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Universal Health Care
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| Lebezniatnikov |
I found this to be a very thoughtful and insightful look at the potential of single-payer healthcare in the United States. The fact that Illinois pays more for health care assistance than all of France and Germany - supposed 'socialist' systems - really shocked me. I'm interested in thoughts on this, as healthcare reform is admittedly not my forte.
| quote: | How Single Payer Health Care Pays For Itself
by Dr. Quentin Young M.D. And Nicholas Skala on October 07, 2008 - 10:01am
The threat of large spending increases normally extinguishes any talk of expanded health coverage. In the wake of the financial system’s speculative collapse, Barack Obama told reporters that he would have to delay initiatives promised on the campaign trail. But international experience demonstrates that universal coverage need not be contingent upon high spending; indeed, the rest of the industrialized world provides comprehensive health benefits to all citizens for around half of the current U.S. outlay.
In fact, Illinoisans already pay enough to cover comprehensive, high-quality care for all – we just don’t get it. The reason we don’t is because insurance companies waste billions of our premium dollars on marketing, underwriting, denying coverage, and fighting claims. Eliminating this profit-focused paperwork would save at least $17 billion annually, enough to provide health care for all Illinoisans without paying more than we already spend. The Health Care for All Illinois Act (HB 311), introduced by Rep. Mary Flowers, is Illinois’ best option for fixing our broken health care system.
Illinois spent $6,714 per person on health care in 2006, compared with $3,678 in Canada, $3,371 in German, and $3,449 in France. While 1.8 million Illinoisans are uninsured and millions of the insured go without needed care due to cost, these countries provide universal care and their populations are healthier. So how is it possible that we spend more and get less?
The reason is we rely on private insurance companies to pay for care. The natural market behavior of insurance companies is to compete to sign up healthy, profitable patients while excluding the sick. To do this, they erect massive bureaucracies for the sole purpose of contesting claims, issuing denials, and screening out the sick.
The scope of the administrative waste is staggering: co-payment collection and processing, eligibility determinations, utilization reviews, sales, billing, collection, marketing. In 2003 Harvard University researchers totaled it up and found that nearly one-third (31 percent) of our health spending goes to administrative costs. Of Illinois’ estimated $87 billion in 2008 health spending, at least $17 billion could be saved simply by replacing private insurers with a single public payer like Medicare. The Government Accounting Office, Congressional Budget Office, and Navigant Consulting, the independent financial consulting firm hired by the state of Illinois, have all confirmed that single-payer financing could produce sufficient savings to cover everyone without additional spending.
Many progressives maintain hope that an Obama presidency will be the harbinger of universal coverage. But the Obama approach, as currently contemplated, has little hope of remedying our state’s health crisis.
The problem is that Obama, like John McCain, maintains faith that the market will assure quality health coverage is available once a few tweaks are made. Obama would offer tax subsides to help Americans buy private health insurance, and in return insurers would compete through a regulated “National Health Insurance Exchange.” A new public insurance plan would compete with private insurers. Many supporters of single-payer believe – wrongly – that such a system could naturally evolve into single-payer. Because administering public programs are inherently costs less, the argument goes, the public plan would out-compete the private insurers and gradually accrue all Americans into a comprehensive single-payer plan.
But this simplistic script ignores both international and domestic experience. In reality, profit-driven insurers have found myriad ways of skimming the cream -- the healthy and profitable patients -- while leaving the sick and costly to public programs. Private Medicare HMOs now receive 114 percent of what it would cost to treat their enrollees in traditional Medicare because of selective advertising and plan design. The private health insurer BUPA recently pulled out of the Irish market after the nation's high court found it had selectively enrolled healthier patients and ordered it to make risk equalization payments. There is little reason to believe the experience in the U.S. would be any different.
