Heeeeeeere's Obamacare!

[DavidJames]

Because health care is carefully rationed in those other nations. Also, to some degree, they are benefiting from the high prices paid by the US for new treatments, which incentivizes and subsidizes research and development. Ungrateful, greasy, foreign sponges hate it when I point this out, but it's true.

At this point it's just an(other) assertion, please provide independent evidence of your claim.

Well, they don't actually, except in those wonderfully circular WHO rankings which give a lot of weight to health care systems which are affordable and egalitarian.

At this point it's just an(other) assertion, please provide independent evidence of your claim.

 

[logger]

A.) Do you have any evidence that these costs are rising?

Yes, my own doubled, first they cancelled it. I'm one of the payers, I assume someone else pays for yours?

Prior to Obamacare, Americans paid the most for healthcare and got the least amount of health care. How does that help anyone?

Once again, U.S. has most expensive, least effective health care system in survey

Randfan does it make sense to you that a system that is the most expensive, is the least effective? Do you think that just might be the culture of emergency care.

With respect to these other countries, do you really think a system that is cheap is most effective?

 

[sunmaster14]

<snip>

Randfan does it make sense to you that a system that is the most expensive, is the least effective? Do you think that just might be the culture of emergency care.

With respect to these other countries, do you really think a system that is cheap is most effective?

Randfan referred to another one of these "circular" studies. Amazingly, the study concludes that even though the US has the most expensive health care system, it ranks poorly in terms of cost efficiency (emphasis added):

Efficiency: On indicators of efficiency, the U.S. ranks last among the 11 countries, with the U.K. and Sweden ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical testing. Sicker survey respondents in the U.K. and France are less likely to visit the emergency room for a condition that could have been treated by a regular doctor, had one been available.

Such insight. Not only is our system wasteful and expensive, but it is expensive and wasteful too.

And the US ranks poorly on "Access" and "Equity" because, well, you know, the US has an expensive health care system.

So the conclusion is that even though the system is expensive, we rank poorly on health care outcomes like Efficiency, Access, and Equity. This is my shocked face.

 

[jimbob]

Why is public health care not resulting in higher healthcare costs in other nations?

Because health care is carefully rationed in those other nations. Also, to some degree, they are benefiting from the high prices paid by the US for new treatments, which incentivizes and subsidizes research and development. Ungrateful, greasy, foreign sponges hate it when I point this out, but it's true.

Lifestyle drugs and me-too copies of other drugs to get round patents. Meanwhile, malaria drugs get a lot of money from philanthropic organisations, but not drugs companies.

Almost as if a rich person will pay more for a treatment for baldness than someone on a dollar a day will pay for lifesaving drugs.

Why do they have better outcomes?

Well, they don't actually, except in those wonderfully circular WHO rankings which give a lot of weight to health care systems which are affordable and egalitarian.

Sorry? Why is that not important. It doesn't matter if the fountain of youth is available in a country if nobody can afford it.

It would be simplistic to say it all falls on public healthcare. However, it is reasonable to say public healthcare has not caused their costs to rise higher than ours. Prior to Obamacare the US paid the most for healthcare of industrialized western nations.

Just because we had an inefficient system, whose original sin of course is the tax subsidy granted to employer provided health care by the government, it doesn't follow that moving to a system with even more government involvement is the right direction to go. A more market-based approach would have been better, in my opinion.

Luckily we can see how Canada's outcomes deviated from the US - from another thread

CMAJ had an [editorial with citations] and in 2002 a peer-reviewed research [article] showing profit motive significantly deducts from quality of care in healthcare, rather than enhancing it.

Canada and the US had identical systems until the end of a transition over 1969-1972, and in the time since then, the US has fallen drastically behind in outcomes and is now more than double the cost. This value gap has grown especially fast since 2000.

IIRC, HMOs' costs outside actual care delivery - eg: accounting, marketing/advertising, lobbying, lawsuits, claim screening, collections - has inflated to about 30% of costs, compared to between 1 and 2% in Canada, depending on province.

The efficiency of US healthcare delivery is considered to be less than half of Canada's, even though Medicare is almost as efficient. This means that outside of Medicare (which has a 2% overhead) - so that means HMOs and private hospitals - is less than half as efficient. Maybe about 35% as efficient, based on my back-of-the-envelope estimate.

 

[DavidJames]

This is my shocked face.

Ironic as it's also the face of those watching who think your assertions and rolling eyes should repudiate the facts.

 

[RandFan]

Yes, my own doubled, first they cancelled it. I'm one of the payers, I assume someone else pays for yours?

This is anecdotal. I'm asking you for evidence that the gross costs or per capita costs have increased. I'm on disability. Disability is insurance that I paid for.

Randfan does it make sense to you that a system that is the most expensive, is the least effective? Do you think that just might be the culture of emergency care.

