"Tim Daneliuk" wrote in message
...
rangerssuck wrote:
On Jun 14, 6:36 pm, "Hawke" wrote:
What's irritating is that no matter how many times you show these
numbers
to
right wing guys it just doesn't sink in
Hawke
Just to irritate you some more, it still has not sunk in. The
problem is while it is easy to come up with those numbers, it is a
lot harder to know why. Correlation does not mean cause and
effect.
An easy way to decrease the cost of healthcare in the US, would be
to eliminate all procedures which will only prolong someones life
by six months and also eliminate all procedures that do not have a
proven success record. If we had done this say thirty years ago,
we would not have any heart transplants , artificial heart valves,
etc.
Dan
Until you have been involved in the decision whether to treat a
loved one aggressively to prolong life or let go ("let nature take
its course"), you don't know what you are talking about.
It isn't a question of treatment or not. The question is payment.
There isn't any reason a person shouldn't be able to buy insurance to
cover anything they need.
Their needs, and the needs of their families for emotional placation,
are not the needs of society.
JC
If you think payment is the question, not treatment, then I have to
ask payment for what? The cost of (let's say) a liver transplant for
a patient who is going to die soon, whether or not the transplant
occurs, is WAY more than the cost of palliative treatment. I have to
ask what we are insuring against. A basic low(er) level of treatment
costs, or the costs of treating everything. IMNSHO, a asic level of
insurance (however defined) should be compulsory (yes, that bad word,
and whether the employee or the employer pays is ultimately only
semantics). On top of that a person should be allowed to insure
against the costs of more complex events/procedures. Freedom of
personal choice, etc., etc.
Society needs some kind of insurance, and the current system is
dysfunctional.
Government in the medical business is a permanent solution to a
temporary
problem. When I was a kid, when you got sick you went to the doctor
and
he
did what he could and it didn't cost much. Now he can do a lot more
but
it's all cutting edge and the costs are horrendous. A hundred years
from
now when the technologies have matured and an NMR scanner is a child's
plaything that you get at Toys R Us for 50 bucks it's going to be back
to
where most people can pay for most medical issues out of pocket without
it
hurting particularly.
But if we get government involved now then government will still be
involved
then.
So would you rather have the government be involved in health care or
just
leave it in the hands of people like used car salesmen? There are
private
alternatives that are worse than the government. How about having Bernie
Madoff handling your health care or the management of AIG? Think they
would
be better than the government? I don't. The greed of businessmen is what
makes them unacceptable for making decisions on people's health care.
You
need people that aren't going to profit from your health problems making
the
decisions. Hopefully, medical professionals without a financial interest
would decide what you need.

Hawke

Here's another angle:

I pay over $10,000 per year for health insurance. A significant
portion of that bill is for prescription drugs. So why the **** is it
that for the two generic prescriptions I fill each month, it's cheaper
to pay the drug store directly than to pay the copays from the
insurance company?

Last week, I noticed a sign at my supermarket saying that their
pharmacy would fill antibiotic prescriptions for FREE, and many others
for $3.95.

My point is that there MUST be a less expensive way to do this.

There is - get the government out of healthcare entirely and watch
competition drive prices down.

There is no real competition in the health care insurance industry, except
for the management of large corporate accounts. Large corporations are not
actually insured by insurance companies; they're self-insured, with the big
insurance companies managing the account for a fee. Corporations have the
best set of incentives to drive health care effectively and efficiently but
it isn't like buying iron ore or accounting services for them, and they,
too, are limited in how much they can shape the overall system.

Prices are artificially high today
precisely because the providers are guaranteed government payment
for some part of the service or pharma vended.

How does that explain the fact that health care prices in Europe run around
1/2 - 2/3 of ours, even where the government guarantees *all* of the payment
there?

Medicare pays only about 80% of what private insurance pays; Medicaid pays
even less. The price standards are set by private managed-care insurers, not
by the government. If it was government-pay only, prices would be at least
20% less just by that fact alone. And corporate benefits managers in Fortune
500 companies are the ones who are determining the managed-care rates.

The current system
is an unholy mess that tries to retain the benefits of competitive
market-based medicine while inserting government control into the
system. This is no more possible than being kind of pregnant.

For the past six years, Big Pharma companies have been my clients, and
private insurers have been my clients' customers (and my audience). You're
quite right that it's an unholy mess, but the reason is a complete
misalignment of incentives.

The incentives to cut costs in the business as a whole are weak. The
stronger incentives are to give at least the impression of relatively
superior care, and, for doctors and hospitals, to justify the use of as many
billable services as possible. For all of the providers, there is a strong
incentive to avoid liability, even at high costs. As any good market theory
will tell us, that's a prescription for prices that are rising faster than
inflation.

There are exceptional hospitals and many physicians who go against the
grain, providing superior care at a much lower-than-average cost. Geisinger
Medical Center in Pennsylvania is an often-cited example; there are others.
They have superior management that bucks the industry trends and habits. But
you can't run a nationwide health care system for 300 million people relying
on superior management. There aren't enough such managers in existence.

You can, however, get much better results by aligning incentives properly so
that all health care management is driven toward a goal of providing better
care for less money. That won't happen as long as the system is mostly
private, because the financial incentives for health care insurers, for
example, are to deny coverage as much as possible; to pay providers as
little as possible; and to exploit the vast statistical and actuarial
complications of health care, along with an advertising and promotion
program in an effective cost benefit ratio, to give the impression of better
service while actually providing as little as they can get away with.
Financial incentives for other providers in the system are similarly twisted
and perverted, although the case is most obvious on the insurance side.

That's not to say health care providers are so cynical that they're driven
only by money, or that they'll always grab the opportunity to deceive. I
worked in that industry long enough to know better. But if financial
incentives are pulling one way and ethical incentives are pulling in a
different way, ethical considerations are going to lose some, if not most,
of the battles. In the end, profit is the most demanding incentive, and the
ways to achieve it are mostly counter-productive to the goal of better and
more cost-efficient care. As the system is structured now, there is no
benefit to coming up with a solution that's 95% as good, but at half the
price. Only killing 5 people out of 100 is not a good advertising slogan in
the health care business.

Whether the system is mostly private or mostly government-run matters much
less than how well the incentives can be aligned with the goals of producing
the best service at the lowest cost. Unlike most industries, health care is
inherently resistant to the benefits of competition, for the reasons I cited
above. It isn't that competition and beneficial incentive structures are
impossible; it's just that no one has figured out how to accomplish them.
You don't go shopping for the best deal when you've just had a heart attack
and they're opening you up. And you don't start searching the Internet for
discount coupons when your child has a fever of 105.

--
Ed Huntress