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Obamacare Part One: Where Has National Health Care Ever Worked?
I question the motives of a politician who says things like government-run national health care will bring good medical care to everyone, that it’s a cost savings measure, it’s a budget balancing program, and that it will not require an increase in taxes on the middle class.
On July 7, 2009, President Obama said:
I am pleased by the progress we're making on health care reform and still believe, as I've said before, that one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest," the president said in the statement. "I look forward to a final product that achieves these very important goals.
President Obama knows these statements are lies.
Why is it that no one in the government can come up with an idea for delivering health care to people other than through a government-run plan? Just on the face of it you would have to question their premise. If they can’t run the post office, Medicare, or anything else efficiently, what makes anyone think they can run the 16% of the economy that is health care?
Yet they continue to press for some form of government-run national health care. To be fair, they have quite a bit of support from their voters who are frustrated with the current “free market” system. Many people think government run health care is actually going to be free.
What everyone wants is a system that gives them good health care, insurance coverage at a fair price, choice as to doctors, access to the best technology, and the knowledge that they won’t go broke because of medical bills. Sounds fair.
What is the best way to deliver that to consumers? Or, to put it the way President Obama would, “what works?”
To come up with the best system possible, why don’t we first take a critical look at the systems around the world that are run or sponsored by governments. Do some research and find out what works and what doesn’t.
Of course the reason the Administration doesn’t want to do that is because all these public health care systems have problems containing costs, have some form of care rationing, and are raising taxes to cover budget shortfalls.
It is clear from a survey of current systems around the world that the programs that offer the best chance of achieving our goals are the ones that have the least amount of government control. The systems that have the most top-down government control are the ones that least meet these goals.
Heavy handed government-run single-payers programs in countries like Great Britain, Canada, and Norway have the least amount of consumer satisfaction, the highest costs, health care rationing, and delays in getting care.
Countries such as France, Netherlands, and Switzerland with national health care systems that are more market oriented, with managed competition, allow consumer choice, cost savings incentives, and market pricing are far more successful.
Every country that has a form of national health care is facing rising costs. More and more they are turning to more market based incentives to better manage costs, increase efficiency, and allow more consumer satisfaction.
By the way, every country to some extent has the same problems Americans complain about: gatekeeper issues, cumbersome prior approvals, lack of access to experimental treatment, and delays in getting treatment.
In light of all the evidence to the contrary why does President Obama continue to press for a public option plan whereby the government would compete with private insurers? It’s because he wants to drive out private companies and replace them with a single-payer system similar to the Medicare system. Since it is estimated that Medicare wastes about one-third of program spending, why go there?
Right now there are three bills pending in Congress They each have mandates for employers and individuals to purchase policies, purchase subsidies for the middle class, increased insurance regulation, and a government-run health care plan, like Medicare, that will compete with private insurance. They are similar to the highly regarded Massachusetts plan.
If anything should convince us not to go down this road, it is the Massachusetts program. After only three years of operation, insurance premiums are shooting up, subsidies to help citizens to purchase policies are skyrocketing ($1.9 billion in 2008), and choice is being limited. Sin taxes have been raised but not enough to keep up with cost increases. It is estimated that spending on health care, public and private, has increased 66% faster than without this plan. Governor Patrick is now talking about rationing care (“manage costs better”). Yet the proponents of the plan promised taxpayers that these things would never happen.
There is also a moral aspect to Obamacare that they don’t like to talk about.
What if I came to you and said that I have a great idea on how we can have everything we want without paying for it. How, you would ask, could we do that? I would answer that we’ll just have the kids and grandkids pay for it. Who cares, we’ll be dead.
In other words, instead of spending our money, we’ll load ourselves up with benefits and spend our kids’ and grandkids’ money to pay for it. You might say, that’s not fair, they haven’t even earned it yet. We can’t spend money that hasn’t been earned yet. We can’t commit them to something they don’t even know that’s coming.
Yes we can! It’s called intergenerational theft.
I think it is fair to assume, based on published reports of past predictions on the cost of federal social welfare programs that the cost of Obamacare will be much greater than the Administration projects. Even if you support the program you have to admit this truth.
We all know that the projected $1.7 trillion cost of the new plan will really be much more. Who will ultimately pay for it? [Play the thinking-over-your-answer music from Jeopardy] Yes, you’re right! Your children and grandchildren.
Here’s what the Cato Institute says:
Medicare and Medicaid are the reason that the size of the federal budget will double from 20 percent to 40 percent of GDP within 80 years. Medicare's unfunded liabilities are in the neighborhood of $80 trillion. The CBO estimates that all income-tax rates would have nearly to double by mid-century (top rate: 66 percent), and increase by nearly 150 percent by 2082 (top rate: 88 percent), just to pay for existing federal programs. If Congress creates a new government health program instead of reforming the ones we've got, tax increases will be inevitable and painful: The CBO estimates that by 2050, economic output could be 20 percent lower than if government remained at its current share of GDP.
There is no question that we have a system that needs reform. But keep in mind, contrary to what Michael Moore’s propaganda says (SiCKO), we have the best quality care in the world. Thousands of people from around the world come here to get medical rather than at home (just ask Italian Prime Minister Silvio Berlusconi).
