Originally posted by Arbiter
Well, for one I'd reorganize our regulatory framework to allow lower tiers of health care service to operate legally and with much more limited liability. Since it would be cheaper to operate these lower tiers of service, they would charge less and more people could afford them.
Second, I'd create a program that provided limited health care services to anyone regardless of their current ability to pay, but which passed as much of the cost as practicable along to the same individuals who used the service in the form of increased future tax obligations. Since many people would die without having paid for all the care they received, this program would involve some cross-subsidization. However, it would be a good order of magnitude or two less than a universal health care program.
I would also take measures to prevent other countries from regulating the price of pharmaceuticals and the fruits of other medical intellectual property invented in the United States to ensure that such countries pay their fair share of research and development costs.
I think that would be a good start. Essentially, I would implement a system that provided for a continuum of health care services, rather than the current stark choice of paying the full cost of the highest levels of care or having no coverage whatsoever. Of course, this would be unsatisfying to those who believe that people have a "right" to the highest level of care, but frankly they can go themselves as far as I'm concerned. If they care so much, then they should get together and create a charitable organization to carry out their mission using their own funds and funds they obtain from people voluntarily, rather than trying to forcibly impose their perverse view of human rights on the rest of society.
Those are actually good suggestions. I like the different tiers of services. While the current system isn't exactly all-or-none, it is very close to it.
How do you supposed we could prevent foreign countries from imposing price limitations on drugs produced in the US? I agree that this shifts the cost of R&D to US consumers, a practice that is largely going unnoticed by the general population. Perhaps we could broker longer patent durations in those countries so the companies could recover over a longer period the costs associated with the R&D for pharmaceutical sales in those countries. Perhaps the US could do something similar; give patent extensions for price discounts (just a thought).
The17sss
I don't want to get between Arbiter and Jerz's dialogue because it's very interesting. I just wanted to throw this soundbite in regarding Daniel Hannan's warning to the U.S. not to go down that road and why:
pkcRAISTLIN
quote:
Originally posted by The17sss
If the healthcare industry worked the same as any other private industry with competition between each other in the market, prices would go down and be affordable. Should an x-ray really cost $1200? no. Medicare and Medicaid are killing the system with govt red tape and costs.
What a fvcking joke. That might be an issue but its hardly the central problem of medical access and especially costs in the US. I mean seriously, hahaha, it’s the government's fault that costs are so high? Can I have whatever you're smoking?? :haha:
quote:
Originally posted by Arbiter
I would also take measures to prevent other countries from regulating the price of pharmaceuticals and the fruits of other medical intellectual property invented in the United States to ensure that such countries pay their fair share of research and development costs.
yeah, let's push the idiotic market extremes to the rest of the world! you're really gonna throw around terms like "fair share" in a market where nothing is fair? you think increasing profit margins for drug companies will lower costs to consumers? really?
quote:
Originally posted by Arbiter
I think that would be a good start. Essentially, I would implement a system that provided for a continuum of health care services, rather than the current stark choice of paying the full cost of the highest levels of care or having no coverage whatsoever. Of course, this would be unsatisfying to those who believe that people have a "right" to the highest level of care, but frankly they can go themselves as far as I'm concerned. If they care so much, then they should get together and create a charitable organization to carry out their mission using their own funds and funds they obtain from people voluntarily, rather than trying to forcibly impose their perverse view of human rights on the rest of society.
yeah, how dare people want affordable healthcare! if you dont have some kind of controls on insurance companies et al and if you dont have some kind of universal health coverage then the costs of care will always be out of reach to most people. there are far far more retarded recipients of government funds than healthcare.
quote:
Originally posted by jerZ07002
healthcare doesn't lend itself well to a free market system.
exactly.
Arbiter
quote:
Originally posted by jerZ07002
How do you supposed we could prevent foreign countries from imposing price limitations on drugs produced in the US? I agree that this shifts the cost of R&D to US consumers, a practice that is largely going unnoticed by the general population. Perhaps we could broker longer patent durations in those countries so the companies could recover over a longer period the costs associated with the R&D for pharmaceutical sales in those countries. Perhaps the US could do something similar; give patent extensions for price discounts (just a thought).
Yeah, working the details of that part could be pretty tricky. There's a few ways we could approach the issue. Negotiating longer patent durations is a good possibility that I hadn't thought of. When the drugs are actually manufactured in the U.S., it may be as simple as just putting a tariff on them, but when they are manufactured abroad it's more difficult. I'd really have to do some more research to have a good handle on the best way to approach the issue, but at a general level the two obvious approaches would be some kind of negotiation with those countries or putting an additional tax or surcharge somewhere upstream of the countries in the stream of commerce so that the additional cost would get passed onto whoever was importing the drugs and then those parties could work out how that affects each country's regulations internally.