Under the Obama plan, decent coverage would remain unaffordable for most Illinoisans while costs would continue to rise. Despite his promises of affordable insurance, the only way to get inexpensive policies is to strip them down with huge co-payments and deductibles. In Massachusetts, the first state to experiment with such a scheme, a 56-year-old making $30,000 annually will have to spend $7,164 in premium and deductible payments before insurance kicks in, and still pony up 20 percent of hospital costs after that.
Such skimpy plans are insurance in name only. Beleaguered Illinois families would remain unable to get care and as costs continue to rise, employers will push more and more middle-class families from relatively comprehensive plans towards new, paper-thin coverage. The only way to simultaneously expand coverage and lower costs is through a single-payer system: “Medicare for All Illinois.”
A single-payer system is the only economically viable reform option. Yet opposition from insurance and drug industry giants continues to intimidate lawmakers and even aspirants to the presidency. We need leaders committed to the health of all people of Illinois.
Dr. Quentin Young is national coordinator of Physicians for a National Health Program; Nicholas Skala is co-founder of Health Care for All Illinois.
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http://progressillinois.com/2008/10...la-single-payer
So maybe we can add this to a list of things that I disagree with Obama about - I didn't realize his reform plan was so half-assed.
I already knew that the administrative costs for Medicare are something like 1/3 of what they are in the private sector - a cost that is passed almost entirely on to the insured. In any case, this definitely shows that our system is in desperate need of reform. |
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| pmoisse |
Interesting article, thanks for posting. I had no idea that one state paid more than two of the largest nations in Europe.
I'm surprised as well that Obama's "plan" for this seems kind of weak, though you never know, once elected he could always bust out some big legislation (doubtful though). |
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| jerZ07002 |
| quote: | Originally posted by Lebezniatnikov
I found this to be a very thoughtful and insightful look at the potential of single-payer healthcare in the United States. The fact that Illinois pays more for health care assistance than all of France and Germany - supposed 'socialist' systems - really shocked me. I'm interested in thoughts on this, as healthcare reform is admittedly not my forte.
http://progressillinois.com/2008/10...la-single-payer
So maybe we can add this to a list of things that I disagree with Obama about - I didn't realize his reform plan was so half-assed.
I already knew that the administrative costs for Medicare are something like 1/3 of what they are in the private sector - a cost that is passed almost entirely on to the insured. In any case, this definitely shows that our system is in desperate need of reform. |
i kind of like the idea of a state providing health care to all of its citizens (instead of the federal government). The state could gain a competitve advantage for businesses setting up shop in the state. If a corporation doesn't have to insure its employees, then it is likely to set up shop in that state. This, however, would be mitigated to an extent by higher taxes (likely sales and corporate taxes), but that would be simpler for a corporation than imposing the extra cost of health care administration since taxes are already necessary. Also, corporations would likely move its employees to that state as well to eliminate more insurance expense, which would increase the tax base for that state. From that point, other states would follow to try to gain the same competitive advantage.
The big downside is that doctors may be less willing to work in the state because they may not get paid nearly as much by a state administered system. However, if the number of patients increase because there is greater access, that could potentially offset the loss of revenue per patient.
Another big ostable is obviously the large insurance lobby. I guess this would have to be tested in a state that isn't home to any major insurance companies.
It would be interesting if someone did a study on this. |
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| Arbiter |
| I doubt I'll ever be persuaded that any type of universal health care is wise, but it is interesting to see that insurance is even less efficient than supposed. All the better reason to avoid it, if you ask me. |
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| Arbiter |
I saw this in the NYT a few weeks ago. It's not exactly on topic, but it's related, and a good read. One thing I hope we can agree on is that to the extent we are funding health care with tax dollars, we want to make sure that they are being spent on people who really need care. It seems both presidential candidates need to study up in that regard...
| quote: | Campaign Myth: Prevention as Cure-All
By H. GILBERT WELCH, M.D
In a presidential campaign that promises straight talk and no gimmicks, why do both candidates champion one of medical care’s most pervasive myths?