There are many free market proposals to “fix” the system which would result in better health care delivered to most of the population without the waste, lack of choice, rationing, runaway costs, and massive tax increases always associated with publicly run systems.
Let’s go with what works.
For more information on this issue, go to Cato on Health Care Reform. It’s an excellent site
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The medical industry in the U.S. isn't an industry at all. It's legalized extortion. It takes people at their weakest (when they are not healthy) and makes them pay as much of their money as possible to get better. As an industry, it is focused on doing this more effectively every day.
Go into an average private medical facility these days -- they are fancier than banks. Money is pouring through these systems like water. The new hospital in my city has all private rooms, a library and a freaking chapel. It's run like a first-class hotel.
Hospital emergency rooms charge $100 for liter bags of saline -- salt water. And we have to pay if we want to live. Where else does your salesperson get to decide what you buy? I go into a hospital in the U.S., sick and helpless, and they decide how much money I'm going to spend before they make me better. It's that simple. And miraculously, we spend about 10 percent more each year.
The medical industry is the new mafia. We pay more and more each year for its "protection." In this whole health care debate, nobody mentions the fact that the medical industry is pretty much the last profitable , high-growth private industry in the U.S.
Nobody seems to mention the fact that only in the health care industry can people predictably still get rich as hell just showing up to work 9 to 5. There are plenty of specialized doctors who do this.
There are lots of doctors who make a million dollars a year working 35 hour weeks in lavish facilities where staff do most of the work. And then they whine about tort reform and how terrible public health care would be.
Are there good doctors who care about helping people, who aren't gold diggers? Sure -- but the system is set up to dis-incentivize such behavior. Fleecing patients is the primary motive in health care these days. Give them the most expensive procedures possible, with the highest profit margins.
And your solution is ... ?
First and foremost, make sure that nobody providing medical services gets paid based on how much their patients (or their patients insurer/payor) are spending. In other words, neither my doctor nor anyone connected to my doctor should make more money if he orders Test A than if he orders Test B or no test at all.
This is the fundamental problem with health care in the U.S.; it's run like a voluntary/market driven service when in fact it's a necessity. You don't get to say "hey, get me a cheaper brand of saline" when they're hooking you up to an IV after a car accident. By the time you're in the hospital, you've already bought the service -- there's no negotiation involved.
Second, whatever pool of patients a medical provider serves, that provider must not have their compensation tied in any way to weeding out the sick from their group and keeping the healthy in their group, or weeding out the poor people in their group and keeping the rich people. Compensation should be tied to the success of treatments/care, not on the providers ability to select healthy or rich people.
This is why a public health care system is optimal. All a private health care system does is gouge those who need it most for as much as it can, while convincing the healthy and rich that the system is great, and there's nothing to worry about (until they get sick and desperate, in which case it's too late -- they're at the mercy of the private health care system).
Your whole life, the private medical industry is lying in wait, biding its time, waiting for that one moment when you need them more than anything. Then, the moment you're in trouble, they close in, say "we'll take care of everything" -- and boom, you've got a six figure bill for a few days of care.
Does anyone in the health care system ever talk about the cost of their service to patients? Of course not. You never see ads for hospitals saying "lowest cost emergency room care right here!" Or from doctors saying "we charge very low office visit fees."
The private health care system is happiest when no one is thinking about price. When the only time they see you is when you're so desperate that you'll pay ANYTHING for them to take care of you. Then they give you what you need, and take as much as they can.
One last thought -- imagine if we had a private fire department, and you had to negotiate with the firemen while your house was burning; or a private police force, and you had to negotiate a price with the police when a burglar was in your home.
That's basically the situation with our health care system. We're being gouged, and they don't want to lose their leverage by having the cost of their service become a public issue, rather than a one-on-one relationship where they have all the power.
Thank you for the interesting comments. It seems that they are divided into two camps, those advocating free market solutions, like me, and those favoring some kind of government plan.
First let me say that I do get much of my data from Cato, Reason, and the Mises Institute. But I also get info from the AMA, MoveOn, the White House, and news media. Because I am a free market advocate I find I have to seek out data supporting my views, rather than having it spoon fed to me by the NYT or the New Yorker. Mea culpa and so what. All the critics have to do is refute the data, not cast stones.
I will also say that in response to those that wish to demonize insurance companies, I have had lots of different kinds of insurance policies over the years: auto, home, professional liability, life, commercial packages, and, yes, health insurance. All these non-health policies have been affordable at the level for which I desired coverage, provided good service when I needed it, and the pricing was very competitive.
So what is it about health insurance that is different than other types of insurance? With all due respect to those who have had tragic situations, there is none. Health care is just another type of insurance and you get what you pay for. The difference, I submit, is government interference in the market.
Since the government started Medicare in 1965, costs for health care have risen substantially, far exceeding the rate of inflation. Yes, in part it is due to expensive technologies (that other countries benefit from), but mostly it is because (i) politicians have raised benefits for constituents, and (ii) without a profit system, costs cannot be controlled.
