Equity market says US Health Bill is killed

[applecorped]

I must admit that the only reason I continue to follow this thread is to ogle Faithkills' avatar.

I loaned him that picture of me.

 

[dudalb]

You are probably wasting your breath. Quasi mystical appeals to nationalism and patriotism are quite deeply ingrained in many Americans. He (?) doesn’t think Americans are more free because of economic theory, he thinks that economic theory is more free because that is how it is in the US. You will see much the same thing in healthcare debates. Regardless of the facts you will never get past the inherent belief that how things have been done in the US are the best way to do them with people that define “the best way to do it” as whatever the US does.

I am in favor of UHC, and I would be considered very Patriotic.
One of the BIG mistakes the Left has made in the US is their contempt for Patriotism, and thereby handing all the powerful emotions that evokes over to the Right.Big Mistake.

 

[Francesca R]

It's no issue if someone considers themself patriotic, or if they feel that their nation is "exceptional", or "exceptionally free".

If they can't corroborate that with much beyond personal preference for what they've got, and if less subjective and broader analysis kinda refutes it, then they're forming their own personal, narrower definitions of those terms.

 

[lomiller]

I am in favor of UHC, and I would be considered very Patriotic.
One of the BIG mistakes the Left has made in the US is their contempt for Patriotism, and thereby handing all the powerful emotions that evokes over to the Right.Big Mistake.

While perhaps less pervasive on the right, the phenomenon I referred too exists on both sides. It also isn’t simply a function of being patriotic, it’s the allowing of the perception of patriotism superseding critical though. You can IMO be patriotic without doing it, but the fact is large segments of both the left and right reject any possibility that what the US is doing is inferior to what other countries are doing no matter what the facts suggest.

Catering to this may be smart politically, but in the long run it results in unworkably policy decisions that undermine the country as a whole. The same type of thing was prevalent in the waning days of the British Empire. For example, Amundson adopted the best technology for the job and was the first person to the South Pole. Scott fixated on English ideas of how it should be done and died in the attempt.

 

[Newtons Bit]

You know I've been reading this thread and I have not been able to decide if faithkill is jsut a sockpuppet or jsut wofully uninformed.

But after reading this quote above perhape we finally discovered his true intent.
He's one of those woo guys wanting open an alernative school of medicine.

All joking asside Faithkill I have to say that this is got to be the dumbest things you posted! There are a LOT of things wrong with the health care industry but standards and the AMA (I am not talking about some specific grip you may have against them)
is NOT one of them.

This is the 100th aniversary fo the Flexner papers http://content.nejm.org/cgi/content/full/355/13/1339

Why don't you spend some time reading about what "medicine"
was when we had your precious free market

I think he was referring to the belief that the AMA forces maximum quotas on the number of doctors a school can graduate a year to keep it's accreditation. I'm not sure if this is an urban legend or not, I haven't researched it.

 

[dudalb]

While perhaps less pervasive on the right, the phenomenon I referred too exists on both sides. It also isn’t simply a function of being patriotic, it’s the allowing of the perception of patriotism superseding critical though. You can IMO be patriotic without doing it, but the fact is large segments of both the left and right reject any possibility that what the US is doing is inferior to what other countries are doing no matter what the facts suggest.

Catering to this may be smart politically, but in the long run it results in unworkably policy decisions that undermine the country as a whole. The same type of thing was prevalent in the waning days of the British Empire. For example, Amundson adopted the best technology for the job and was the first person to the South Pole. Scott fixated on English ideas of how it should be done and died in the attempt.

Agreed, but on the other hand Americans ARE different then Europeans in many ways, and this has to be taken into account.
I think that Any UHC program to suceed in the US has to have a large amount of individual choice and allow someone to go "doctor shopping". Some Bureaucrat simply assigining somebody to a doctor is not going to cut it with anybody, left or right.

 

[dudalb]

I think he was referring to the belief that the AMA forces maximum quotas on the number of doctors a school can graduate a year to keep it's accreditation. I'm not sure if this is an urban legend or not, I haven't researched it.