Absolutely. Of course it makes sense. Economics 101. The cost of something is not necessarily indicative of it's quality or effectiveness. logger, does it not occur to you that as the health of a nation decreases so does its productivity? Human societies and socioeconomic systems are complex things that are not easily reduced to such simplistic appeals. The ER is expensive. Not treating people who are infectious or who are needed at their jobs but cannot work because of sickness is also expensive. There are no simple answers only pragmatic evidence that there is a strong argument to be made that it is in the best interest of a social species to care for the vulnerable.

With respect to these other countries, do you really think a system that is cheap is most effective?

First off I don't believe that it is cheap. However, I do very much think that systems that are cheaper than the American one of the past are far more effective and demonstrably so.

 

[sunmaster14]

Lifestyle drugs and me-too copies of other drugs to get round patents.

A lot of drugs are incremental improvements. They might increase cancer survival rates by a few percent or extend life by a few months. In the US, these drugs get added to the formularies pretty quickly. Not very cost-effective, but they push the research along. The cumulative effect of these incremental improvements is quite material over a couple of decades.

Meanwhile, malaria drugs get a lot of money from philanthropic organisations, but not drugs companies.

Almost as if a rich person will pay more for a treatment for baldness than someone on a dollar a day will pay for lifesaving drugs.

Since when are drug companies in the business of helping poor people? If you want poor people in Africa to have malaria drugs, then give them money to buy malaria drugs. Then the drug companies will develop malaria drugs. This isn't rocket science.

Sorry? Why is that not important. It doesn't matter if the fountain of youth is available in a country if nobody can afford it.

I'm objecting to the double counting. Most people who attack the US health care system claim that we spend more money per capita and get worse results. The first part is undisputed. The second part is bogus.

Luckily we can see how Canada's outcomes deviated from the US - from another thread

The administrative overhead in the US system is not the fundamental problem, but in any case it's in part due to our regulatory setup, where each state is different. The calculation of overhead is also overstated (or understated in the case of Medicare). Medicare looks like it has low overhead because the average subscriber has such large medical bills, so the denominator is large. Those on private insurance plans tend to be younger and healthier so you have lower medical bills per subscriber (a smaller denominator).

 

[RandFan]

Car insurance is good. I have certain risks in driving that are specific to me: my needs, my driving record, the car I drive. I pay for my level of risk. ¹Health insurance is nothing like this. I have no choice in the level of coverage I want. I want catastrophic. No copays, no preventive, no maternity, no BC. Thus, I am not paying for insurance anymore in that I am not insuring risks that I actually have.

²I don't think that necessarily follows.

³Neither do I. But ACA is overkill. We could have met those needs countless other ways. Instead, we forced everyone into cookie-cutter "insurance" plans that don't actually solve the problem.

⁴Gotcha entertainment "news," is great comedy but not great at presenting the facts without bias. I shudder to think how many people form their opinions based on this kind of thing. Knoxville is not equivalent to a third-world country. You could start a free clinic any place in the US and people would go. This piece does not "prove" that America does not have the best system in the world. Neither does the US' placement on a list generated by WHO. For the record, I wouldn't place the US at the top of the list either, but we are certainly one of the best when it comes to quality of care and outcomes of people who interact with the healthcare system. ⁵We can do better in making sure more people can access the system. This probably sums it up better than I can.

⁶If I had to get treated for cancer, heart disease, etc, I would choose the US system over any other in the world. I think we have the best educated doctors who benefit from most of the medical research being done here in the States. I want every citizen to have more access to our system. However, I don't want to accomplish that by adopting a system that would hurt the things we are very good at.

1. Health insurance is like that. Perhaps not exactly the same but very close. There are in fact many plans to choose from. You will pay one way or the other. People who need to go to the ER because they can't afford a physician are using a very expensive form of health care that is offset with increased costs to those who can pay.
2. It's been varified by science. First there were observations of social species. A hypothesis was formed and experiments were carried out in an attempt to falsify the hypothesis. To date the field research and social science have not falsified the hypothesis.
3. An arguable point. We don't have a working model that consists of the kind of soclutions you suggest. IMO: This is just ad hoc rationalization. That's not to say that there could not be something better.
4. I have, on this forum, presented many, many examples and studies to support the proposition. The Daily Show is not scientific but easily puts the lie to the notion that America is a great place for health care.
5. Forgive me but this is a platitude. Yes, we could do better. We started a national debate about Health Care under Bill Clinton and very little was done about the real problems that many Americans had with obtaining quality health care. Particularly children. The problem I have is that nothing ever gets done. The ACA was in large part an invention of the Heritage foundation. Dole ran on it. It was a sub standard response to single payer but it was a market driven solution.
6. If a person is rich then America has been a good place for healthcare. The problem as you note is that for far too many people good healthcare is out of reach. I've seen no evidence that America is likely to be worse off for the ACA. This argument seems to be an invalid appeal to fear of change of the status quo.