Thanks to those who have pointed out the massive cost shifting that has occurred over the years: the government has cut back on payments to Medicare health care providers while expanding benefits, so health care providers have had to shift the cost to those who have private insurance. It is far, far from being a free market system.
The critics of the “free market” talk of the “right” to health care without understanding what that word means. What they mean by “right” is to force someone else to pay for their health care coverage. What kind of right is it to point a gun to someone’s head and demand money for another’s health care? Because you can do it doesn't make it right. See natural law, Hume and Locke.
I ask these critics to simply point out a system where the government runs or controls the health care system that works? Of course, if you think that a system with massive cost overruns, higher taxes, and rationing the delivery of health care “works,” then we have no basis for rational discussion.
Even the English and Canadian systems are better in delivering health care then U.S. and have higher consumer satisfaction (many articles show that neither English or Canadian people would accept the U.S. system). Every one of the other health systems is at least 40% cheaper then ours. So quit your nonsense, and check your facts.
Perhaps, but are they sustainable without having to cost shift the burden onto the private sector? All signs point to no.
Of course people like these programs! The beneficiaries get mostly sufficient health care for a low cost to them, and there's no pressure to, you know, save their money for medical care. That way they're free to consume, consume, consume! I mean, as long as you have a productive population that can absorb the inefficiencies and cost increases...it could last forever, right?
There's always enough food to go around, until the grasshoppers outnumber the ants. Guess where we are right now?
Oh, and I'm sure people feel satisfied on heroin too, doesn't mean everyone should start shooting up.
Time to shoot holes in this big barn's side. Can't miss no matter how poor of a shot you are.
The Post Office is a private company with an anti-trust exemption. So, government does not run the post office. It is a pretty poorly run corporation.
Medicare? 5% administrative with 95% of the money disbursed. No health care corporation comes even close. That is efficiency. Corporate provided health care? $700 billion dollars in inefficiency, waste, fraud, and abuse. Yes, that sounds efficient. And drives up health care costs.
The problem with Medicare are those individuals and corporations who defraud Medicare. Medicare does not have adequate controls to detect corporate and individual abuse.
As far as "government" health care being free? Corporate health care costs. The Council on Foreign Relations that, compared to OECD countries, The U.S. spends 134% on average. The CFR currently currently states, "...ballooning dollar figures place a heavy burden on companies doing business in the United States and can put them at a substantial competitive disadvantage in the international marketplace." Without the burden of health care costs, profitability would rise and American businesses could afford to hire more workers.
The United States Health care costs can average over $7,300 USD when compared to $5,000 USD for Norway and $2,300 USD for The United Kingdom. All citizens in those countries are covered and infant mortality rates are improved. Life expectancy is also higher than in The U.S.
As far as the current survey, foreigners do not experience the American health system. I wonder what they would say if asked to compare their country's health care experience with ours. Therefor, the study you give as an example is irrelevant. Wait, they might not be even covered by health care. The number of uninsured is rising. So is poverty, homelessness, the U6 unemployment rate, etc...
There will be a health care tax in The United States to pay for this. No free lunch. Everyone covered. At less than the current rate. Better than paying taxes (called health care premiums) to a corporation for sub-standard health care.
Massachusetts is a disaster, as it relies upon private corporations, mandated health care purchase, and taxes to buy health care for those who cannot afford it. Massachusetts' system relies upon a corporate system to provide care. Over the past decade, health insurance premiums have increased 131%, an average of 13.1% per year, far outpacing inflation. No wonder Massachusetts is in trouble.
In 2009, The U.S. spent $2.5 trillion USD on health care. At $1.7 trillion (we know it is going to be expensive, not by how much), that is a $800 billion dollar savings for the economy. Actually, The CBO estimates $1 trillion USD. A savings of $1.5 trillion dollars better used elswhere (job creation, business loans, R&D, infrastructure support, etc.)
Health care rationing? A public-option would cover basic health care. Any Cadillac coverage should be purchased and provided by corporations. As it should be. Have a heart attack? You are covered. Need foot inserts? Maybe not.
The U.S. does have the best health care system in the world. If you can afford it. Berlusconi? Bad example. He has The Italian government paying for his health care. A head of state, much like President Obama, needs complete health care. And if Berlusconi were not head of state, he could rent a private floor at Johns Hopkins. Much like Saudi princes do when they need the best health care. In The U.S., money buys you access. Look at the enshrined-in-law bribery practiced by Congress.
Your post seems more propaganda than factual. I would throw it in the circular file for blog articles. Your examples are poorly chosen and you rely upon some broad statements with little factual basis.
Fail.
"The Post Office is a private company with an anti-trust exemption. So, government does not run the post office. It is a pretty poorly run corporation."
Anti-trust exemption means that it is a government-sponsored entity only propped up by government action. Left to its own devices in a free market the Post Office would have gone out of business decades ago. Monopolies are far too difficult to maintain in a free market, outside government support.
"The problem with Medicare are those individuals and corporations who defraud Medicare. Medicare does not have adequate controls to detect corporate and individual abuse."
Then ask yourself why this is allowed to happen. If there is that much abuse going on perhaps that's a clue that government should have no business in administering it.
The only thing Medicare is efficient at is cost-shifting the burden to the private sector, which contributes to the private sector fraud and abuse. $30 dollar aspirins wouldn't be a factor if Medicare paid market prices. It does not.