Arbiter
quote:
Originally posted by pkcRAISTLIN
yeah, how dare people want affordable healthcare! if you dont have some kind of controls on insurance companies et al and if you dont have some kind of universal health coverage then the costs of care will always be out of reach to most people. there are far far more retarded recipients of government funds than healthcare.
There's not enough money in the world to give every person everything they want at a price they can afford. Personally, as a general matter I'm not a fan of even trying to just give people what they want--I'd much prefer that they earn it, since it tends to give people better incentives. But, since basic health care, somewhat like food and shelter (although quite different in some important respects), is a peculiar need, I'm willing to make limited exceptions to that general principle.
Universal health care is, in my view, an irrational overreaction to a admittedly serious problem. If we had a lack of affordable housing, few would suggest we provide a free mansion to each family unable to afford shelter. A better solution would be to facilitate the construction of more low-income apartment buildings. I think that our current lack of affordable health care calls for the creation of low-income health care services.
pkcRAISTLIN
quote:
Originally posted by Arbiter
There's not enough money in the world to give every person everything they want at a price they can afford. Personally, as a general matter I'm not a fan of even trying to just give people what they want--I'd much prefer that they earn it, since it tends to give people better incentives. But, since basic health care, somewhat like food and shelter (although quite different in some important respects), is a peculiar need, I'm willing to make limited exceptions to that general principle.
Universal health care is, in my view, an irrational overreaction to a admittedly serious problem. If we had a lack of affordable housing, few would suggest we provide a free mansion to each family unable to afford shelter. A better solution would be to facilitate the construction of more low-income apartment buildings. I think that our current lack of affordable health care calls for the creation of low-income health care services.
Well, yeah. I certainly don’t think people should have access to every procedure under the sun just because they feel like it. I don't really care whether its universal coverage or what, I just think it is blatantly criminal of insurance companies to be denying insurance to people because they're sick (I mean, whats the fvcking point in insurance if it wont cover you when youre sick ffs?) nor charging exorbitant premiums while not even providing adequate coverage. Not to mention the age-old insurance scam of denying paying customers proper coverage for sneaky loopholes or RETROACTIVE denial of contracts. I mean wtf???
When you consider how many people are losing their jobs in the US right now, and with it medical insruance, I can't imagine how fvcked things would be for many people.
Many many western countries, australia included, seem to do OK with different systems of universal coverage. I don’t see why the richest nation on earth should have it any harder. I know to join a private health fund it wouldn't cost me more than a couple thousand a year. You guys are paying that kind of price a MONTH.
As jerz said, healthcare simply isn't something that lends itself to the free market very well. Companies lose money when their insured get sick, why would you want to insure people who are bound to use their coverage??
Sunsnail
i have a 500$ copay lol
Arbiter
quote:
Originally posted by pkcRAISTLIN
Well, yeah. I certainly don’t think people should have access to every procedure under the sun just because they feel like it. I don't really care whether its universal coverage or what, I just think it is blatantly criminal of insurance companies to be denying insurance to people because they're sick (I mean, whats the fvcking point in insurance if it wont cover you when youre sick ffs?) nor charging exorbitant premiums while not even providing adequate coverage. Not to mention the age-old insurance scam of denying paying customers proper coverage for sneaky loopholes or RETROACTIVE denial of contracts. I mean wtf???
When you consider how many people are losing their jobs in the US right now, and with it medical insruance, I can't imagine how fvcked things would be for many people.
Many many western countries, australia included, seem to do OK with different systems of universal coverage. I don’t see why the richest nation on earth should have it any harder. I know to join a private health fund it wouldn't cost me more than a couple thousand a year. You guys are paying that kind of price a MONTH.
As jerz said, healthcare simply isn't something that lends itself to the free market very well. Companies lose money when their insured get sick, why would you want to insure people who are bound to use their coverage??
Well, I certainly agree that reform is necessary, but I am not necessarily willing to accept any reform merely because it promises change. It's defintily true that some regulation is necessary for the health care market, but in some ways I think the larger problem is that health care is not something that lends itself to insurance.