The myth is that like magic, preventive medicine will simultaneously reduce costs and improve health.
Senator John McCain argues that “the best care is preventative care,” and his health care reform plan claims that “by emphasizing prevention” and other measures “we can reduce health care costs.” Senator Barack Obama’s plan says, “Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.”
It may sound like common sense. But it is still a myth.
The term “preventive medicine” no longer means what it used to: keeping people well by promoting healthy habits, like exercising, eating a balanced diet and not smoking. To their credit, both candidates ardently support that approach.
But the medical model for prevention has become less about health promotion and more about early diagnosis. Both candidates appear to have bought into it: Mr. Obama encourages annual checkups and screening, Mr. McCain early testing and screening.
It boils down to encouraging the well to have themselves tested to make sure they are not sick. And that approach doesn’t save money; it costs money.
Increasing the amount of testing for an ever-expanding list of problems always identifies many more people as having disease and still more as being “at risk.” Screening for heart disease, problems in major blood vessels and a variety of cancers has led to millions of diagnoses of these diseases in people who would never have become sick.
Likewise, recent expansions in the definitions of diabetes, high cholesterol and osteoporosis defined millions more as suddenly needing therapy. A new definition of “abnormal bone density,” for example, turned 6.8 million American women into osteoporosis patients literally overnight.
These interventions do prevent advanced illness in some patients, but relatively few. Any savings from preventing those cases is dwarfed by the cost of intervening early in millions of additional patients. No wonder pharmaceutical companies and medical centers see preventive medicine as a great way to turn people into patients — and paying customers.
If preventive medicine were effective in improving the nation’s health, it might warrant these added expenditures. But you can’t assume it is. Early diagnosis may help some, but it undoubtedly leads others to be treated for “diseases” that would never have bothered them. That’s called overdiagnosis.
Early screening is like the “check engine” light in your car. It can alert you to problems that need to be fixed, but too often it picks up trivial abnormalities that don’t affect performance, like one sensor’s recognizing that another sensor isn’t sensing.
And if we look hard enough, we’ll probably find out that one of your check-engine lights is on.
Overdiagnosis occurs even among what were once considered uniformly deadly diseases.
When it comes to cancer, for example, there is a very broad spectrum of diseases. Some kill rapidly, some progress slowly, and some do not progress at all.
That is why some doctors recommend “watchful waiting” for men with early prostate cancer: most cases never prove fatal. It was because of concerns about overdiagnosis that the United States Preventive Services Task Force recently recommended against prostate cancer screening in men over 75. Similar phenomena have been documented in early-stage breast cancer, lung cancer and melanoma.
Most diseases exist along a similar spectrum. Even without treatment, most cases of aortic aneurysm never result in a fatal rupture, most patients with osteoporosis won’t fracture their hip, and most people with diabetes won’t lose a limb.
It’s hard to ignore a “check-engine” light. Some mechanics reset them and see if they come on again, but often they lead you to a repair. And you may have had the unfortunate experience that a repair makes matters worse.
If so, you have some feel for the problem of overdiagnosis. Almost everybody with a diagnosis undergoes treatment. And all of our treatments have some harms. From 1 to 5 percent of patients die after major surgery, and as we are all increasingly aware, prescription medicines carry real risks. Recent experiences with hormone replacement (breast cancer) and Vioxx (heart attacks) are potent reminders that our “best” new treatments may harbor unpleasant surprises.
For those who are ill, the potential benefits typically overwhelm the potential harms. But the calculus is different for those recruited to consume preventive medicine: those who are well. They are the ones at risk for overdiagnosis — and overdiagnosed patients can’t benefit from prevention, because there is nothing to prevent. Instead, they can only be harmed.
Both presidential candidates need to challenge the conventional wisdom about preventive medicine. They should ask whether the path to a healthy society is the one that turns those who are well into patients anxious about their future. They should inquire whether more diagnoses will lead to more unnecessary treatment. And they should question whether suggestions that preventive medicine will save money — and fix the health care system — pass the tests of evidence and logic.
