Can someone explain the health care 'crisis' to me?

[Richard Tanner]

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[ QUOTE ]
Are you arguing for or against socialism, because all of the problems you described are caused by too much socialism, not a lack of more.

The frightening thing is that the people who advocate socialism never understand that it does not, in fact, increase access to goods and services, which is the stated aim, but instead always reduces the quantity and quality of services available.

[/ QUOTE ]

I'm calling for universal health coverage. Call it what you want.

The frightening thing is that you are arguing from theory, not a comparison of actual health care systems. You start from a theoretical position, that anything you define as socialism is always bad, therefore single payer health care must be bad. But if we compare the systems of Canada and Europe to the US, studies consistently find that they treat more people at lower costs. Yes, new problems may come from trading systems. But the real life experience is that patients in the other countries survive better.

I suspect you will use some sleight of hand and say that the US problem is collectivism, not free market. But that's arguing from theory again, not facts on the ground. In a reality based universe, Canada and Western Europes' collective health care is superior. And if we go to single payer, we would have the advantage of learning from all the past experience; borrowing what works, avoiding Canada's ban on out of network coverage.

A general note. The rhetoric of anarchocapitalists gives me a powerful feeling of deja vu -- to 1983 conversations with Trotskyites. Twenty year olds who had just read the Manifesto had all the answers. Socialism solved everything. Shortages might occur? No, economic democracy would unleash the creative abilities of the masses, and outproduce previous systems. What about the USSR? That isn't real socialism. If you do it the ideologically correct way, all those problems will disappear. Ideology ALWAYS provided a dodge from pesky facts.

Like anarchocapitalists, the Trotskyites had no existing example of successful socialism (they are Trots, so they are critical of China and the USSR). So ALL their arguments were from the pristine, mathematically precise world of ideology.

Eventually, a wing of ACs will start grappling with the problem of reality, and trying to adapt their theories to fit pragmatic conditions. Then another wing will jump on them for "revisionism," abandoning the path to the true heaven. You heard it here first. It's all happened before.
Seek truth from fact. Show me an ideology with all the answers, and I'll show you a burning bush.

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There is no practicality, just theory. No shades of gray, just black and white. [/sarcasm}

I don't advocate universal health care (there seem to be alot of problems with it) but nor can I advocate 100% free market health care either. I should know, I'm part of it.

To quote a show vaguely dealing with medicine, "People are just bastard covered bastards with bastard cream filling" and your experiences with health care are most likely going to be common place if the industry is deregulated entirely.

Edit: Re: Bolded part: Truer words were never spoken.

Cody

[natedogg]

[ QUOTE ]
Come my son, and listen.

Since you've been healthy enough not to find out on your own, here's what to expect, from my own family's experience.


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I assure you you are quite wrong. In fact, my immediate family has just undergone a procedure which totalled 170K. I know exactly what I'm talking about when I say that health care is cheap, accessible, and competetive in this country, despite the burden of regulation that is hindering it already.

[ QUOTE ]

You are charged $800 for a $200 procedure. You haven't met your yearly deductible yet, so the anesthesiologist bills you instead of your insurance company. Insurance company is charged only $200 for that particular procedure, but you get stuck with an $800 bill for being you.

Children's health insurance is canceled without notice. When queried, the company claims that photocopied forms you sent were illegible. You know this isn't true because this is the second time they've pulled this. Repeat three times with more inventive excuses.

You wait 3 months for an appointment with what turns out to be a nurse who is screening things for a doctor. You persuade her you have something that really needs to be seen. NOW you make an appointment with the doctor -- in three months.

A doctor you finally develop rapport with gets transferred to another county. Medical conglomerates do that sort of thing.

Your father (a retired physician) waits in an emergency room for 6 hours with chest pains before being closely examined. By this time, the heart muscle is badly damaged. He dies.

A prescription you've been taking for years is rejected by the new insurance company. Why? That drug is not in the list in their manual. (Real issue: no generic version available.) You must pay a monthly $50 CO-payment. This is name-brand insurance, Blue Cross!

Insurance refuses to pay for a surgical procedure. You spend TWO DAYS on the phone attempting to reach higher ups, who eventually confirm that yes, it's supposed to be covered.

A doctor charges a friend $800 for a five minute visual/hand examination of a child's arm. No lab work or x-rays or casts of any kind are involved. You need to see a doctor of that same specialization. You beg the insurance company not to send you to a proven crook. Sorry, only in-network doctors will be paid for.

A doctor under pressure to shorten his per patient time informs you of a new condition that you have. He gives 30 seconds of generic boilerplate explanation, then vanishes. You ask a nurse if you are supposed to leave now, or wait for something else.