"There will be a health care tax in The United States to pay for this. No free lunch. Everyone covered. At less than the current rate. Better than paying taxes (called health care premiums) to a corporation for sub-standard health care."
Are you expecting the poor to pay for this, who arguably will get the most use out of it? Sorry, there aren't enough rich people to fleece anymore, and the middle class is tapped out.
"Health care rationing? A public-option would cover basic health care."
And who decides what comprises "basic health care"? A Congressional committee? A bureaucrat appointed by the President? Do you really want politicians to decide what is adequate health care for you? The same politicians, by the way, that will keep their lifetime gold-plated health benefits.
I would much rather have a large free market of healthcare insurers competing for my business, all offering different levels of service, than being forced into a public option that by its very nature renders private options too costly.
Simple supply and demand, when people perceive something as extraordinarily low-cost or free, demand skyrockets. Do you really see people getting turned away because their five-year old has a sniffle, when they have no skin in the game?
"The U.S. does have the best health care system in the world. If you can afford it."
Yes it does, but ask yourself why some can't afford it. People with insurance tend not to shop around for the best prices. Hospitals are forced to treat patients despite legal residence status or an ability to pay. Government programs like Medicare force massive cost-shifting onto those who have the ability to pay full price, namely insurance companies and cash payers.
The veil is coming off the idea that single-payer systems work. They only work through that giant sucking sound of fleecing the private sector, on the front end through taxes and on the back end through cost shifts. Once the private sector's ability to pay collapses (which we are now seeing), that burden will fall back on the socialized system like a ton of bricks.
As with every other government "benefit", this one is designed as a vote-buying scheme, nothing more.
Social Security was a vote-buying scheme designed to lock seniors into an inescapable dependency cycle.
The Great Society was a vote-buying scheme designed to lock poor people into an inescapable dependency cycle.
Obamacare is a vote-buying scheme designed to lock the middle class into an inescapable dependency cycle.
Our educational system is designed to render people too stupid to question any of it.
All of it will continue until it can't, until there are no more people to fleece to pay for it all.
Bread and circuses, people.
If you want to read a quality analytical piece on comparative health care systems, please read "The Healing of America" by T. R. Reid.
It is much more comprehensive, logical and well-thought out than the emotionally biased drivel posted by Econophile and its subsequent commentaries.
When Zerohedge is in its area of expertise the posters are pretty good, but when they stray you wind up with nonsense worthy of Glenn Beck. Econophile's first post on health care lacked any substance whatsoever. By way of fleshing it out, s/he adds a few tired canards about the Post Office and the always popular 'when has government ever done anything right'?
First of all - the P.O. does a perfectly decent job. The PO provides services the country requires regardless of their profitability - remote and rural areas get daily service just like urban ones, even though from a profit standpoint they lose money. And I don't think .44 to send a letter 2000 miles is at all unreasonable.
As to 'when has government ever done anything right'? Government seems to do healthcare pretty well where they have single payer. Countries with government financed systems pay far less for care, and since people in other countries live just as long or longer than we do, it can't be too bad. BTW, what countries with single payer are agitating to change their systems to be like ours? The stupidity of econophile's remarks about government cost increases while ignoring double digit insurance premium hikes has been noted by many earlier posters.
Econophile's birther-esque tripe brings down ZH's quality.
Yo, you mean the US post office which is doing so well that they're mulling over service cuts like eliminating Saturday delivery to save money?
FAIL!
Come up with an example of government success.
I bet you can't.
TANSTAAFL - THERE AIN'T NO SUCH THING AS A FREE LUNCH!!!
I live in Canada. I would suggest that most of us up here are satisfied with the public health care system. Forget the surveys. No political party would ever dream of trying to change it. Yes we have long wait times for some treatments, but most serious ailments are dealt with promptly. This is from experience. Most conditions can afford a wait. It's a small price to pay for equal access. If all Americans had access to health care, there would be wait times there too. I find it amusing that while you guys are going bankrupt, you are criticising other countries about our systems. When you are forced to pay your bills, we'll see how happy you are with your precious private system.
Who pays for it all again?
"The incoming president of the Canadian Medical Association says Canada's health-care system is sick and doctors need to develop a plan to cure it.
Dr. Anne Doig says patients are getting less than optimal care, and she adds that physicians from across the country – who will gather in Saskatoon today for their annual meeting – recognize that changes must be made.
"We all agree that the system is imploding, we all agree that things are more precarious than perhaps Canadians realize," Doig told The Canadian Press."
http://www.healthzone.ca/health/newsfeatures/article/681882--top-doctor-...
TANSTAAFL!!!!!!!!!
THERE AIN'T NO SUCH THING AS A FREE LUNCH!!!!!!!
No one said it was perfect or optimal. Who said it was a free lunch? We pay the taxes. It's satisfactory and yes it needs improvement. More family doctors in rural regions are desperately needed. But taken as a whole it is preferred to a private system that fails many of it's citizens. That's how many of us see it.
