in South America I've brought up the subject in Chile and Argentina - same deal. 

We're smart.  We can look around the world and develop a system that best fits us.  The current one has been in place a long time and is not working.  We pay more than anyone else in the world and with not as good outcomes.  We can fix this.  The only (yea, I know) think in the way is politics. 

[2buttons]

People at all levels of the financial spectrum "ration" care, even in socialized medicine. Just because you are wealthy does not mean that you are going to go in for preventative medicine. I make a solid income, and I tend to delay seeing the doc until I have reached a critical mass of reasons to go in, and I have zero copay.  On the flip side I have heard stories from folks in socialized medicine that their parents go to the doctor because its a social thing to do among that cohort, even if nothing is ailing them - they go to get checked out.  Its also why people who have the option under the new system are not signing up, and taking the penalty if they have to, because the incentive is not there.

Don't kid yourself, just because you are not paying out of pocket for it at point of visit, you are most definitely paying for it through something, most likely taxes.  Healthcare aint free mo matter where you live.

[shenlong55]

Oh - we ration health care in the US.  By financial ability.  Don't kid yourself.

Why would you ever think that is a meaningful statement?  First, it's not technically true under most definitions of rationing.  Rationing at least carries the connotation that a fixed amount is provided.  But ignoring that, do you think there are people in the U.S. that are not familiar with the concept of paying for goods and services? 

If we're going to state the obvious, then yes, we "ration" healthcare to roughly the same extent we ration food and most other goods.  The difference is that when you use a pricing mechanism to allocate resources, the spending on those resources generally reflect what people value, and also encourages more people to provide what people value.  When you have government simply ration resources, you get at best spending with no reflection of who values what most, and at worst spending that reflects who is politically connected.

ration: allow each person to have only a fixed amount of (a particular commodity).
My fixed amount is just being determined by how much money I have to spend on healthcare instead of by a government entity.  If I am somehow allowed to consume more healthcare than I actually have money for then I'd love to hear about that.

[Northwestie]

People at all levels of the financial spectrum "ration" care, even in socialized medicine. Just because you are wealthy does not mean that you are going to go in for preventative medicine. I make a solid income, and I tend to delay seeing the doc until I have reached a critical mass of reasons to go in, and I have zero copay.  On the flip side I have heard stories from folks in socialized medicine that their parents go to the doctor because its a social thing to do among that cohort, even if nothing is ailing them - they go to get checked out.  Its also why people who have the option under the new system are not signing up, and taking the penalty if they have to, because the incentive is not there.

Don't kid yourself, just because you are not paying out of pocket for it at point of visit, you are most definitely paying for it through something, most likely taxes.  Healthcare aint free mo matter where you live.

Semantics - threshold, barrier, wall - what would you suggest we use to describe a system that allows some to have access to health care and others not?

Yea - in England they set up sewing circles in the doctor's office to just visit.

No kidding we pay for it one way or another.  It's just with a universal healthcare system EVERYONE is covered - and we would spend much less on healthcare.  What a notion.

[yuka]

Oh - we ration health care in the US.  By financial ability.  Don't kid yourself.

Why would you ever think that is a meaningful statement?  First, it's not technically true under most definitions of rationing.  Rationing at least carries the connotation that a fixed amount is provided.  But ignoring that, do you think there are people in the U.S. that are not familiar with the concept of paying for goods and services? 

If we're going to state the obvious, then yes, we "ration" healthcare to roughly the same extent we ration food and most other goods.  The difference is that when you use a pricing mechanism to allocate resources, the spending on those resources generally reflect what people value, and also encourages more people to provide what people value.  When you have government simply ration resources, you get at best spending with no reflection of who values what most, and at worst spending that reflects who is politically connected.

The bolded part is only true if the people have no say in what the government does, and no control over who makes up the government.

Government spending is finite.  All government resources are rationed.  Ideally, in a democracy they are rationed in a way that reflects what the majority of the people who make up a country want and value.

You say this, but I'm not sure that Americans able to accept failure just because it makes no sense to keep throwing money at the problem; not, at least, when voters so widely and directly interface with the system. Our other big area of high-spending, poor-outcome programs is transportation, and I think we see much of the same in that area.

[2buttons]

I agree that everyone is covered, but take issue with the idea that it will actually be cheaper.

We just need to be honest that it will be more expensive to put more people on healthcare, and that is not happening now.  We are seeing the costs play out in front of our very eyes. Companies are getting out because they are losing money.

Again, pie is fixed. So whatever changes we make will result in different outcomes/costs to society.