 

[Trakar]

...fear of change of the status quo.

the essence of conservatism, and the antithesis of progressivism!

 

[Minoosh]

Ungrateful, greasy, foreign sponges hate it when I point this out, but it's true.

The extreme contempt you profess here may color your opinions. Ungrateful greasy foreign sponges would qualify to me as hate speech, but maybe you have fair measures of ingratitude, greasiness and foreignness.

Just because we had an inefficient system, whose original sin of course is the tax subsidy granted to employer provided health care by the government, it doesn't follow that moving to a system with even more government involvement is the right direction to go. A more market-based approach would have been better, in my opinion.

Yet the single-payer model seems to be working OK, with lower costs and better outcomes. We had market-based insurance and it worked fine for people who could afford it. But actually, it was not so great by objective measures.

 

[Border Reiver]

The administrative overhead in the US system is not the fundamental problem, but in any case it's in part due to our regulatory setup, where each state is different.

Just to point out, in Canada the administration of the Healthcare system is a provincial responsibility (provinces being the administrative equivalent of states).

The federal government's role in healthcare is to ensure that the provinces keep to a minimum level of care, regulate the introduction of new drugs, etc.

 

[sunmaster14]

The extreme contempt you profess here may color your opinions. Ungrateful greasy foreign sponges would qualify to me as hate speech, but maybe you have fair measures of ingratitude, greasiness and foreignness.

I was trying to inject a little humor into a serious point by using hyperbole. Yes, I could use emoticons to avoid confusion, but they take all the fun out of it.

Yet the single-payer model seems to be working OK, with lower costs and better outcomes. We had market-based insurance and it worked fine for people who could afford it. But actually, it was not so great by objective measures.

The single-payer model seems to be working OK, but in comparison to what? There's no good point of reference, and for the record, the US did not have and does not have market-based health care (health care is not insurance). People in single-payer model countries may be satisfied with their health care in the same way that East Germans used to be satisfied driving Trabants. They only have their fellow citizens as a point of reference.

And one of my points in the post you replied to is that the rest of the world is actually benefiting enormously from the inefficient US model. Drug companies charge US customers a high enough price that investments in R&D are profitable. Then single-payer countries are usually free to come in and purchase the same drugs at a discount, since, to the drug companies, it's all gravy from then on. If the discount isn't sufficient, then single-payer countries will just wait until the price comes down. It's generally not discussed (let alone appreciated) how much the inefficient US payment model actually drives and funds investment in medical R&D. If the US converts to a single-payer model, the effect on medical progress could be devastating.

 

[sunmaster14]

Just to point out, in Canada the administration of the Healthcare system is a provincial responsibility (provinces being the administrative equivalent of states).

The federal government's role in healthcare is to ensure that the provinces keep to a minimum level of care, regulate the introduction of new drugs, etc.

Well, before Obamacare (and even after I think), states actually decided on the minimum level of care, as well as all of the rules governing how insurance policies are designed, priced, and sold. For example, New York already had community rating and guaranteed issue, whereas most states didn't. In the US, insurance companies in aggregate had to deal with 50 different regulatory schemes. And then of course the employer-based insurance model exacerbated the complexity, since you're unnecessarily aggregating customers into mini-pools, each with their own preferences which needed to be separately negotiated and administered.

So, yes, our system sucked in many ways, but we don't need to go to single-payer to fix it. In fact, all we really needed to do was remove the tax subsidy for employer-based health care over time and allow interstate sale of insurance policies, and the free market would do the rest. Easy-peasy.

 

[Blue Mountain]

(snip) The single-payer model seems to be working OK, but in comparison to what? There's no good point of reference, and for the record, the US did not have and does not have market-based health care (health care is not insurance). People in single-payer model countries may be satisfied with their health care in the same way that East Germans used to be satisfied driving Trabants. They only have their fellow citizens as a point of reference.(snip)

You're revealing your ignorance on this topic. The choice is not a binary one between a full public single-payer system like Canada and the UK or the chaos that is the American system.

Many countries have universal health insurance regulated by the government but provided by private companies. Switzerland is the first one that comes to mind. All citizens must take out insurance, and all providers must supply a minimum policy. (I'm not sure how subsidies work for low income people.) The insurance companies compete on extended policies and additional benefits.

 

[RandFan]

Market based health care.

I have a choice when it comes to both my insurance and doctor. I have chosen Hummana and a local doctor I like very much.

How on Earth is healthcare insurance and healthcare in America not market driven?

• I can choose my provider (not owned or run by the state).
• I can choose my plan (one crafted by a private firm).
• I can choose my doctor (one who is independent or affiliated with a private organization).