H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, N.H., is the author of “Should I Be Tested for Cancer? Maybe Not and Here’s Why” (University of California Press).
http://www.nytimes.com/2008/10/07/h...&em&oref=slogin |
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| Arbiter |
Via www.usatoday.com:
| quote: | Authors of a new study hope to begin a debate challenging the conventional wisdom about early detection of breast cancer. In an article in today's Archives of Internal Medicine, they ask: Do breast tumors ever go away on their own?
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In the study, American and Norwegian researchers compared the number of breast cancers found in more than 100,000 Norwegian women who were screened every two years with a roughly equal number who received only one mammogram after six years.
Women with cancer who are screened more frequently could be diagnosed earlier. But the two strategies should find about the same number of cancers, authors say. Yet doctors actually found 22% more breast cancers among the women who got more frequent mammograms.
That raises the possibility that mammograms found cancers that eventually went away — and never needed to be treated, says co-author H. Gilbert Welch of the VA Outcomes Group in White River Junction, Vt.
Other experts disputed the study's findings and note that mammograms are proven to save lives. The American Cancer Society recommends most women get annual screenings after age 40.
There are many reasons why women screened more frequently might be more likely to be diagnosed with cancer, says the cancer society's Robert Smith. Although a single scan may miss small tumors, doctors may more easily find cancers on repeat mammograms, especially if they compare new results with previous images.
"It's important that people not wonder if women lost their breasts for no reason," Smith says. "That's reprehensible conjecture." |
(study)
This is a good example of the proverbial cancer of the American health care system that needs to be cured either (a) before we proceed with any type of universal health care initiative or (b) as part of that initiative.
The problem isn't just that "preventive medicine" has not remotely shown itself to be cost-effective, it's that extremely large swaths of the medical establishment are determined to ignore evidence to the contrary, costs to the patient - whether financial or otherwise - be damned.
Anyone who does not immediately find Dr. Robert Smith's remarks here extremely troubling needs to consider exactly whose interests Dr. Smith and the American Cancer Society are advancing - because it sure doesn't look like it's the patients'.
Here's how someone who actually gave two s about cancer patients would respond to this study:
| quote: | | "This study is a valuable contibution to the medical literature. While it is far too early to draw any firm conclusions from these data, and there are many possible explanations for the apparent discrepancy, it's extremely important that we aggressively investigate the matter. Considering that our goal is to ensure the best possible outcome for women with breast cancer, it's important that we accurately gauge the risk that a particular tumor will prove life threatening, such that we can optimally balance the benefits of early treatment against the cost of potential overdiagnosis and unnecessary treatment." |
In contrast, here's what Dr. Smith's remark suggests:
| quote: | | "It would be reprehensible conjecture to wonder whether women lost their breasts for no reason. Even though the data presented strongly suggest the possibility of unnecessary treatment and I have no alternative explanation that is not, at best, the very same sort of conjecture, we should simply ignore the possibility that we might be harming patients who did not require treatment. Clearly there is evidence pointing in different directions on the issue, so let's just pretend that there is no possibility that we are overtreating anyone. Who cares about the best interests of future patients anyway?" |
A quick perusal of the American Medical Association's principles of medical ethics shows that Dr. Smith's attitude is contrary to, at the very least, principles I, II, V, and VIII (and probably more).
Further, a brief google background check on Dr. Smith reveals that, in addition to his position at the American Cancer Society, he serves or has served on the Center for Medicare and Medicaid Services Breast Cancer Expert Group and the Centers for Disease Control's Breast and Cervical Cancer Early Detection and Control Advisory Committee.
With that in mind, the question I have is this:
If we do create a system of universal healthcare, who exactly is going to be managing the details? Is it going to be someone capable of genuinely keeping the best interests of the patient in mind, while also managing the responsibility that comes with determining how massive amounts of public funds will be expended? Or will it be placed in the hands of people like Dr. Smith, who will presumably push to enact policies with other interests in mind?