Maybe, but the idea that licensing physicians intereferes with the "Free Market" is common meme among Libertarians.

 

[Rolfe]

I think that Any UHC program to suceed in the US has to have a large amount of individual choice and allow someone to go "doctor shopping". Some Bureaucrat simply assigining somebody to a doctor is not going to cut it with anybody, left or right.

Does that ("some bureaucrat simply assigining somebody to a doctor") happen anywhere? Not that I'm aware of. Except maybe in the USA in some circumstances....

This seems to be yet another assumption made by Americans about life in Europe that has simply no foundation to it. What on earth would give anyone such an idea?

Within the NHS, you can register with whichever doctor you choose. There used to be some geographical restrictions, based on the premise that a doctor should be close enough to visit the patient if necessary. This has recently been revoked, however, to allow people to register with doctors near their workplace if they find that more convenient.

You can also change your doctor at will, for whatever reason. Some years ago, my father's doctor was rude to him. I can't remember the exact circumstances, but he (the doctor) was an unpleasant little git to be honest. Both my parents simply filled in the paperwork to be moved to the list of another practice in the town - actually, working within the same multi-practice health centre. The new practice was very happy to have more patients, because they get paid according to how many patients they look after. The original doctor was mad as hell. He called my father up and said, what do you think you're playing at, I'm trying to build up a business here. History does nor record what my Dad said to him, but he should have thought of that before he let himself be rude to his patients.

When I was looking at houses to move to my present location, the vendor of one of the houses started to give me the run-down on the local doctors, to help me choose. She praised one "open-minded" practice for sending her daughter to a homoeopath. I was able to give that one a body-swerve.

Once we'd moved, my mother found herself with a long journey to see her eye consultant. He offered her two choices of consultant at hospitals a bit nearer, but she elected to stay with the original guy because she liked him. Then that consultant left, and she wasn't very impressed with the replacement. She enquired at the office, discovered that a more senior expert was now doing clinics at a hospital considerably nearer, and the admin people simply switched her to his list on request.

If you find you need hospital treatment, you are guaranteed by law a choice of at least three hospitals and consultants, unless your condition requires a relatively scarce speciality. Information about all the hospitals including waiting times and other performance metrics is available online to help you make your choice.

Absolutely none of this involves a bureaucrat. The government pays the bills and sets performance targets and stuff like that. It has absolutely no interest in micromanaging the way any individual patient is treated.

In France it's even less prescriptive. While in Britain you need a referral from your GP to see a specialist, in France you can just walk into the office of the specialist of your choice. The government merely picks up the bills.

In contrast, I keep hearing examples in the USA of patients being severely restricted in which hospital they can attend or which specialist they can see, because their insurance company doesn't deal with the hospital or specialist that would be the patient's first choice. How is that not "bureaucrat simply assigning somebody to a doctor"? Seems to me that cuts it with the US population as things are. It's not something we're used to here at all though.

I don't want to sound snarky, but I do wish you Merikans would actually find out how the systems you think you don't want to copy actually work before letting fly with ridiculous straw-man assertions.

Rolfe.

 

[Random]

I think he was referring to the belief that the AMA forces maximum quotas on the number of doctors a school can graduate a year to keep it's accreditation. I'm not sure if this is an urban legend or not, I haven't researched it.

Doesn't really matter. Probably the biggest single cost of healthcare in the US is that one third of all medical procedures in the US are unnecessary. Not sure how adding more doctors is supposed to help that.

 

[lomiller]

Agreed, but on the other hand Americans ARE different then Europeans in many ways, and this has to be taken into account.
I think that Any UHC program to suceed in the US has to have a large amount of individual choice and allow someone to go "doctor shopping". Some Bureaucrat simply assigining somebody to a doctor is not going to cut it with anybody, left or right.

AFAIK Rolf is correct, the only country where you are likely to be told “you must use this doctor” is the US. It will be an insurance company/HMO saying it and not a bureaucrat, but I don’t see how that makes much difference.

