The point, Rolfe, is that when everything is "free", there is no incentive to seek the best value, but to grab everything you can. It was a pretty simple, obvious, and apt analogy. It's very basic economics. Sorry it was beyond you.
We've gone into the matter in enough detail that I understand the Americans' objections really and truly are entirely ideological, not practical.
It's very practical. Our government is profoundly inept. We do not want a medical system with the organization of FEMA, the safety of AMTRACK, the cost containment of the Pentagon and the compassion of the IRS.
Here's an interesting, plausible (but not definitive) explanation of what factors may contribute to the US having poorer numbers.
http://tinyurl.com/2d5ael
So reputable that the WHO stopped ranking countries because they realized how idiotic it was to rank Columbia ahead of the US, huh? Sounds real reputable.
One of the criteria the oh-so-reputable WHO used was how socialized the health care was! So surprise – countries with more socialized health care ranked higher, and then this was used by advocates to "prove" it's better.
The two main problems with all this is that it doesn't address the big-ticket expenditure at all, and it doesn't do a lot to widen access. Insurance is still required for the big-ticket items, and we simply don't know if the decrease in expenditure on the little things will be enough to make a difference to the system as a whole.
Deductibles make insurance cheaper. High deductibles make it much cheaper. The idea is that most people would be able to accumulate money in their plan, and buy insurance with increasingly higher deductibles.
As for freedom, we could let the employee opt out of the plan completely, and if they were stupid enough to do that and were hit with an expensive illness they'd learn that stupidly is expensive, and in many cases is a capital crime.
Smart people budget for their expenses. This plan makes it much easier for them to do so.
Individuals spending their own money will do better, but probably not as well as all that. How is an individual to know whether the $40 glucose meter is really better than the $10 one, or whether the $80 one is just an insane waste of money?
Um, by reading? By asking their doctor? By applying some common sense?
Consider that the huge US prescription bill put through by Bush
prohibited the government from shopping for the best price. That's what happens when financial decisions are made by congress weasels who are wholly owned subsidiaries of Big Pharma (and just about every other big sector of business.) Individuals are under no such compunction.
And as you pointed out, big donors will enforce their own ideology, so, for example, no maternity beds for the single mothers and maybe even no AIDS treatment for the homosexuals.
What makes you think the government is immune from such decisions? The morning after pill, which has been used in Europe safely and effectively for years, was blocked by a
single fundy in the FDA. One guy kept it out of the hands of the public for years because he believed it would make his imaginary sky-daddy pout. There is still a vocal minority, one that had way too much power in this country for way too long, and who may get it back again, who would do exactly that – they want to prohibit abortions, and some want to prohibit birth control.
The other day I pealed apart one of the test strips for my glucose meter to see what was inside it. Virtually nothing – a few stamped circuits. I tried to find the cost of production, but nobody in the business will discuss it. One finical analyst estimates its 8-12 cents, but that seems very high, given the economies of scale and the fact that these things are stamped out by the billions.
They sell for about a buck each. A 900% markup, at least. Type II guys like me use 2-3 a day. Type I diabetics may use as many as a dozen. How do pharmaceutical companies get away with such outrageous overcharging? By having insurance pay for it. Very, very few of us pay for our strips directly. They're covered by either private insurance or government insurance, so we pay our co-pay (or, in many cases, pay
nothing) and don't think about it. But…if a substantial number of us were paying out of our pockets, if most of us bought them with our own money, through a health account, we'd shop for the best price. A company would be able to sell them quite profitably for fifty cents each. And another company would say "We could still make a huge profit if we capture the market with a twenty-five cent strip." Another entrepreneur would find a way to make them for a penny and sell them for a dime. The price would plummet to the point where it becomes trivial. That's how the free market works.
But there is no free market for the strips, so they remain priced at a buck each. There is no incentive for anyone to make them cheaper, because there is no incentive for the tens of millions of diabetics to shop for a cheaper product.
And that's just one example. When the doctor says "Here's a $100/month solution for your acid reflux," instead of thinking "that's just a ten dollar co-pay" we'd have an incentive to say "Can we try the $5/month OTC solution first?" The pharmaceutical company would suddenly have an incentive to lower their price substantially in order to compete.
