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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.

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.

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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.

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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.

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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.

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Originally posted by RickyM you're just a shit version of Moral Hazard. At least he knows what he's talking about.

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Originally posted by pkcRAISTLIN lol, i love it when moral feels the need to lay the smack down

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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.

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Originally posted by RickyM you're just a shit version of Moral Hazard. At least he knows what he's talking about.

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Originally posted by pkcRAISTLIN lol, i love it when moral feels the need to lay the smack down

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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%

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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.

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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.

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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.

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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

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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? http://www.hc-sc.gc.ca/hcs-sss/medi-assur/index-eng.php

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.

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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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Originally posted by RickyM you're just a shit version of Moral Hazard. At least he knows what he's talking about.

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Originally posted by pkcRAISTLIN lol, i love it when moral feels the need to lay the smack down

Last edited by Moral Hazard on Jul-28-2009 at 12:55