Originally posted by jerZ07002
yes they do. The problem is that operating expenses are so high there is no choice but to charge as much as they do (well, they could charge less but then doctors wouldn't be driving porsches, and there would be little incentive to going through 10 years of schooling if there wasn't a pretty big payday at the back end). Doctors are service providers like any other provider. They need to build a client base and they compete with other doctors for that business. Hospitals are quite the same. If they didn't compete they wouldn't need to advertise.
Like PKC said, they may compete on some level, but the competition is far from fair. I'd liken it to a oligopoly. Demand is inelastic. They can raise prices and the change in demand will change little to none.
Posted by jerZ07002 on Jul-27-2009 03:05:
quote:
Originally posted by pkcRAISTLIN
So, where are all the 50% off stock-take sales? Offers of price-matching? 2 for 1 deals? Doctors/hospitals taking pay cuts to gain more clients? When you�re doing work that can only be paid by the insured, what incentive is there to keep costs low when the insurer will foot massive, massive bills anyway?
Don�t get me wrong, I have no problems with people enjoying the fruits of their labour, but I simply don�t buy the argument that hospitals/doctors compete in the same manner that non-specialist sectors of society do. Every segment of the US health system has a privatised, profit-driven mechanic behind it. Why is everyone so surprised when each separate part of that system keeps going up in price? Why are comparable public systems able to offer far better costings, even though they�re the evil, inefficient government? When healthcare isn�t run as a profit-making enterprise (or when there�s a dual system to share the burden), costs remain far lower than anything the US can even dream of.
to be fair, i never said they compete on the same level (i agree it's not like a competition between GM and Ford). the nature of health care is such that people will pay what they need in order to attain the services they require. It's not like buying a bottle of coke or pepsi (i.e., if coke is too expensive they will go to pepsi). What people don't realize is that the price for health services is affected largely by the expenses associated with insurance costs and the prices insurance companies are willing to pay doctors for the services provided to the covered clients. What we don't see is the price competition among private insurers for what they pay doctors. The pricing war is not at the doctor level, but at the group insured level. Unforutantely, the major pricing competition applies when big companies are shopping for insurance plans and insurers offer their plans to the companies. At that point, the company is shopped a catalogue of doctors, premiums, co-pays, etc... To a certain extent, insurance companies keep the cost down for the insured (i.e., they only compensate doctors a certain amount). On the other hand, the uninsured pick up the tab because doctors are free to charge what they please (as anyone who actually looks at their medical bills in the US notices, the charged fee is usually much more than the amount the doctor is compensated by the insurance company - the excess only being paid by uninsured). Just because we don't see the competition doesn't mean it doesn't exist. Moreover, doctors compete daily for patients. They may not compete through pricing wars like other industries, but that doesn't mean they don't compete. Also, doctors actually charge different amounts. But, to the insured, I couldn't give a fuck about what the doctor charges, i only charge about the quality of the service. So, i guess to a certain extent, consumer behaviors and attitudes drive the perceived lack of competition.
Posted by Moral Hazard on Jul-27-2009 17:26:
quote:
Originally posted by The17sss
2 words: tort reform.
Why do you think doctors peform so many extra tests? Because they have to, due to the industry being rampant with ambulance chasing lawyers just waiting for a misdiagnosis so they can get after a multi-million dollar lawsuit; the doctors almost HAVE to do it to protect themselves from bankruptcy. They aren't out scheming for ways to make more money, as Obama suggested those evil pediatricians do with removing tonsils. A limit on lawsuit amounts could vastly bring down healthcare costs.... malpractice insurance is also getting insanely high because of this, which ultimately raises the costs too.
Tort reform would help immensely... however it never will with Democrats in charge because the trial lawyers are the 2nd highest financial contributing group to their party.
The level of litigeousness in the US is no different then in Canada and our health care is comparative in quality (higher by some measures) and much less expensive.