I'd like to believe the former. But I don't. |
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| George Smiley |
What does it mean Illinois pays more than France etc?
Does that mean the state pays that out of its revenues, or does it mean the combined amount spent on health by the population of Illinois? |
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| pkcRAISTLIN |
| quote: | Originally posted by Arbiter
I doubt I'll ever be persuaded that any type of universal health care is wise, but it is interesting to see that insurance is even less efficient than supposed. All the better reason to avoid it, if you ask me. |
how else would you make health care affordable? or is that "unwise" as well??
i mean, i knew the US system had serious issues, but i wasn't aware of just how crazily bad and horrible (dare i say evil) the insurance system is over there. what an absolute ing joke.
sick around america
http://www.pbs.org/wgbh/pages/front...ndamerica/view/
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At its best, American health care can be very good. For Microsoft employee Mark Murray and his wife, Melinda, their employee health plan paid for eight years of fertility treatments and covered all the costs of a very complicated pregnancy. "If it wasn't for our health insurance," Murray says, "we wouldn't have a baby boy right now." The Murrays' medical bills totaled between $500,000 and $1 million, and their plan covered every penny.
But beyond large, high-wage employers like Microsoft, FRONTLINE learns that available, affordable, adequate insurance is becoming hard to find. Small businesses face a very bleak outlook for finding and keeping coverage. Coverage is becoming more expensive and less comprehensive, with high deductibles, co-pays and coverage limits. Georgetown University Research Professor Karen Pollitz explains that for many people, the current system is "like having an airbag in your car that's made out of tissue paper: I'm so glad that it's there, but if I ever get in a crash, it's not going to protect me."
Outside of employer-based health care plans, matters are even worse. Americans seeking insurance in the individual market must submit to "medical underwriting," and if they have a pre-existing condition, they will likely be denied. Kaiser Permanente Chairman and CEO George Halverson says frankly: "I could not get insurance. I've had heart surgery, and so I am completely uninsurable in the private market. So it's important that I keep my job."
Across the U.S., FRONTLINE finds people making life decisions based on health insurance, stuck in jobs because of so-called job lock. One such person is 23-year-old Twin Cities, Minn., resident Matt Johnson, who put his career dreams on hold to get a job at Menards home improvement store because its benefits package covers his ulcerative colitis. Americans even stay in bad marriages, says Professor Pollitz, "because they just can't afford to divorce their health insurance."
For those Americans who find health coverage in the private market, there's no guarantee it will protect them. In 2007, Palm Desert, Calif., realtor Jennifer Thompson received a letter from Blue Cross accepting her for coverage that read: "Congratulations! You have been approved for coverage with Blue Cross of California. ... The immediate value of your coverage is peace of mind." But then Thompson discovered she had a cancer that required surgery, and three days after leaving the hospital, she received a letter from Blue Cross saying that her insurance was "rescinded," leaving her uninsured and owing more than $160,000 in medical bills. Blue Cross cited Thompson's previous history of cancer and results from a recent doctor's visit as the reasons for the rescission. "Our system is not working," says Professor Pollitz. "It's designed to cut out on you right when you need it the most." When questioned about Thompson's case, Sam Nussbaum, chief medical officer of WellPoint, which owns Blue Cross of California, told FRONTLINE that because of legal considerations, "I can't speak to that circumstance ... but no one likes to see a situation like this. People are buying health security."
In the past, some states required insurance companies to cover everyone but found that many people waited to buy insurance until they fell ill, causing "adverse selection," or a higher ratio of unhealthy to healthy people in the insurance pool. As a result, insurance companies stopped doing business in those states. Today, only five states—New York, New Jersey, Massachusetts, Maine and Vermont—guarantee everyone insurance, a "privilege" reflected in premiums. "If we look at the average premium of those states," says WellPoint's Nussbaum, "that premium is three times higher on average—maybe $600 to $700 versus a [state] where the insurance market has allowed medical underwriting."