The basic idea of insurance is to deal with potential costs in the future by spreading those costs among people who share risk. But this works best for costs which are incurred as the result of suddent events, like a house burning down or an automobile accident. That's because after the damage occurs, there is an immediate return to uncertainty about future incidents, and therefore the possibility of either an actualized cost or no cost. But with health insurance, an individual with a pre-existing condition may not be seeking coverage for mere potential future costs: they are seeking coverage for future costs that are more or less certain. Naturally, neither the insurance company nor the rest of the risk pool will be enthused about insuring such a person for less than the costs they are guaranteed to impose on the rest of the group.
Imagine that instead of buying insurance from a large company, you decided to form your own private risk pool with 10 people you knew personally. Suppose you estimated that each of you had about the same risk, so you just agreed that everyone would pay 10% of whatever health care anyone in the group needed. Now suppose one person in the group dies, and the surviving members decide to add another person to bring the total back to ten. Would you want to select a person for that 10th spot who had a pre-existing condition that was going to cost several hundred thousand dollars over the next few years, knowing that you would definitely have to pay 10% of that in addition to whatever other health care needs they might incur in the future? Of course not. So I don't think it's really a fair assessment to say that insurance companies, which are basically responsible for organizing a much larger risk pool, are acting in a criminal manner when they refuse to insure people with pre-existing conditions, knowing that they would have to pass the cost of those conditions on to all the existing policy-holders. They are only doing what is in their best interest and in the best interest of the rest of their customers, and I'm not sure it's fair to blame them for the larger systemic problems over which they have no control.
Unfortunately, the cost of health care is so high that few people can pay out of pocket. For the rest there is no practical alternative but insurance, even though it's not at all well-suited to the problem. It certainly presents a quandary, and one I agree the government has a role in addressing. However, the government response needs to be highly nuanced, because a brute-force mass taxation and mass provision of health care is certain to create considerable inequity.
To name one example among many, there are 100 million odd obese folks here in America who, if they are in the same risk pool as the rest of us, are going to get the undeserved benefit of imposing a portion of the cost of their unhealthy lifestyle upon everyone else. I certainly don't think it would be equitable for those of us who take care of ourselves to be obliged to pay for the consequences of their poor choices. Normally, we'd just charge them more for their insurance to offset the increased risk. But is that going to happen under a universal health care plan? What about those who can't pay? Even if they can't pay, they can surely stop eating so much, and most of them can probably get off their ass a couple of times a week too -- are we going to force them to do that? There are just so many issues at play here, and it seems to me that most universal health care advocates are so obsessed with the current inavailability of health care that they ignore all the new inequities their proposals might create.
The17sss
quote:
Originally posted by pkcRAISTLIN
I mean seriously, hahaha, it’s the government's fault that costs are so high? Can I have whatever you're smoking?? :haha:
We haven't always had Medicare and Medicaid. Look at the % differences in healthcare costs today compared to when those 2 programs didn't exist.
Lebezniatnikov
quote:
Originally posted by The17sss
We haven't always had Medicare and Medicaid. Look at the % differences in healthcare costs today compared to when those 2 programs didn't exist.
Causation? Can I see some?
Lebezniatnikov
quote:
Originally posted by The17sss
You can use the example of schools... our public school system is a ing joke. ty teachers are virtually impossible to get fired and ty schools continue to operate; mediocrity and failure are the norms. For all the money government pours into education, look at the return we get on that investment. The one area where the government ISN'T involved is pre-schools. They are forced to compete with each other for business, and you end up seeing schools that don't cut it go out of business, and the ones that provide better quality education and resources for children thrive. So, like everything else, if government would get it's grubby hands OUT and leave it to more of a market approach, competition would drive down prices and drive up quality.
:wtf: :wtf: :wtf: :wtf: :wtf:
Seriously?
Aside from the point that removing government completely from education would destroy public education (which with I'm sure you're philosophically fine), can you tell me what happens to inner city or rural poor that can't afford to pay tuition for elementary school? Your plan would be great for doctor's kids in the suburbs, but would absolutely destroy social mobility in this country by eliminating any chance low-income families have of securing an education (forget quality) for their children.
jerZ07002
quote:
Originally posted by Arbiter
Well, I certainly agree that reform is necessary, but I am not necessarily willing to accept any reform merely because it promises change. It's defintily true that some regulation is necessary for the health care market, but in some ways I think the larger problem is that health care is not something that lends itself to insurance.