Posted by Moral Hazard on Jul-27-2009 17:32:
quote:
Originally posted by jerZ07002
The US doesn't have a marginal rate of 30%.
Odd, when I fed my income into a US marginal tax rate calculator that's what it gave me. I just checked again... based on the brackets I'd be 33%
[/QUOTE] Plus, the Provincial taxes in Canada are much higher than State personal income taxes in the US....[/QUOTE]
God help me; however, I think ******** did a decent job addressing this.
Posted by jerZ07002 on Jul-27-2009 19:02:
quote:
Originally posted by Moral Hazard
God help me; however, I think ******** did a decent job addressing this.
******** provided a bunch of provincial taxes that range well above the average US state personal income tax rates. Are you suggesting that British COlumbia's top rate of almost 15% is not more burdensome than california's top rate of 9% or NJ's top rate of about 8%
Posted by NeoPhono on Jul-27-2009 21:25:
quote:
Originally posted by Krypton
The point is, doctor's and hospitals don't compete. They have no incentive to lower prices, or provide value for treatment.
Hospitals most certainly do compete, along with doctors, but healthcare in the US is driven by consumers (patients) and the driving force for consumers is quality, not cost. The trend in the last 10-15 years has been for hospitals to become more of "spas" than traditional hospitals. Patients make conscious decisions to go to hospitals and clinics that appear to be of the highest quality, be it real or perceived. Hospitals sink billions into renovating rooms, getting more comfortable beds and making sure they offer the latest and greatest procedures. All of these things are expensive, but when it comes down to it, it's the only driving force for healthcare consumers in our current system. Hospitals who are unable to keep up with the constant upgrading fail.
If someone becomes sick or injured, they seek out the highest quality care and pay little or no attention to cost. Healthcare is an inelastic commodity. We could continue using techniques that are older but still useful instead of using cutting-edge technologies that offer modest to slight improvements, but nobody wants to do that. No one chooses the use of clot-busting medications after grandma's stroke when they could have an interventionalist do it invasively instead. No one wants their prostate resected the "old" way when you could have a robot-assisted procedure instead.
The only thing currently capping costs is the price of insurance. If we have a government run system, then the government would do the same. It's a trade-off and there is no perfect system. As long as people continue to demand the best quality available, you're going to have to impose limits either through price or availability. In our current system it's price that mostly dictates this. In most government healthcare system it's availability which indirectly controls costs. Like I said though, there's always a trade-off.
So, in short, hospitals and doctors do compete, but in much different ways than in other industries. A car dealer might attract customers by offering discounts on some models and that attracts people because they're balancing quality with affordability. In an analogous situation to healthcare, the dealership would attract customers by offering the highest quality cars available in hopes their cars are better than the competition.
Posted by Arbiter on Jul-27-2009 22:12:
quote:
Originally posted by NeoPhono
Hospitals most certainly do compete, along with doctors, but healthcare in the US is driven by consumers (patients) and the driving force for consumers is quality, not cost. The trend in the last 10-15 years has been for hospitals to become more of "spas" than traditional hospitals. Patients make conscious decisions to go to hospitals and clinics that appear to be of the highest quality, be it real or perceived.
Of course consumers make those choices when they are insured and do not directly pay the price for the level of quality they are recieving. Why would someone who is paying the same amount out-of-pocket either way choose a less expensive treatment option? If enough people did it, it might affect their premiums, but an individual has no incentive to choose the less costly alternative, even if they would prefer to do so if they, rather than an insurance company, were going to reap the financial reward from that option.
It seems to me that this problem is even greater under most government-run systems, since there is even more cross-subsidization. Perhaps that is not inescapably so, however.
For example, I'd be interested in exploring the possibility of a government-subsidized system in which people initially paid a relatively high tax rate, but whose tax rate scaled downwards as they grew older if their consumption of subsidized health care was substantially less than average. This would give the individual patient the possibility of actually realizing some (if not all) of the financial benefit of electing to use less health care, be it quantitatively or qualitatively. It might still be the case that most everyone would tend to choose the most expensive option, but at least we would get a more accurate picture of what demand would look like if not for the moral hazard of insurance, and it includes an element of individual choice, which I would hope most people would agree is valuable in and of itself.