I live in Canada where we have a public health care system. It has it flaws regarding wait times, but I would suggest most of us up here are not dissatisfied. Forget the surveys. No political party would ever dream of removing this system for a fully private one. If every American had access to health care, perhaps you would have longer wait times as well. Most conditions can wait. The important life saving emergencies are attended to quickly. I find it amusing listening to you folks complain about how inefficient a government run system is, while you guys go bankrupt. When you have to start paying the bills, we'll see how high you rate on the surveys.
I've lived in both Australia and Spain for extended periods and have a brother working as a doctor in a major NY hospital. Both Australia and Spain have systems of 'socialised medicine' delivering good levels of care and waiting lists that are mostly manageable; for significantly less than the US system of 'privatised' medicine.
In both countries the public system is an effective competitor to the private sector, avoiding abnormal profits and forcing efficiencies on insurers, doctors or hospitals. As a result the system costs less overall and is more accesible.
Coverage is compulsory but reasonably priced and there are many public and private care choices. I don't see Americans trying to privatise defence, police or other essential services or trying to make them optional. It's about time the US 'got with the program' and realised that basic health care is an essential service that will not be provided efficiently by the private sector alone.
How many of you have ever waited more than three hours in the emergency room with a broken bone or torn ligament? America has the best health care now? PLEASE. I live in Germany the and care here (socialized) is far superior. I also have not had to wait like I have in America.
If you think we have a market-based system for health care in the U.S. right now, you have your head in the sand. The current system is designed to keep people quiet while big insurance fat cats get rich. The system needs urgent reform. People without insurance clog the emergency rroms now anyway, as NO ONE can be denied care in the US. Why do you think the wait will be longer if people can get adequate care sooner? If you're insured, you're paying for their care now, anyway, when they can't afford the emergency room services that are required because they don't get timely treatment. America's problems begin with those who believe we have a free market system and fight to keep the wealth in the hands of powerful idiots who laugh at them from their ivory towers.
You referred to Sicko, which makes me curious where does Cuba stand in these rankings? And how much does their system cost their government? Just curious. Also what is the HMOs part in all of this? I've never been able to figure out what they actually do. They seem like a union of some sort, but without actually accomplishing anything but padding their own coffers. Aren't unions the epitome of market inefficiency?
TIA
Fidel flew in a Spanish doctor to do his surgery. Does that answer your question? In socialist systems there is no method to calculate "cost" without a profit system.
HMOs (health maintenance organizations) are pre-paid health plans that collect money up front. Any money not spent on patient care can typically be used to pay physician and executive perks. This keeps down the cost of health care.
Aw Jesus-Living-Christ, Econophile.
Let's repost my rant from your "Heather Graham healthcare" comment section; glad YOU liked it, gotta preach to these other fools...
http://www.zerohedge.com/article/heather-graham-health-care-policy#comme...
Comment #111398 (by Anonymous) above is a gem:
"Medicare is bankrupt. Enjoy it while you can. That IS the problem, moron. How to set up a system that lasts."
And the same goes for EVERY other big government project. When the FLUCK do people finally learn?
And to the Libertarian basher above (#111267, above):
Why do you think Jim Rogers refers to the denizens of the Capitol Hill Whorehouse as Republicrats & Demoblicans? Cause they're all the damn same - NONE of them TRULY advocate for small government. They all want to "help", and their road to hell is paved with "good" intentions, bigger goverment, and more treasury and muni-bond issuance. MORE DEBT, MORE DEBT, MORE DEBT. JESUS-EVER-LIVING-CHRIST!
YO, JACKASSES, yeah YOU, who believes in big government!!!
LEARN SOMETHING NOW!
"The trouble with socialism is that eventually you run out of other people's money."
- Margaret Thatcher
This all sounds great except the premise of the article is built on two arguments that are false or lacking information. As to cost containment it's obvious "free market" system can't contain costs either experiencing double digit premium increases in 9 out of the last 10 years to cover costs. In addition, we are currently spending 16.3% of our GDP on healthcare, far exceeding the next closest country (England) at 13%.
Finally, there will have to be some form of care rationing. We don't need to run to the doctor for every little snivel or chill we get and we don't need prescription medication for everything. I would say our current level of health relative to the rest of the Western world would suggest having anything and everything health care thrown at us for every little ailment isn't working too well right now.
"As to cost containment it's obvious "free market" system can't contain costs either experiencing double digit premium increases in 9 out of the last 10 years to cover costs."
Why do you suppose costs are increasing? Is it the quality of the care? Is it the hard costs of out-of-control malpractice suits and/or the soft costs of malpractice fears (e.g. ass-covering by docs and hospitals)?
Are doctors getting paid more? No.
Are nurses getting paid more? No.
How about profits from health insurance providers (for health care insurance only). Apparently not. http://news.yahoo.com/s/ap/20091025/ap_on_go_co/us_fact_check_health_ins...
Hmmmm. Where could all that increase come from.....I'll give you two guesses.
"Finally, there will have to be some form of care rationing."
I agree. It should be more like auto insurance, where YOU pay for routine maintenance and insurance pays for major issues. It's not perfect, but it's a start in the direction of personal responsibility and personal choice.
you are saying the cost increases in healthcare is the result of lawyers and malpractice? That is your argument? Healthcare in America today works as it should in a capitalist market. Price times Quantity equals Sales. Where in that equation is the wellness of the patient and public being considered?