Your sister is a doctor at Mayo. One after another, her colleagues are driven out of the company -- replaced in one case by a doctor who had not worked in a year due to substance abuse problems. Why? The new hires would not challenge the corporate bean counters.

And we are a basically healthy, highly educated Caucasian family adept at pressing bureaucrats. Imagine what it is like for everyone else.

Here is the underlying problem with our HMO/ private insurance system. The way the companies cut costs and boost profits is by denying coverage, not through efficiencies or expanded services. A large portion of every health care dollar (30% is what comes to mind, Paul Krugman wrote about this) is spent on the bureaucracy whose job it is to invent regulations that deny coverage. As one outfit's profits go up, its competitors must develop more byzantine ways of restricting coverage.

Years ago, the complaint was that arrogant, unapproachable doctors thought they're god. Now we find out that an overbearing individual is far preferable to a corporate bureaucracy, which offers no face to challenge. The doctors are degraded by corporate even more than the patients.

Your grandparent's life skills included learning to fix farm machinery. You will learn to pour through coverage manuals like a lawyer, in order to force action out of institutions whose job is to not do their job.


[/ QUOTE ]

I have a hard time believing your story and I have an even harder time believing that someone could be so incompetent as to let most of the things happen that you describe.

For instance, if you really do have a high deductible plan you benefit from your insurance company's prenegotiated rates with providers. In other words, you won't be stuck with an $800 bill for a $200 procedure because your insurance company requires the providers to charge the negotiated rates. Why? Because then you don't hit your deductible as fast. it saves them money to makes sure you aren't getting over charged.

I have one of those plans, thats why I know more about this than most people.

Even if you were stuck with a high bill directly, getting billed is far different from paying it. All medical providers bill insanely high amounts on the first bill. You need to call them and tell them you can't afford it, it's cheaper elsewhere, and they will drop the price.

Or even better, SHOP AROUND. If you're not insured, and you need a procedure, you shop around. Duh. Doctors LOVE getting paid directly. trust me they will offer you a competetive price if you tell them youre shopping for a direct-pay service.

Also, some of the problems you describe are lawsuit worthy.

Cancelling "children's" insurance doesn't even happen. It's a family plan 95% of the time. Cancelling *without notice*? Are you joking? You have a golden ticket my friend, especially if they have a condition. Call your lawyer today! You just struck gold.


Sitting in an ER for hours while your heart disintegrates? That is an error of medical negligence, not a system error. ERs do not routinely allow heart attack patients to sit around for hours. That is an edge case, an anomaly, and worth millions potentially, and also not something that would be solved by single-payer health care. Human error won't go away with government's involvement my friend.

Lastly, as you say, much of the insurance company's energy is spent on dealing with regulations. This is not an argument in favor of MORE regulation.


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But at least we don't have a single-payer health system. I hear that destroys freedom.

[/ QUOTE ]

Yes, it does. Maybe you don't think it's a strong argument but it is true nonetheless.

natedogg

[pokerbobo]

[ QUOTE ]
[ QUOTE ]
Are you arguing for or against socialism, because all of the problems you described are caused by too much socialism, not a lack of more.

The frightening thing is that the people who advocate socialism never understand that it does not, in fact, increase access to goods and services, which is the stated aim, but instead always reduces the quantity and quality of services available.

[/ QUOTE ]

I'm calling for universal health coverage. Call it what you want.

The frightening thing is that you are arguing from theory, not a comparison of actual health care systems. You start from a theoretical position, that anything you define as socialism is always bad, therefore single payer health care must be bad. But if we compare the systems of Canada and Europe to the US, studies consistently find that they treat more people at lower costs. Yes, new problems may come from trading systems. But the real life experience is that patients in the other countries survive better.

I suspect you will use some sleight of hand and say that the US problem is collectivism, not free market. But that's arguing from theory again, not facts on the ground. In a reality based universe, Canada and Western Europes' collective health care is superior. And if we go to single payer, we would have the advantage of learning from all the past experience; borrowing what works, avoiding Canada's ban on out of network coverage.

A general note. The rhetoric of anarchocapitalists gives me a powerful feeling of deja vu -- to 1983 conversations with Trotskyites. Twenty year olds who had just read the Manifesto had all the answers. Socialism solved everything. Shortages might occur? No, economic democracy would unleash the creative abilities of the masses, and outproduce previous systems. What about the USSR? That isn't real socialism. If you do it the ideologically correct way, all those problems will disappear. Ideology ALWAYS provided a dodge from pesky facts.

Like anarchocapitalists, the Trotskyites had no existing example of successful socialism (they are Trots, so they are critical of China and the USSR). So ALL their arguments were from the pristine, mathematically precise world of ideology.