Posted by NeoPhono on Jul-27-2009 22:30:
quote:
Originally posted by Arbiter
Of course consumers make those choices when they are insured and do not directly pay the price for the level of quality they are recieving. Why would someone who is paying the same amount out-of-pocket either way choose a less expensive treatment option? If enough people did it, it might affect their premiums, but an individual has no incentive to choose the less costly alternative, even if they would prefer to do so if they, rather than an insurance company, were going to reap the financial reward from that option.
It seems to me that this problem is even greater under most government-run systems, since there is even more cross-subsidization. Perhaps that is not inescapably so, however.
For example, I'd be interested in exploring the possibility of a government-subsidized system in which people initially paid a relatively high tax rate, but whose tax rate scaled downwards as they grew older if their consumption of subsidized health care was substantially less than average. This would give the individual patient the possibility of actually realizing some (if not all) of the financial benefit of electing to use less health care, be it quantitatively or qualitatively. It might still be the case that most everyone would tend to choose the most expensive option, but at least we would get a more accurate picture of what demand would look like if not for the moral hazard of insurance, and it includes an element of individual choice, which I would hope most people would agree is valuable in and of itself.
I do think a tiered system is probably the best option. Give everyone basic coverage with limitations when it comes to certain types of treatment. If people want more options, or the ability to have access to more expensive types of care, they can double-insure themselves with either a private system or add-ons to the government care. You'd achieve cost reduction with a good deal of the population while still insuring everyone has some basic coverage and that those with the means could still have access to the types of treatment they want. I'm sure many would point out the inherent inequality, but I think it's a compromise that would need to be made. I also like the idea of "good health" tax rebates for those that are minimal users of the health system. It would be a good way to encourage healthy lifestyles without overtly punishing those with less-than-stellar health.
Posted by pkcRAISTLIN on Jul-28-2009 00:17:
quote:
Originally posted by Arbiter
It seems to me that this problem is even greater under most government-run systems, since there is even more cross-subsidization. Perhaps that is not inescapably so, however.
whilst i think your deductions are sound, i still think you're wrong. patients in public care dont necessarily get to choose dozens of wonderful treatments because they're not paying for it. they get what they need and little more. elective medical treatment can see you on a waiting list for a very, very long time. that's the real catch of the public system. i certainly don't think the issue would approach the same magnitude you might see from 100% insured people in america. you guys do tend to be pretty demanding compared to other cultures Posted by NeoPhono on Jul-28-2009 01:56:
quote:
Originally posted by ********
How would you compare this with Canada's current health care system? Is it in anyway equivocable to what you think would work? If so how the same how different?
It is similar except that I would remove all the "disincentives" for private health care that Canada currently has. In essence you'd have a stratified public and private health system. As I said before, you'd have inherent inequalities, but it would still give everyone basic guarantees to care while allowing those who can afford it to bypass some of the public system waiting times and have access to more expensive or alternative care.
Posted by Moral Hazard on Jul-28-2009 12:41:
quote:
Originally posted by jerZ07002
******** provided a bunch of provincial taxes that range well above the average US state personal income tax rates. Are you suggesting that British COlumbia's top rate of almost 15% is not more burdensome than california's top rate of 9% or NJ's top rate of about 8%
You have to look at combined Fed and Provincial/state taxes, since the division of responsibilities between our Fed and Provinces is different then the Fed and States; looking at just the province:state for Canadian:US tax rates is not comparing apples to apples...
I just ran the calculations for a BC resident and California resident with a gross income of $100,000.... in BC the combined tax would be $26,578, in CA the combined tax would be $26,493.