If capitalism was the answer for everything, we should be pushing the benefits of privatized armies and get rid of the U.S. Navy, Air Force, and Army. Oh, I guess we are with Blackwater, Custer Battles, etc... How is that working out for us?
It appears to work fine in Europe and Canada. Get a grip on yourself.
Cripes.
The title of the post is 'Where Has National Health Care Ever Worked?' and buried in amongst the pro-health indistry boilerplate is this -
'It is clear from a survey of current systems around the world that the programs that offer the best chance of achieving our goals are the ones that have the least amount of government control. The systems that have the most top-down government control are the ones that least meet these goals.
Heavy handed government-run single-payers programs in countries like Great Britain, Canada, and Norway have the least amount of consumer satisfaction, the highest costs, health care rationing, and delays in getting care.
Countries such as France, Netherlands, and Switzerland with national health care systems that are more market oriented, with managed competition, allow consumer choice, cost savings incentives, and market pricing are far more successful.'
That's it, apparently. The Cato has done a study and there's no more thinking to be done.
'There are many free market proposals to “fix” the system'
You mean as in the free market that has operated in Wall Street for the last ten years, that 'free market'? 'Free market proposals' from the healthcare industry are a bit like bailout proposals being pitched by Blankfein and Dimon at Geithner and Bernanke, who in turn pitch them to Congress. If an easy buck can't be made screwing the public, it won't even be considered let alone adopted.
But then, this is a country that in the event of bankruptcy pays 'secured creditors' and bondholders and government, and well, everyone, before a 30 year veteran employee gets his pension (if he's lucky enough to still have one rather than a 401K). A country that has spent 3 trillion dollars invading and murdering hundreds of thousands of innocent people for... remind me, I forget. A country whose leadership is saddling it's citizens, many of them not yet born, with debts of trillions of dollars, many not yet printed, in order to bankroll the profligacy and greed of the banks who bankroll them.
You're either a vulture in America, or one of the poor lambs they feed on. People it seems have an inbuilt sense of which of these castes they belong to. It's not hard to determine where the author sees himself.
One of the anonymees said 'Does the poster actually have Medicare? Because I do, and I also have had private insurance, and Medicare beats every private plan I've had every day of the week and twice on Sundays. Medicare also runs at a fraction of the overhead that private insurance does.'
I am Australian. Howard's government tried to force private health insurance down everyone's gob whether they liked it or not and that (along with his pet project to deny Australian workers the right to bargain collectively, and the fact that everyone had had a gutful of him) was what did for him in the end.
We here are very aware of the sort of health system that obtains over there, and any attempts to push us down that path (something US trade reps and ambassadors tend to opine about at times) will be pretty fiercely resisted. Our national sense of fairness and equity is by no means the finished article, but I think it's healthier than yours. Medicare works fine and any politician who tried to break it would be signing their own death warrant.
Anyway, some of these pieces seem more like advertisements to me than part of a healthy, balanced diet of debate.
Here's the bottom line folks. The government run single payer system known as Medicare is bankrupt. The Dems need to keep it limping along until after 2012 without cutting benefits or raising taxes. So they launch a "reform", skim the "accruals" that should be "accrued", and use the loot to keep Medicare going until after Obama gets reelected. After that, it all crashes down.
Don't get caught in the false dilemna, the current system vs. a government system. Here are some real reforms:
1. Tort Reform: patient pays for the malpractice insurance, it is optional. Doctor can't be sued.
2. Make employee medical benefits taxable.
3. Allow people to buy whatever insurance plan they want, and from whatever State. Maximum competition.
4. Eliminate Medicare and Medicaid. Forward the tax to the States and let them set up charitable health clinics with the tax.
5. Eliminate doctor and nurse licensing. Doctors and nurses could still be certified, but anyone could practice medicine, however they must post their credentials.
6. Allow pharmacists to prescribe any medicine.
7. Eliminate the Federal certs that hospitals have to go through. Push it down to the State level.
In India, a lavish, resort style hospital, with your own assigned doctor, and huge personal staff, private room, etc... a heart bypass will run you $10,000, all inclusive. Their system matches the above listed points.
re #4:
Because, of course, there are always benefits to eliminating economies of scale and 90% access points to the system. Specifically, there's the benefit that lots of people currently using it won't be able to when their family doctor has to send them to the charitable clinic across town because Medicare is gone.
re #5:
I'm sure that seems like a good idea, right up until you realize that most people won't ever bother reading the certifications. If you go to see a doctor, you should be able to be confident that he has medical training, and not have to verify it yourself. Any halfwit with a laser printer can make a pretty good diploma.
I can't even read your comments. I had a patient with a BMI of 91 yesterday. Do you even know what that is? She was 5 foot tall, and 400 hundred pounds. I had to keep her alive during a procedure that I won't begin to decribse. DO NOT TALK ABOUT WHAT YOU HAVE NO IDEA.
http://www.lighterlife.com/bmi_calculator.aspx#
Thank you for for paid services. Im sure on that scale you needed it.