In Canada 90% of doctors are private businessmen who accept/reject patients as they see fit. You go see whatever doctor you want, and they give you the treatment you and the doctor deem most suitable.

 

[lomiller]

Doesn't really matter. Probably the biggest single cost of healthcare in the US is that one third of all medical procedures in the US are unnecessary. Not sure how adding more doctors is supposed to help that.

I’m not sure that’s the biggest cost. From what I’ve read ~30% of US health care costs go towards administration. That’s massively higher then anyplace else.

In addition to over treatment, another big cost items are doctor pay, US doctors are make a lot more money then anyplace else. (This clearly could be due to restrictions on the number of doctors)

 

[WildCat]

In other words, get rid of all medical licencsing laws. Allow any fool to practice medicine.
Thanks for reminding me why I am NOT a Libertarian.

I actually think FaithKills has a point here.

The AMA does strive to keep the number of doctors low in order to increase their pay. There's no reason more medical schools can't be opened and more doctors produced. In fact, one of the reasons medical schools can charge so much is the supply of medical schools and thus slots in them is artificially low.

I'm not in favor of getting rid of medical licensing laws, but I see no reason the AMA should have so much power in this regard.

 

[Ziggurat]

Maybe, but the idea that licensing physicians intereferes with the "Free Market" is common meme among Libertarians.

Yes, but even in a strictly free market system, you can still have accreditation systems. Someone without accreditation would not be prevented from practicing medicine, but would be at a steep competitive disadvantage compared to someone with accreditation.

 

[Rolfe]

There seems to be a bit of a dichotomy here. On the one hand you (in the USA) have these chiropractors, coming out of schools that seem to want to maximise their student numbers in the name of profit. These guys then have trouble attracting enough patients to build a viable practice, and we hear about chiropractic training courses that are mostly about marketing and how to persuade people to come in for repeated "adjustments" even if there's nothing wrong with them. Then on the other hand, I hear many posters alleging that there is a genuine shortage of real doctors and that is one thing keeping the prices up.

I'm not so sure how serious this doctor shortage really is, given the apparent lack of waiting lists in the US. There always seems to be someone ready and willing to take you on if you have the money. It has the feel more of a price-fixing cartel to me, though perhaps I'm wrong.

There's also the question of unnecessary investigations and procedures. There seems to be a lot more of that going on, or at least alleged, in the USA - partly because of defensive medicine, but partly because there seems to be nobody really laying down the law about what is and isn't appropriate in certain situations. There are allegations that some doctors are inflating their incomes by doing more work on some patients than their condition really warrants. That doesn't sound like a profession where there's a real personnel shortage.

I came across a similar situation in Britain the other day, though the political dynamics of it are different because of the funding system. A doctor was being criticised because his unit hadn't filled its quota of day-surgery haemorrhoid operations. (This sounds to me like way too much micromanagement of hospital procedure, but it's one of the things they do to try to stop waiting lists building up for simple procedures.) The doctor protested that 80% of haemorrhoid cases would settle perfectly well with changes to diet and lifestye, and surgery was only appropriate for the remaining 20% where that wasn't working. Why should he drag in patients for surgery he didn't believe was needed, just to satisfy some artificial target?

The difference is, because the doctor was on a salary, not paid by the procedure, he was willing to speak out about this and highlight the problem. It's likely this sort of speaking out will get the guidelines and the targets changed. If his income had been directly tied to how many of these operations he did, would he have said anything, or would he simply have scheduled every patient presenting with haemorrhoids for surgery?

I don't know what the ratio of doctors per head of population in the USA actually is, or how it compares with other countries. I'm not sure I'm seriously convinced there's a genuine shortage on the information presented though.

One also has to consider the uneven access to medical treatment in the USA. The suggestion is that there's a substantial amount of unmet need among people who don't have adequate insurance coverage or private means. This seems to be borne out by the attendance at these roadshow events run by the third-world charity people, who have discovered that setting up in parts of the USA will get a similar response to setting up in Peru. Would there be sufficient personnel to cope if these people were able to access medical treatment through the normal GP/hospital network? Again I'd like to see some statistics on doctors per head of population in the USA compared to European countries.