Honestly... when you compare the services received... no. With BC's taxes the citizen gets free health care, heavily subsidised university education, automobile liability insurance (ICBC), less poverty, better social and civil services... I'd say it's worth the extra tax... hell, just in health care premiums you're coming out ahead.
***edit - those are 2008 rates
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[[ LINK REMOVED ]] Posted by Arbiter on Jul-28-2009 18:56:
quote:
Originally posted by Moral Hazard
I just ran the calculations for a BC resident and California resident with a gross income of $100,000.... in BC the combined tax would be $26,578, in CA the combined tax would be $26,493.
To be fair, CA is hardly typical. Several U.S. states don't even have income tax.
Posted by Moral Hazard on Jul-28-2009 19:07:
quote:
Originally posted by Arbiter
To be fair, CA is hardly typical. Several U.S. states don't even have income tax.
BC is on the high end in Canada, as well. As I said earlier, you can't just compare fed:fed or province:state because the division of powers are different. BTW, I only used California because it was the state cited to me.
Posted by pkcRAISTLIN on Jul-29-2009 02:07:
this has been a fascinating topic. it has brought further definition to all the the TA liberals' (yes, i hate that term but for convenience's sake...) ideological framework(s). makes a nice change than arguing with those stupid conservatives
Posted by MisterOpus1 on Jul-29-2009 16:24:
quote:
Originally posted by The17sss
2 words: tort reform.
Why do you think doctors peform so many extra tests? Because they have to, due to the industry being rampant with ambulance chasing lawyers just waiting for a misdiagnosis so they can get after a multi-million dollar lawsuit; the doctors almost HAVE to do it to protect themselves from bankruptcy. They aren't out scheming for ways to make more money, as Obama suggested those evil pediatricians do with removing tonsils. A limit on lawsuit amounts could vastly bring down healthcare costs.... malpractice insurance is also getting insanely high because of this, which ultimately raises the costs too.
Tort reform would help immensely... however it never will with Democrats in charge because the trial lawyers are the 2nd highest financial contributing group to their party.
In 2004, the CBO "pegged medical malpractice costs at 2 percent of U.S. health spending":
Premiums are not being driven by malpractice lawsuits, no matter what the insurance industries want to claim and want you to believe. They are driving up their prices by their own fuzzy economics, nothing more.
Posted by NeoPhono on Jul-30-2009 01:53:
quote:
Originally posted by MisterOpus1
In 2004, the CBO "pegged medical malpractice costs at 2 percent of U.S. health spending":
Premiums are not being driven by malpractice lawsuits, no matter what the insurance industries want to claim and want you to believe. They are driving up their prices by their own fuzzy economics, nothing more.
Malpractice is more of a plague on certain specialties rather than the medical profession as a whole. In total, it is only roughly 1% of costs, but for OB/GYN and for neurosurgery, malpractice is a BIG deal. So yes, overall tort reform would have little impact to medical costs, but when it comes to making sure we have enough people around to deliver babies and operate on brains, tort reform would make a huge impact for the better.
Posted by The17sss on Jul-30-2009 04:27:
quote:
Originally posted by MisterOpus1
Premiums are not being driven by malpractice lawsuits, no matter what the insurance industries want to claim and want you to believe. They are driving up their prices by their own fuzzy economics, nothing more.
I heard a surgeon talking on CNBC the other day saying that 15% of medical costs (about $350 billion per year) comes from doctors practicing "cover your ass" medicine to avoid the liabilities associated with malpractice suits. His point, which I was trying to make also, is that putting a cap on malpractice suits would lower medical costs because doctors wouldn't be doing so much of that "lawsuit preventative" extra testing.
Posted by MisterOpus1 on Jul-30-2009 14:54:
quote:
Originally posted by The17sss
I heard a surgeon talking on CNBC the other day saying that 15% of medical costs (about $350 billion per year) comes from doctors practicing "cover your ass" medicine to avoid the liabilities associated with malpractice suits. His point, which I was trying to make also, is that putting a cap on malpractice suits would lower medical costs because doctors wouldn't be doing so much of that "lawsuit preventative" extra testing.