The basic idea of insurance is to deal with potential costs in the future by spreading those costs among people who share risk. But this works best for costs which are incurred as the result of suddent events, like a house burning down or an automobile accident. That's because after the damage occurs, there is an immediate return to uncertainty about future incidents, and therefore the possibility of either an actualized cost or no cost. But with health insurance, an individual with a pre-existing condition may not be seeking coverage for mere potential future costs: they are seeking coverage for future costs that are more or less certain. Naturally, neither the insurance company nor the rest of the risk pool will be enthused about insuring such a person for less than the costs they are guaranteed to impose on the rest of the group.
Imagine that instead of buying insurance from a large company, you decided to form your own private risk pool with 10 people you knew personally. Suppose you estimated that each of you had about the same risk, so you just agreed that everyone would pay 10% of whatever health care anyone in the group needed. Now suppose one person in the group dies, and the surviving members decide to add another person to bring the total back to ten. Would you want to select a person for that 10th spot who had a pre-existing condition that was going to cost several hundred thousand dollars over the next few years, knowing that you would definitely have to pay 10% of that in addition to whatever other health care needs they might incur in the future? Of course not. So I don't think it's really a fair assessment to say that insurance companies, which are basically responsible for organizing a much larger risk pool, are acting in a criminal manner when they refuse to insure people with pre-existing conditions, knowing that they would have to pass the cost of those conditions on to all the existing policy-holders. They are only doing what is in their best interest and in the best interest of the rest of their customers, and I'm not sure it's fair to blame them for the larger systemic problems over which they have no control.
Unfortunately, the cost of health care is so high that few people can pay out of pocket. For the rest there is no practical alternative but insurance, even though it's not at all well-suited to the problem. It certainly presents a quandary, and one I agree the government has a role in addressing. However, the government response needs to be highly nuanced, because a brute-force mass taxation and mass provision of health care is certain to create considerable inequity.
To name one example among many, there are 100 million odd obese folks here in America who, if they are in the same risk pool as the rest of us, are going to get the undeserved benefit of imposing a portion of the cost of their unhealthy lifestyle upon everyone else. I certainly don't think it would be equitable for those of us who take care of ourselves to be obliged to pay for the consequences of their poor choices. Normally, we'd just charge them more for their insurance to offset the increased risk. But is that going to happen under a universal health care plan? What about those who can't pay? Even if they can't pay, they can surely stop eating so much, and most of them can probably get off their ass a couple of times a week too -- are we going to force them to do that? There are just so many issues at play here, and it seems to me that most universal health care advocates are so obsessed with the current inavailability of health care that they ignore all the new inequities their proposals might create.
Your take on health insurance is insightful. After reading your post, I tend to agree with you. A large segment of the population doesn't seek insurance to spread the risk of a low probability risk. Rather, they seek to spread the cost of the eventuality. I wouldn't take on that risk if I were a private insurer.
To reduce the cost of healthcare we need to understand the cost component. A significant driver of cost is malpractice insurance and the cost of medications and equipment. To reduce the cost of malpractice insurance, the government needs to reduce or eliminate tort liability for doctors. This exemption or limitation, however, should be a quid pro quo. In return, doctors should have to limit their fees to a certain amount, which could be determined by a non-profit group (so that the government doesn't have control of everything). The program would be elective so that doctors not electing to limit liability could charge as much as they please (the downside for them is they would have to incur the cost of malpractice insurance). There could even be tiers, e.g., a doctor could elect a certain level of liability. This tiered structure could allow consumers could pick a doctor according to how much they could recover in a malpractice suit. Presumably, it would also create different levels of pricing (with the doctors with the least amount of liability costing the least and the doctors with the greatest amount of liability costing the most). Implicitly, this may also sort doctors by skill level, with the best doctors opting to retain unlimited liability so that they could charge more since they wouldn't be limited (which could be an issue). On the insurance side, health insurance could be designed so that participants could see doctors only within a certain tier, thus creating various different pricing options. This is in addition to the other options available (e.g., higher premiums, higher deductibles, etc...).
I guess a remaining issue for people injured by a doctor who is not subject to liability is how would they be compensated. Well, their compensation came in the form of more affordable insurance. Part of their insurance package is they are disclaiming their right to sue that doctor.
As for reducing the cost of medication and equipment, we could implement a patent extension program for medicines and equipment. This progam would also be a quid pro quo program. Companies electing a longer patent extension program would be required to recover the same profits and R&D costs in the longer period as they were going to recover in the shorter 20 year period (with adjustments for the time value of money, and perhaps a small allowance for increase in profits so that the cash stream in the program results in a greater NPV than for the cash flow stream under the normal patent period).
