"Wes" wrote in message
...
"Ed Huntress" wrote:
"Wes" wrote in message
...
"Ed Huntress" wrote:
Ha! I thought you were talking about the health plans managed by the
federal
Office of Personnel Management. g They run the FEHB program for
federal
employees.
I was wondering what you thought I meant by OPM. 
FWIW, Larry is full of crap. The public option has nothing to do with
the
subsidy plans. It scares the hell out of private insurance companies
because, if it's run as well as Medicare, it will beat their prices by
15% -
25% or more.
Will it run as bad as Medicaid?
Each state runs its own Medicaid. State governments in general are
incompetent to do much more than name the official state bird. James
Madison
had it right: the more local the government, the less competent it is
likely
to be.
I'm a big fan of state sovereignty so we will just have to disagree on
that.
And there are so many fine examples for you to point to, like California,
Louisianna, Illinois, New York, Michigan, New Jersey, etc., etc. d8-)
Half the state governments in the country have a chance of becoming the
subjects of comic books.
The trouble with it is that the private insurers will try to co-opt it,
through lobbying, so that it becomes the sinkhole for people with
pre-existing conditions. Then costs will go up, and the private insurers
can
go back to printing money.
Ed, I hope you realize there are a lot of people that really think the
public option is
going to be affordable as in 100 to 200 bucks a month. That isn't going
to happen.
I don't know who those people are, Wes. For some people with *very* low
incomes, it may well come out to a cost like that -- as will subsidized
private insurance.
As you know since I mention it often, I catch all three hours of C-Span
Washington
Journal. The call in portions of the program is where I'm hearing it.
If you want, see if I can find anything serious. It may all just be wild
speculation; as I said, I haven't paid much attention. I don't listen to
call-ins of any kind. They depress me.
I'd still like to see a rate schedule for the public option, the
particulars of what is
covered, co pays, and all that messy stuff that ruins the dream.
Wes
Have you looked for one? There have been some projections. I haven't paid
much attention to them myself.
My ear radar is on alert, I've never heard anything. My googlefu hasn't
turned up
anything solid either.
I'm more interested in putting an end to the
unpaid emergency room care; getting a grip on pharmaceutical costs (which
isn't really in the bill, but which it will enable); and putting the AMA
on
the spot to start doing something about health care costs. Right now
that's
in the hands of the private insurance companies, and they've failed at it,
utterly. That's not because they're stupid or evil. It's because they have
no incentive to do so. In fact, their incentive is quite the opposite.
How do you deal with unpaid emergency care? That appears to be a factor
in the overall
cost of insurance since in the end, someone has to pay.
You make sure it isn't unpaid. First, you try to reduce it with a universal
system that, one hopes, will lead to more early detection.
For example, once Gunner had his stents a few years back, he should have
been on a regular stress-test schedule that could have detected his
impending second heart attack. They may not have had to saw him open. Then
he may not have had a stroke.
This is all statistical/actuarial stuff. The numbers are out there, in the
professional medical literature.
Once you have a rational, universal system going, you fold the remaining
emergency-room care into the total insured community. It already is,
actually, except that we pay it now in the form of taxes and substantially
higher hospital bills.
Now on pharmaceutical costs, I don't think we should have to pay a dime
more than any
other western country. One world price for the developed nations unless a
case can be
made for extra costs for litigation or testing by country. Discounts to
third world
countries, I'm willing to pay for.
I've heard that in the case of other countries, they have laws under the
WTO agreements
that if a deal on pricing can't be cut, they can make the drug inhouse
reguardless of US
patents.
http://www.wto.org/english/tratop_E/...a_ato186_e.htm
Go half way down. Closest thing I can find at the moment.
Yeah. TRIPS. It's a very fluid thing. There's a lengthy discussion about it
in a recent book that I just read, _Bad Samaritans_. The US is trying to ram
it down the world's throat, with mixed success. You may be interested that
Canada didn't recognize foreign drug patents until the '90s. I think it was
about the same for Switzerland -- 1988, IIRC. So it isn't a third-world
thing.
That's true for the US, too, BTW. We invoked it a few years ago by breaking
a European patent (Sanofi? I forget who held the patent.) on an antidote for
anthrax. Our military is using it now, but we made millions of doses for the
general population after the anthrax letter scare.
It's complicated. The European Union produced a report a few years ago,
slamming the countries of Europe for putting price controls on drugs,
producing all kinds of tables and numbers showing that the US had grabbed
most of the world's pharma research because this is where they make their
money. They showed the jobs and tax revenues that were generated from it,
and it showed that the US came out ahead. In fact, I had one of those jobs,
so I'm not entirely skeptical.
But I'm wary of it. It's one of those macroeconomic views of a microeconomic
situation, which don't show all of the mal-distribution of costs throughout
a society. My gut feeling is that we'd be better off with price controls on
drugs, just like every other developed country has done. But I'm sure that
the European report was as least partly correct, that we'd lose most of the
industry if we did so. They'd move to India and to the Third World, because
drugs can be made anywhere.
We'd get the same result if we could re-import US-made drugs from other
countries. Once you do that, the drug companies have no incentive to keep
their HQ's and production facilities in the US. None.
I wish I could give you cites but last night while I was listening to
Cspan-1, I heard
that most medical centers have a year over year expectation of a 7% annual
increase in
returns.
You'd need to see a full analysis of that. The raw figure doesn't mean much.
Once the system is somewhat rationalized, with universal care and some
tools
that let us grab medical care and insurance by the balls, it will be a
matter of how intelligently we use those powers. That's a big "if." But
right now, it's running out of control, with no incentives for anyone to
control costs. As David Brooks put it, it's a system of "perverse
incentives."
I can agree that there are a lot of forces in action. Now will both sides
agree to
eliminate the perverse parts?
Absolutely not. The conservatives will not accept the fact that the
essential problem with health care in the US is multiple market failures
that are inherently unfixable. They'll keep trying to jimmy the rules to
make a real market out of it. On this one, I agree with the Democrats: there
is no way that anyone knows of to make a real market out of the health care
business. You can squeeze the balloon but the air keeps moving to another
end.
If one is discovered, I'd be all for it. But I don't believe that such a
thing exists.
--
Ed Huntress