I've also heard similar testimony's from doctors and surgeons. In our PT practice we have liability insurance as well, but thankfully has never been used in the 11 years we've been open (knock on wood). I don't deny that there are certain cases that involve high costs with malpractice insurance, and I'd surmise that there could be a wide range of annual premiums depending on the type of practice. But in general the statistics simply don't bear it out as being a primary factor regarding overall costs:
Conyers to Introduce Constitutional Amendment Making Health Care a �Right�
Wednesday, July 29, 2009
By Nicholas Ballasy, Video Reporter
(CNSNews.com) - During his speech at a recent National Press Club luncheon, House Judiciary Chairman John Conyers (D-Mich.) said he is introducing a constitutional amendment that would establish health care as �a right� for all Americans.
�We need a real serious bill and, by the way, the fundamental question, �Is health care a constitutional right?�� he said. �I mean, do you have a right to health care in the American system of government or not?�
�Well, we believe that people do and we�re introducing a constitutional amendment just to make it real clear so that you don�t have to infer or assume that that�s a given and all that.�
In order for you to receive health care someone else has to either expend time or property. To claim a "right" to health care is to claim a "right" to someone else's time .. that is, a right to a portion of their life: whatever portion of their life it takes for them to either render the health service or produce the medical implement or drug that is being used. Who in the do you think you are to claim a portion of someone else's life as YOURS?
So my question is, if somehow, someway, some amendment was drawn up and actually passed that says that healthcare is a "constitutional right" and there were no doctors, how would people be able to claim their so called "right?" How can something be a right if you are dependent on the actions of others to attain it? Life, Liberty, Pursuit of Happiness and all that, sure. Do I have a "right" to a cellphone? food? A computer? These are all things that must be earned or acquired by mutual exchange. That's just how I see it.
I'm fine with addressing problems with healthcare like price inflation, proper regulation, tort reform, etc. But I am not a supported of any sort of universal mandate single payor type of system.
Posted by MisterOpus1 on Jul-30-2009 16:24:
quote:
Originally posted by Shakka
In order for you to receive health care someone else has to either expend time or property. To claim a "right" to health care is to claim a "right" to someone else's time .. that is, a right to a portion of their life: whatever portion of their life it takes for them to either render the health service or produce the medical implement or drug that is being used. Who in the do you think you are to claim a portion of someone else's life as YOURS?
I dunno, should we be asking the same of firefighters when our house is burning down? Should we be asking the same of policemen when someone is breaking into our house?
Or better yet, this didn't really seem to be such a huge issue for most Republicans when the SCHIP bill was passed. Why was so little hubub raised when children are given government health care but not adults?
quote:
So my question is, if somehow, someway, some amendment was drawn up and actually passed that says that healthcare is a "constitutional right" and there were no doctors, how would people be able to claim their so called "right?" How can something be a right if you are dependent on the actions of others to attain it? Life, Liberty, Pursuit of Happiness and all that, sure. Do I have a "right" to a cellphone? food? A computer? These are all things that must be earned or acquired by mutual exchange. That's just how I see it.
I know. I just happen to disagree a little bit. Many of the things that we describe as "rights" are dependent upon the jobs of others. Yes, we do have a constitutional right to life and liberty, but do we not rely heavily on those on the judicial system, many of which happen to work for the government and are payed by our tax $, to guarantee and enforce those rights?
quote:
I'm fine with addressing problems with healthcare like price inflation, proper regulation, tort reform, etc. But I am not a supported of any sort of universal mandate single payor type of system.
Again, something that we disagree on. I think there are certain levels involved with basic health care "rights" that should be given and are currently not given now. Unfortunately I'm a little pressed today and won't be able to talk further on it until later.
Posted by Shakka on Jul-30-2009 17:17:
quote:
Originally posted by MisterOpus1
I dunno, should we be asking the same of firefighters when our house is burning down? Should we be asking the same of policemen when someone is breaking into our house?