If that isn't market driven then someone, anyone, please tell me what is?

 

[sunmaster14]

You're revealing your ignorance on this topic. The choice is not a binary one between a full public single-payer system like Canada and the UK or the chaos that is the American system.

Many countries have universal health insurance regulated by the government but provided by private companies. Switzerland is the first one that comes to mind. All citizens must take out insurance, and all providers must supply a minimum policy. (I'm not sure how subsidies work for low income people.) The insurance companies compete on extended policies and additional benefits.

Straw man. Not only did I not say there was a binary choice, I implied that the best choice was not one that any country currently embraces. There are obviously a range of options, and in my opinion the more the consumer feels the direct costs of his health care decisions (which is what I mean by market-based), the better.

 

[sunmaster14]

I have a choice when it comes to both my insurance and doctor. I have chosen Hummana and a local doctor I like very much.

How on Earth is healthcare insurance and healthcare in America not market driven?

• I can choose my provider (not owned or run by the state).
• I can choose my plan (one crafted by a private firm).
• I can choose my doctor (one who is independent or affiliated with a private organization).

If that isn't market driven then someone, anyone, please tell me what is?

Market driven means that there is no 3rd party payer for the vast majority of health care decisions, and that therefore the cost/benefit analysis is done at the consumer level.

For example, did the price your doctor charges your insurance company enter into your decision to choose him? If not, then it was not a market-based decision, at least not directly. Does the price of a medical procedure enter into your analysis as to whether or not to go forward with it? If not, then it is not a market-based decision.

There has been some progress towards bringing the cost-benefit analysis down to the level of the consumer. High deductibles do that, as well as co-payments and restricted provider networks. But these are Rube Goldberg type solutions. Best thing is to have insurance be more like car insurance (i.e. catastrophic) and have people pay for routine medical expenses out of pocket. The problem of affordability can be mitigated by providing refundable vouchers to poor people. I favor a $5K grant from the federal government per year per person, of which $1K is "use it or lose it." The rest can be kept by the grantee if the money is not spent.

Note that there are some areas of medical care which do function like free markets because they are typically not covered, or are poorly covered, by insurance. These include dental care, vision care, and cosmetic surgery. All three of these areas are more market-driven and all three have experienced low price inflation.

 

[Fast Eddie B]

In GA, there was only one company offering a Bronze plan.

Not much free market choice there, whoever you choose to blame.

 

[jimbob]

Market driven means that there is no 3rd party payer for the vast majority of health care decisions, and that therefore the cost/benefit analysis is done at the consumer level.

For example, did the price your doctor charges your insurance company enter into your decision to choose him? If not, then it was not a market-based decision, at least not directly. Does the price of a medical procedure enter into your analysis as to whether or not to go forward with it? If not, then it is not a market-based decision.

There has been some progress towards bringing the cost-benefit analysis down to the level of the consumer. High deductibles do that, as well as co-payments and restricted provider networks. But these are Rube Goldberg type solutions. Best thing is to have insurance be more like car insurance (i.e. catastrophic) and have people pay for routine medical expenses out of pocket. The problem of affordability can be mitigated by providing refundable vouchers to poor people. I favor a $5K grant from the federal government per year per person, of which $1K is "use it or lose it." The rest can be kept by the grantee if the money is not spent.

Note that there are some areas of medical care which do function like free markets because they are typically not covered, or are poorly covered, by insurance. These include dental care, vision care, and cosmetic surgery. All three of these areas are more market-driven and all three have experienced low price inflation.

Like this?

From a different thread

If we had an actual free market, then most of these problems would disappear. First of all, in a free market there are no barriers to entry, and this assumption holds up particularly well in the case of health-care where anyone can start a local business. All of this competition means lower prices for you (and lower profits for business). Second, consumers are informed (no asymmetries); they're not swayed by silly superstitions and they don't need something like ten years of training. Moreover, bad decisions are perfectly reversible and consumers have lots of time to shop around. Third, indivisible benefits and costs: not happenin' here. When other people get sick and die, it's on them. Some people -- yes, I'm talking about communists -- like those two old white guys in the video -- will complain about how much is lost in "worker productivity" on account of days missed due to tooth aches and chest pains. Well, boohoo. Fourth: the children. It's actually better if fewer kids see doctors because it toughens them up. It's like my doctor says, "what doesn't kill you can only make you stronger." This may sound counter-intuitive to you. If it does sound counter-intuitive, then you're stupid, and you need to get your "duh-face" checked out... if you can. Fif: no government bureaucrats. Instead of decisions made by some poindexter in Washington who thinks he knows more than your doctor, under a free market they'll be made by some business major in Connecticut who doesn't care if he knows better than your doctor.

 

[The_Animus]

It amazes me how often people will take the time to post something that a quick google search would show is false.