For some Americans, life becomes a quest to find and keep health insurance. In 1994, Nikki White, a Bristol, Tenn., native with dreams of becoming a doctor, was diagnosed with lupus, a serious but treatable autoimmune disorder. Too ill to work, she lost her health insurance for several years, but then received coverage from the state's Medicaid program. Soon, budget cuts made her ineligible for the state program. A few months later, White was rushed to the ER with severe lupus complications and racked up nearly $1 million in medical bills. She finally secured insurance under the government HIPPA law, but her condition was too advanced, and in 2006, at the age of 32, she died. White's primary care physician, Amylyn Crawford, tells FRONTLINE: "Nikki didn't die from lupus. Nikki died secondary to the complications of a failing health care system."
Around the world, other developed democracies offer universal health care, requiring insurance companies to cover everyone. People are mandated to buy it; insurance for the poor is subsidized; and governments control prices by setting the cost of everything from doctors' salaries and hospital rooms to drugs and MRIs. But efforts to implement similar policies in the U.S. have proven unsuccessful. In 2006, Massachusetts implemented reforms mandating everyone be covered by health insurance, but there are still problems of affordability. FRONTLINE profiles the Abramses, a Massachusetts family of four earning $63,000 annually, who found that although they were too prosperous to receive a health care subsidy, they could not afford to buy a health care insurance policy at around $12,000 a year. "What we're finding out in Massachusetts," says veteran insurance industry executive and consultant Robert Laszewski, "you can mandate that people have health insurance, but if it costs more than they can afford, it doesn't matter."
As President Obama launches his plan for reforming health care, Kaiser Family Foundation President Drew Altman tells FRONTLINE: "This is the first big opportunity for health reform since ... [the] early 1990s. And a question is again, pointedly, whether we will blow the opportunity again this time or [whether] we will actually get it all done or get something significant done." But consultant Laszewski wonders if Americans have the will to make it happen. "Every doctor I meet says he's underpaid. I've yet to meet a hospital executive who thinks he or she can operate on less. I have yet to meet a patient who is willing to sacrifice care. So we have this $2.2 trillion system, and I haven't met anybody in any of the stakeholders that's willing to take less. And until we're willing to have that conversation, we're just sort of nibbling around the edges." |
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| The17sss |
| quote: | Originally posted by pkcRAISTLIN
how else would you make health care affordable? or is that "unwise" as well?? |
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.
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.
Edit: forgot to mention this example. Look what happened in Hawaii last year after an experiment with universal healthcare. Seven months after launching "Keiki Care," a flood of enrollments caused it to run over budget. The social engineers in Hawaiian government learned a lesson about free market economics.
| quote: | Hawaii is dropping the only state universal child health care program in the country just seven months after it launched.
Gov. Linda Lingle’s administration cited budget shortfalls and other available health care options for eliminating funding for the program. A state official said families were dropping private coverage so their children would be eligible for the subsidized plan.
“People who were already able to afford health care began to stop paying for it so they could get it for free,” said Dr. Kenny Fink, the administrator for Med-QUEST at the Department of Human Services. “I don’t believe that was the intent of the program.” |
The doctor is wrong though... taxpayers didn’t get this for "free". They paid for it with their taxes.
http://abcnews.go.com/Health/wireStory?id=6054721 |
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| jerZ07002 |
| 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.
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.
Edit: forgot to mention this example. Look what happened in Hawaii last year after an experiment with universal healthcare. Seven months after launching "Keiki Care," a flood of enrollments caused it to run over budget. The social engineers in Hawaiian government learned a lesson about free market economics.