I assume you paid for your house yourself, and you paid your taxes which provide for those services. I hope you're not implying that I should foot the bill for your house.
quote:
Or better yet, this didn't really seem to be such a huge issue for most Republicans when the SCHIP bill was passed. Why was so little hubub raised when children are given government health care but not adults?
Because adults should be exactly that...adults who can responsibly take care of themselves (yes, there are exceptions, but I don't subscribe to 40 million people simply are victims of the man when so many of them voluntarily choose to risk it an not have insurance and then expect a bailout like so many others when things don't go their way, or the millions of illegal immigrants who we would also be asked to subsidize despite their non-tax payor status). Children are different.
quote:
I know. I just happen to disagree a little bit. Many of the things that we describe as "rights" are dependent upon the jobs of others. Yes, we do have a constitutional right to life and liberty, but do we not rely heavily on those on the judicial system, many of which happen to work for the government and are payed by our tax $, to guarantee and enforce those rights?
To enforce rights, not to provide them or to subsidize them at the cost of others.
quote:
Again, something that we disagree on. I think there are certain levels involved with basic health care "rights" that should be given and are currently not given now. Unfortunately I'm a little pressed today and won't be able to talk further on it until later.
Basic, perhaps, but don't tell me that a person who doesn't pay for their coverage is somehow entitled to all of the bells and whistles of premium care that I pay thousands of dollars for. Maybe we pay too much for our healthcare here (and I don't dispute that), however you get what you pay for.
Posted by thedoggyworld on Jul-30-2009 22:04:
It would be nice if the Supreme Court made public statements on health care reform. I'd love to hear their views.
Posted by Arbiter on Jul-30-2009 22:53:
quote:
Originally posted by Shakka
Do I have a "right" to a cellphone? food? A computer? These are all things that must be earned or acquired by mutual exchange. That's just how I see it.
Eh, you should see some of the rights these 20th century constitutions proclaim. For example, a few guarantee a "right" to equal pay for equal work. Just imagine what it would entail for a court to take such rights seriously...
Posted by NeoPhono on Jul-31-2009 01:24:
quote:
Originally posted by Arbiter
Eh, you should see some of the rights these 20th century constitutions proclaim. For example, a few guarantee a "right" to equal pay for equal work. Just imagine what it would entail for a court to take such rights seriously...
Yes. Along with the example you've given, we currently have a problem with confusing "right" and "entitlement." The real question we're asking is whether we believe health care should be an entitlement guaranteed to all. The major problem we have then is that with other entitlements, there are consequences for abusing or defrauding the system. How would we do that with health care? What if someone decides to live in an unhealthy manner that causes overdue burden on the system? Do we somehow "punish" them, or just allow them to raise others' burden because of their own disregard? Tough questions.
Posted by Shakka on Aug-01-2009 22:05:
A difficult question I ponder...
For those that are pro-evolution (and I certainly am)...do you not subscribe to Darwinian theory? We spend all of this money and valuable resources to support people and populations (foreign aid included) that would unquestionably die out because we are a sympathetic culture...yet we quibble about running out of resources and providing "free" healthcare to support and sustain the weakest among us...
Wouldn't a true proponent of evolution support the survival of the fittest and the elimination of the weakest? Is there any internal conflict for any of you on this issue? I may not have explained it well enough, but bottom line, if you support things like universal healthcare, aren't you being the slightest bit dishonest with yourself? I mean, it's easily explainable for a charitable, God fearing citizen to sacrifice himself/herself and act altruistically for the benefit of his neighbor...but if you're a true evolutionist...isn't there an element of hypocrisy in some of these liberal viewpoints?
Objectively speaking, wouldn't we all be better off in the long run if we didn't pour our limited resources and energy into taking care of the weak? Aren't some of these healthcare initiatives (NOT ALL OF THEM) out of sync with some of the more basic tenets that you believe in?