I want Intel to run our healtcare system and do for it what it did for computers.
And keep Microsoft out of it.
Dang, where is that link to the recent story of UK doctors and nurses working for NHS being given private insurance so they could jump queues and get appts and treatments more quickly :)
As Dr. Ezikiel Emanuel regarding "complete lives system": “this considers prognosis. … When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” (The Lancet, Volume 373, Issue 9661, Pages 423 - 431, 31 January 2009)
There is a line in the sand. Do Americans want their doctors to work for the State or for their patients.
Nazi Germany made a choice.
>"...bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete..."
Classic case of political rhetoric BULLSHIT.
Everything is supposedly about the fact that a) helath care is unavailable to people (i.e. it's a "scarce" thing) and b) health care costs are just too dang high (because it's a "scare" thing).
Well, we're talking elementary economics here (so basic that everyone should understand it BEFORE they take Econ 101, I mean "elementary" as in "elementary school" level).
If you have a product or service that is "priced too high" then you obviously have a scarcity problem -- ergo the only solution is to end the scarcity by allowing more PROVIDERS of that product into the market. IOW, cancel the cartels that are limiting the market and set the market free to create more doctors, clinics & hospitals. (There's a burger or taco joint just about everywhere -- mainly because there is no "American Burgermaker Association" or "Council on Taco-makers Education" much less restrictive statures and licensing that prevents new ones from opening up.)
But no... we're going to pretend that changing WHO pays the bill is going to somehow "magically" fix everything and create a superabundant supply?
Huh?????
Good luck trying to create outta thin air these providers you're looking for to solve the health care scarcity. The truth is those providers are not out there, not with any amount of training. If you know a good set of doctors and specialists, you better stick with them, schmooze them if necessary. Amazingly enough, most excellent physicians don't require any schmooze--the profession, if you're good at it--is reward enough itself. What really pisses physicians off the most about this whole discussion is that most opinions are about as uninformed as they are passionate. Obama comes to mind. No matter what the population decides, the physicians are going to have to make the system work. If you have a bunch of physician-stinkers you'll have a stinking health care system. Also, if the demographics are that most of the population is getting older (not the case in Canada--that's why that population still likes single payor), your health care system is going to become more expensive, no way around it. No one is going to take out your stinking colon polyp for nothing.
Yea, you small government assholes, what the hell do you think private insurance companies are? What if you had to go through a middle man to buy a tire at Cosco? Competition yes, but middle men no...
First off, tires are quite a bit different from health care. If your car needs new tires and you can't afford them...guess what? You ride the bus or carpool.
So what happens when you get shot in the chest? Holistic medicine? Prayer? No, you need surgery or you will die. Tires are easy and cheap to make, surgeons are not.
So, catastrophic procedures tend to be pricey. There we are. Do people have a ton of cash sitting around with 30% income tax rates, Social Security taxes, Medicare taxes, state taxes, property taxes, and sales taxes? Probably not.
The answer is catastrophic coverage. If you don't want comprehensive, fine...open a MSA and pay out of pocket for routine stuff. But if you get into a car accident, get cancer, or stab yourself in the eye with your Wii remote, guess what? It won't bankrupt you and the hospital gets paid.
Oh yes, and if you want to see medical care get cheaper, get rid of Medicare, Medicaid, and the shitstorm of regulations burdening the medical industry. Charity should be handling the hard-luck cases, not a sinkhole government program run by bureaucratic slugs with lifetime medical care. Perhaps if your average taxpayer didn't see 50% of his paycheck disappear every two weeks, those charities would be better funded.
For one thing we don't think they are "insurance" companies because we aren't commies idiots like you.
Yea, you small government assholes, what the hell do you think private insurance companies are? What if you had to go through a middle man to buy a tire at Cosco? Competition yes, but middle men no...
Rusty nails it. I harp on this at work ... and I indirectly work in insurance … like my coworkers … who don’t get it …
Insurance in the classical sense has always been about distributing risk across a group of players. I don’t think this is a foreign concept to the regulars of ZH. But with healthcare, the word “insurance” is stretched, because it’s not about distributing risk; its about distributing *cost*.
Semantics? Yes, but it matters.
For example, what are the odds I will be in a car accident on the way to work? Well, how many miles do I drive each day? How old am I? What is my gender? How many wrecks have I had in the past N years? Actuaries take all this information, and more, and have numbers to answer it. These are the questions you usually get asked, in addition to your work zip code and your home zip code, when getting auto insurance. They are asked for a reason; they help determine the odds of an accident so you can be quoted accordingly. If auto insurance companies can manage to do this competitively they make money.
The problem with health car is that the “odds of an accident” aren’t odds if they are the norm. What are the “odds” of health problems for someone who is 55, overweight, doesn’t exercise, and smokes.
Auto is about the random cost where health is about the norm cost; it is apples and oranges.
So one might conclude that the model for health only works when there are more healthy people than “sick” people. Bingo!
As I (anonymously) pointed out in another thread a while back, one only has to look at the demographics of the US to play connect the dots. Specifically, at what historical point would one have to refer to in order to find a corresponding percent of the workforce being removed from productive (taxed) employment over a span of a few years. I read this in a small biz magazine years ago (2005?). The answer they claimed was the bubonic plague (time span five years I believe – they cited 2009 to 20014).