The doctor is wrong though... taxpayers didn’t get this for "free". They paid for it with their taxes.
http://abcnews.go.com/Health/wireStory?id=6054721 |
healthcare doesn't lend itself well to a free market system. When given the choice of death or pay thousands of dollars, most people will just pay. There is no substitute for many treatments. As a result, health insurance costs can only be reduced so much by compeititon in health insurance.
As for education, the problem isn't a free market problem. The issue is a mostly an economic problem (poor kids have less access to better resources). If you use pure logic to extrapolate the results of a market educational system, you will see that the the poor will receive worse education and the rich and middle class will receive better educations. This is because the current 'good' schools (which will become the competitive schools) are located in the good neighborhoods. That leaves the 'bad' schools (which will become the uncompetitive schools) in the bad neighborhoods. Since poor people, who currently receive the poor education, have less access to transportation, and it is unlikely the states will provide parents busing to transport kids to competitive schools, they will be limited to a select few kids in the areas. In addition, the better schools will likely accept mostly highly qualified students who are already from these areas. Many good teachers in the bad schools will be lured away to the better schools by the prospect of high performance based salaries, leaving the bad schools worse off. Also, competitive schools will be able to demand higher tuiton for students, which will put pressure on the budgets of these areas, resultin in increased property taxes, further driving out marginally poor people from these areas. |
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| Krypton |
You guys need to look at Japan. They have universal coverage but spend half of what Americans spend. And they have one of the highest life expentencies in the world.
LISTEN TO THIS
| quote: | All Things Considered, April 14, 2008 · Japan produces cars, color TVs and computers, but it also produces the world's healthiest people. It has the longest healthy life expectancy on Earth and spends half as much on health care as the United States.
That long life expectancy is partly due to diet and lifestyle, but the country's universal health care system plays a key role, too.
Everyone in Japan is required to get a health insurance policy, either at work or through a community-based insurer. The government picks up the tab for those who are too poor.
It's a model of social insurance that is used in many wealthy countries. But it's definitely not "socialized medicine." Eighty percent of Japan's hospitals are privately owned — more than in the United States — and almost every doctor's office is a private business.
Health Care for Anyone at Anytime
Dr. Kono Hitoshi is a typical doctor. He runs a private, 19-bed hospital in the Tokyo neighborhood of Soshigaya.
"The best thing about the Japanese medical system is that all citizens are covered," Kono says. "Anyone, anywhere, anytime — and it's cheap."
Patients don't have to make appointments at his hospital, either.
The Japanese go to the doctor about three times as often as Americans. Because there are no gatekeepers, they can see any specialist they want.
Keeping Costs Low
Japanese patients also stay in the hospital much longer than Americans, on average. They love technology such as magnetic resonance imaging; they have nearly twice as many scans per capita as Americans do. A neck scan can cost $1,200 in the United States.
Professor Ikegami Naoki, Japan's top health economist, explains how Japan keeps MRIs affordable.
"Well, in 2002, the government says that the MRIs, we are paying too much. So in order to be within the total budget, we will cut them by 35 percent," Ikegami says.
This is how Japan keeps cost so low. The Japanese Health Ministry tightly controls the price of health care down to the smallest detail. Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug.
That helps keep premiums to around $280 a month for the average Japanese family, a lot less than Americans pay. And Japan's employers pick up at least half of that. If you lose your job, you keep your health insurance.
An Accommodating Insurance System
Japanese insurers are a lot more accommodating than their American counterparts. For one thing, they can't deny a claim. And they have to cover everybody.
Even an applicant with heart disease can't be turned down, says Ikegami, the professor. "That is forbidden."
Nor do health care plans covering basic health care for workers and their families make a profit.
"Anything left over is carried over to the next year," Ikegami says. If the carryover was big, "then the premium rate would go down."
http://www.npr.org/templates/story/...toryId=89626309 |
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| Arbiter |
| quote: | Originally posted by pkcRAISTLIN
how else would you make health care affordable? or is that "unwise" as well?? |
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. |
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