Rolfe.

 

[332nd]

There seems to be a bit of a dichotomy here. On the one hand you (in the USA) have these chiropractors, coming out of schools that seem to want to maximise their student numbers in the name of profit. These guys then have trouble attracting enough patients to build a viable practice, and we hear about chiropractic training courses that are mostly about marketing and how to persuade people to come in for repeated "adjustments" even if there's nothing wrong with them. Then on the other hand, I hear many posters alleging that there is a genuine shortage of real doctors and that is one thing keeping the prices up.

I'm not so sure how serious this doctor shortage really is, given the apparent lack of waiting lists in the US. There always seems to be someone ready and willing to take you on if you have the money. It has the feel more of a price-fixing cartel to me, though perhaps I'm wrong.

There's also the question of unnecessary investigations and procedures. There seems to be a lot more of that going on, or at least alleged, in the USA - partly because of defensive medicine, but partly because there seems to be nobody really laying down the law about what is and isn't appropriate in certain situations. There are allegations that some doctors are inflating their incomes by doing more work on some patients than their condition really warrants. That doesn't sound like a profession where there's a real personnel shortage.

I came across a similar situation in Britain the other day, though the political dynamics of it are different because of the funding system. A doctor was being criticised because his unit hadn't filled its quota of day-surgery haemorrhoid operations. (This sounds to me like way too much micromanagement of hospital procedure, but it's one of the things they do to try to stop waiting lists building up for simple procedures.) The doctor protested that 80% of haemorrhoid cases would settle perfectly well with changes to diet and lifestye, and surgery was only appropriate for the remaining 20% where that wasn't working. Why should he drag in patients for surgery he didn't believe was needed, just to satisfy some artificial target?

The difference is, because the doctor was on a salary, not paid by the procedure, he was willing to speak out about this and highlight the problem. It's likely this sort of speaking out will get the guidelines and the targets changed. If his income had been directly tied to how many of these operations he did, would he have said anything, or would he simply have scheduled every patient presenting with haemorrhoids for surgery?

I don't know what the ratio of doctors per head of population in the USA actually is, or how it compares with other countries. I'm not sure I'm seriously convinced there's a genuine shortage on the information presented though.

One also has to consider the uneven access to medical treatment in the USA. The suggestion is that there's a substantial amount of unmet need among people who don't have adequate insurance coverage or private means. This seems to be borne out by the attendance at these roadshow events run by the third-world charity people, who have discovered that setting up in parts of the USA will get a similar response to setting up in Peru. Would there be sufficient personnel to cope if these people were able to access medical treatment through the normal GP/hospital network? Again I'd like to see some statistics on doctors per head of population in the USA compared to European countries.

Rolfe.

http://www.dartmouth.edu/~mss/data analysis/Volume I pdf /122 On the Average I P per .pdf

1.6 per 1,000

http://www.forbes.com/2009/07/02/health-care-costs-opinions-columnists-reform.html

For example, we have fewer physicians per capita than most other OECD countries: 2.43 per 1,000 population versus an OECD average of 3.1.

 

[Rolfe]

Thanks. I was doing some googling and came up with this link.

http://www.nationmaster.com/graph/hea_phy_per_1000_peo-physicians-per-1-000-people

The countries at the top seem to be mainly states with very small populations, and some places we wouldn't normally regard as meccas for quality care - a lot of Eastern European states are near the top.

A lot of places like Germany, Austria, France and Switzerland are in the 3 to 3.5 range. The USA, at 2.3, seems low by that comparison. But look at who else is in the same general ball park.

Britain 2.2
Canada 2.1
Australia 2.5
New Zealand 2.2

So actually, the USA has a fairly similar number of doctors per head of population compared to the countries most posters here tend to compare it to. Maybe we'd all be doing better if we were up there with the countries in mainland western Europe, but it isn't a big factor in comparisons with Britain, Canada or the Antipodes.