The US is reaching the tipping point in health care where it is going to crush business in costs if its not reigned in. Without a government plan to dump costs on, our current health care system is about to roll over; the old/sick/non-paying are going to eclipse the young/healthy/paying. This will force up rates on the net payers to the point they will simply opt out.
CrazyCooter
PS: the right side widget is blocking the text box ... in IE and FF. Banners too big?
The problem is that people aren't willing to go off and die quietly somewhere.
Wow! Who is this bizarre Nazi dog you have writing for you? "Market?" What "market?" Oh, you mean the police state oligopolies which are currently collapsing in the "successful" states like France?
This person is quite the creepy police state scum. I thought Franco was dead. Apparently he's alive and well and writing for Zerohedge.
And like I'd believe anything out of the Cato Institute. Isn't Richard Mellon Scaife--a certifiable lunatic--a supporter of that little police state conspiracy?
Wow! Who is this bizarre Nazi dog you have writing for you? "Market?" What "market?" Oh, you mean the police state oligopolies which are currently collapsing in the "successful" states like France?
This person is quite the creepy police state scum. I thought Franco was dead. Apparently he's alive and well and writing for Zerohedge.
The health insurance industry encouraged huge "retail" price increases by the providers so that they could then "negotiate" them down to normal prices to show the employers and their subscribers what a great value they were providing to justify their existence. If the providers pass on the "discounted" price directly to consumers (instead of forcing us to get that pricing through the insurance companies) healthcare costs would be at 30% of today's "retail" pricing.
I was in a bad car accident 3 years ago and the hospital bill totaled to $150,000. However, due to a lack of consciousness when I was admitted, they thought I didn't have any health insurance so when I was discharged they offered to settle the bill for just $25,000 if I would pay the full amount within thirty days. When I explained I had coverage through UHC then they went ahead and billed them. When I got the EOB from UHC - it had the same price of $150,000 but after taking the negotiated discounts, UHC was only being billed $29,000.
Of course this was UHC, the healthcare insurance company that paid their CEO over 1 billion dollars that year. So did they pay the bill? Of course not...first they tried to lay it off on the car insurance companies. Then they claimed the hospital hadn't gotten "pre-authorization" for the unconscious guy in the emergency room that they didn't know had any UHC insurance. After a little over a year of running through these little trick and trap mazes between UHC's various customer service centers in India, the Phillipines, etc. along with the hospital's accounting department and collections services, including several detailed and certified letters of how this was my problem and it would soon be growing larger because now I would be responsible for the legal bills to collect from me...I finally get a call from the Hospital's legal department and the legal assistant at the other end said "no problem - I run into about 10 of these situations a year with UHC. I have a contact I call in their legal group and once I tell him that you, your employer, and we here at the hospital know the claim is legitimate and they'll have to litigate, he then overides all their claims payment prevention systems and the bill is paid."
Sure enough, 30 days later (now over 1.5 years from my discharge from the hospital) I got a new EOB statement from UHC showing they would be paying their discounted amount of $29,000.
So, 2 questions for you...(1) What value add did UHC really provide over this 1.5 year medical and financial nightmare of mine? (2) What was the real "cost" of the hospital stay? (A) $150,000 (B) $29,000 or (C) $25,000
IF ANY OF YOU IDIOTS THINK YOU HAVE GREAT HEALTH INSURANCE, THEN I SURE HOPE YOU GET THE OPPORTUNITY TO USE IT SOMETIME!
there is a massive difference from having the talent of our medical professionals (best in the world), having the ability to afford high quality care, and the 10% of our population that can not achieve even the minimal level of this. unemployment is about even with the number of people without insurance and look at the outrage over the unemployment situation. at some point we have to realize that part of being the "best country in the world" is making sure all of us get at least a basic level of coverage and care.
But .gov is incapable of facilitating this. Why are all forms of "necessary" medical care increasing in cost, while boob jobs, botox, and veterinary care are decreasing in price or increasing at a far slower rate?
Drug prices increased something like 15% the same year Medicare Pt. D was passed. Why?
Answer: .gov intervention
I for one do not want a bunch of people, who have decided that Stevia is not sweet, and cannot be labeled as such, deciding what is/is not valid health care. Proper diet/nutrition would render at least 50% of the health care services delivered in this country un-necessary.
Dr. Ezikiel Emanuel: “ (complete lives system) - this considers prognosis. … When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most chance, whereas the youngest and oldest people get chances that are attenuated.” (The Lancet, Volume 373, Issue 9661, Pages 423 - 431, 31 January 2009)
Do you guys want a doctor who works for you or for the State? This is what the debate is all about.
"Heavy handed government-run single-payers programs in countries like Great Britain, Canada, and Norway have the least amount of consumer satisfaction, the highest costs, health care rationing, and delays in getting care."
Source?
"Every country that has a form of national health care is facing rising costs."
So our system is saving us from rising costs?
Is it even worth pointing out to you teabaggers that there are no single-payer system proposals even being seriously considered by anyone? Or does that get in the way of your paranoid ignorance?