No need to demonize people for trying to be objective and intellectually honest about this public policy issue.

[Jrr85]

Oh - we ration health care in the US.  By financial ability.  Don't kid yourself.

Why would you ever think that is a meaningful statement?  First, it's not technically true under most definitions of rationing.  Rationing at least carries the connotation that a fixed amount is provided.  But ignoring that, do you think there are people in the U.S. that are not familiar with the concept of paying for goods and services? 

If we're going to state the obvious, then yes, we "ration" healthcare to roughly the same extent we ration food and most other goods.  The difference is that when you use a pricing mechanism to allocate resources, the spending on those resources generally reflect what people value, and also encourages more people to provide what people value.  When you have government simply ration resources, you get at best spending with no reflection of who values what most, and at worst spending that reflects who is politically connected.

ration: allow each person to have only a fixed amount of (a particular commodity).
My fixed amount is just being determined by how much money I have to spend on healthcare instead of by a government entity.  If I am somehow allowed to consume more healthcare than I actually have money for then I'd love to hear about that.

In other words, it's not a fixed amount.  You don't get $1000 worth of care even if you're willing to pay for $5000 worth of care.  This is somewhat a pointless semantics argument, but it's just annoying that people not only feel the need to point out the we do not get to consume infinite health care resources in the U.S., but do so with if not incorrect at least imprecise terminology. 

[MustachianAccountant]

I agree that everyone is covered, but take issue with the idea that it will actually be cheaper.

I don't understand what is driving this belief for you. Other countries spend less than us. The GAO study concluded we'd save money too. What are you basing the "it will cost more" statements on?

[Northwestie]

I agree that everyone is covered, but take issue with the idea that it will actually be cheaper.

I don't understand what is driving this belief for you. Other countries spend less than us. The GAO study concluded we'd save money too. What are you basing the "it will cost more" statements on?

Faith

[yuka]

I agree that everyone is covered, but take issue with the idea that it will actually be cheaper.

We just need to be honest that it will be more expensive to put more people on healthcare, and that is not happening now.  We are seeing the costs play out in front of our very eyes. Companies are getting out because they are losing money.

Again, pie is fixed. So whatever changes we make will result in different outcomes/costs to society.

No need to demonize people for trying to be objective and intellectually honest about this public policy issue.

I think that we could come out with both a cheaper program and statistically better outcomes if someone were able to design a system, unmolested by outside influences. We'd do it by reducing end-of-life care and shifting that money into savings and more productive applications. We could also do more sensible things with our hospitals, like the option (already mentioned in this article) of not giving each patient his or her own room.

Having said that, I don't think that the political maneuver to reach that state is possible in the US.

[shenlong55]

Oh - we ration health care in the US.  By financial ability.  Don't kid yourself.

Why would you ever think that is a meaningful statement?  First, it's not technically true under most definitions of rationing.  Rationing at least carries the connotation that a fixed amount is provided.  But ignoring that, do you think there are people in the U.S. that are not familiar with the concept of paying for goods and services? 

If we're going to state the obvious, then yes, we "ration" healthcare to roughly the same extent we ration food and most other goods.  The difference is that when you use a pricing mechanism to allocate resources, the spending on those resources generally reflect what people value, and also encourages more people to provide what people value.  When you have government simply ration resources, you get at best spending with no reflection of who values what most, and at worst spending that reflects who is politically connected.

ration: allow each person to have only a fixed amount of (a particular commodity).
My fixed amount is just being determined by how much money I have to spend on healthcare instead of by a government entity.  If I am somehow allowed to consume more healthcare than I actually have money for then I'd love to hear about that.

In other words, it's not a fixed amount.  You don't get $1000 worth of care even if you're willing to pay for $5000 worth of care.  This is somewhat a pointless semantics argument, but it's just annoying that people not only feel the need to point out the we do not get to consume infinite health care resources in the U.S., but do so with if not incorrect at least imprecise terminology.

Yes it is.  Just because it can change over time doesn't mean it's not a fixed amount and if it does then "fixed amount" doesn't apply to government entities rationing care either.  Currently, you get exactly how much healthcare you are able to pay for (fixed by monetary means).  In a government run system it's possible that you may get exactly how much healthcare a government entity decides is necessary (fixed by a government entity).  A government entity could theoretically change what services are available to you at the same rate that your stash changes what services are available to you.  I see no difference between the two scenarios other than how the decision is made on what services are available at any given time.

Also, the bolded part is imprecise.  It doesn't matter how much I'm willing to pay, only how much I currently have available to pay.