Rolfe.

 

[Newtons Bit]

Yes, but even in a strictly free market system, you can still have accreditation systems. Someone without accreditation would not be prevented from practicing medicine, but would be at a steep competitive disadvantage compared to someone with accreditation.

I have a fairly libertarian bent, but I am 100% for licensing professions that deal with the health and safety of people. That said, I'm also in a profession that licenses the crap out of people.

 

[Rolfe]

For example. This is not a happy tale.

http://news.bbc.co.uk/1/hi/health/8497911.stm

I don't know if you want to blame the NHS for employing this idiot, or the private agency who supplied him to the NHS, but in my view it's basically a problem of crappy licensing in Germany, and ridiculous EU legislation that means if a doctor is licensed in one state all the others have to accept him on trust.

Dammit, even I know the right dose of diamorphine for a morphine-naive human patient, after having read the evidence in the Shipman enquiry. That guy gave the poor man ten times that, an appropriate dose for a terminal cancer patient on long-term treatment. And all the poor man had was a kidney stone.

The doctor actually ran a clinic specialising in cosmetic treatments in Germany. One wonders what recent experience he had in first-opinion emergency work? Fatigue was also held to be a factor, as he had just flown in. But how tired do you have to be to forget 10mg?

They need to sort out this regulation/accreditation thing before anyone else dies.

Rolfe.

 

[Francesca R]

I didn't respond on this stuff previously, but for the record I agree with all the quoted parts:

The ways to fix health care in the US are easy.

Tort reform. Loser pays, just like in some European nations. This is needless overhead.
Insurance portability. Get rid of the antitrust exemption and allow interstate competition.

[ . . . ]

Drug reimportation. The cost of maintaining pharma's IP 'rights' are too high.
Remove coverage mandates. We don't need to protect aromatherapy and acupuncture. If people want that in their plan fine. If not they shouldn't be forced. These drive up costs by creating needless demand. People will utilize resources if they are forced to pay for them.

They should all work to shift the supply curve of medical service right (IE increase it), or in other words lower its cost for any particular quantity. In the case of alternative medicine (the last one), by lowering the demand for altmed (by not mandating it), the supply of that should drop and the supply of regular medicine could increase in its place. Even if it doesn't it saves the public cost of meeting what should be a privately funded demand (IMO)

Shift the tax break from employer to individual. Gradually devolve it. (along with all 'targeted' tax subsidies for that matter) Subsidies drive up demand and thus drive up costs.

This makes sense with mandatory coverage, not otherwise IMO. It would otherwise increase the extent of self-selection in medical insurance markets, which is the most glaring guarantor of its failure to clear except at a mushrooming price.

With respect to this:

Remove the AMA/LCME's licensing authority. This is a provider supply monopoly that needs to end. Expanding demand without allowing supply to grow is a recipe for higher prices. Of course that's the whole point of the AMA.

I suspect that the licensing bodies of medical supply in the US--and in the UK--almost certainly do function to a significant extent as anti-competitive cartelised special interest groups that push the supply left (IE decrease it, or increase its price at a particular quantity), Protectionist collective action organisations also generally lower the incentives for innovation and productivity growth in most forms of service delivery which further prevents supply shifting right. And it is mathematically impossible to stop the national spend on healthcare from increasing--as a share of GDP--if demand is increased while supply sticks. Price controls on supply merely turn increased cost into rationing.

To say that opposition to anti-competitive practices that distort the market is necessarily opposition to regulatory standards is false.

 

[Francesca R]

I have a fairly libertarian bent, but I am 100% for licensing professions that deal with the health and safety of people.

How do you deal with their incentive to raise barriers to competition?

Incidentally, history shows that almost every profession is prepared to have a go at lobbying for self-written regulations, ostensibly on the grounds of public safety (rather than group interest)--manicurists, plumbers, hairdressers . . .