Eventually, a wing of ACs will start grappling with the problem of reality, and trying to adapt their theories to fit pragmatic conditions. Then another wing will jump on them for "revisionism," abandoning the path to the true heaven. You heard it here first. It's all happened before.

Seek truth from fact. Show me an ideology with all the answers, and I'll show you a burning bush.

[/ QUOTE ]

A few problems here.... Doctors will be paid a set amount for procedure X. Govt will increase this amount with inflation year after year like is done with almost all govt budget items. Problem: There is no incentive to improve on procedure X. In a capitalist system, procedure Y and Z can be created that may improve results and or lower cost of procedure. In a govt program, who is going to improve on procedures or lessen costs when it nets out as a loss in income. The capitalist program provides this incentive by competition, whereas any improvements to treatment or lower costs can be marketed to provide greater income to doctors and provide lower costs and better care to patients.

I may be off, but I think America provides a great deal of the innovation in medicine. Take the incentive away and where will future innovation come from? Are you willing to slow this innovation to gain a socialist type HC system in America?

I have no problem with govt running programs.... I have a huge problem being forced into these programs. I have no problem with Soc. Sec., but I have a huge problem being forced to participate in the worst retirement program on the market. The same would hold true with healthcare. I would not voluntarily sign up for any govt program, yet I am forced to pay into all of them.

I have not read any of the plans from the nitwits running for pres in 08, but I am assuming every one of them has employers paying a portion of the costs for these plans. This is another recipe for disaster. All this means is the employees will foot the bill, because this cost will be shaved off the wages paid to the employees. Again, I do not want this. My wife works for a large company and we like our HC as is. I can ask for more money at my employer because of the cost savings I offer them by not requiring HC thru thier program. I am sure I am not alone here, but again, the govt in their infinite wisdom will place a FICA like tax into everyone's paycheck, so every employee pays the "fair share" owed. End result for me is a smaller paycheck.

Count me out... these programs suck.

[revots33]

Nice post Bill.

It seems to me the idea that "if you only make 25K a year you're a loser who doesn't deserve medical coverage anyway" is not only inhumane but ridiculous. Same for, "if you've got a pre-existing condition just go die already, you don't deserve to be insured or treated."

[mosdef]

[ QUOTE ]
A few problems here.... Doctors will be paid a set amount for procedure X. Govt will increase this amount with inflation year after year like is done with almost all govt budget items. Problem: There is no incentive to improve on procedure X. In a capitalist system, procedure Y and Z can be created that may improve results and or lower cost of procedure. In a govt program, who is going to improve on procedures or lessen costs when it nets out as a loss in income. The capitalist program provides this incentive by competition, whereas any improvements to treatment or lower costs can be marketed to provide greater income to doctors and provide lower costs and better care to patients.

[/ QUOTE ]

I think there's a couple of problems with this kind of thinking (although generally speaking you have a point).

First of all, if doctors are being paid $300 (as per government regs) for procedure X, and procedure X takes an hour to do and a $5,000 piece of equipment, then they are very incentivized to discover innovative ways to do the procedure in 15 minutes and/or with a piece of $1,000 equipment.

Secondly, many medical innovations are done by research physicians who are 1) compensated via salary by their facility and 2) are interested in research more than patient care. Making the market for medical services competitive will not necessarily drive frontline doctors to start a research lab in their basements on weekends.

Finally, medical services "don't work like" consumer goods. Certainly, many doctors are in it for the money, but conversely many doctors are in health care because they care about health care. Now, they're not immune to financial pressures, but there is a real cultural difference between doctors and, say, bond traders. That is to say, creating financial incentives for doctors doesn't have the same effect is does for commissioned sales people.

[pokerbobo]

[ QUOTE ]
[ QUOTE ]
A few problems here.... Doctors will be paid a set amount for procedure X. Govt will increase this amount with inflation year after year like is done with almost all govt budget items. Problem: There is no incentive to improve on procedure X. In a capitalist system, procedure Y and Z can be created that may improve results and or lower cost of procedure. In a govt program, who is going to improve on procedures or lessen costs when it nets out as a loss in income. The capitalist program provides this incentive by competition, whereas any improvements to treatment or lower costs can be marketed to provide greater income to doctors and provide lower costs and better care to patients.

[/ QUOTE ]

I think there's a couple of problems with this kind of thinking (although generally speaking you have a point).

First of all, if doctors are being paid $300 (as per government regs) for procedure X, and procedure X takes an hour to do and a $5,000 piece of equipment, then they are very incentivized to discover innovative ways to do the procedure in 15 minutes and/or with a piece of $1,000 equipment.

Secondly, many medical innovations are done by research physicians who are 1) compensated via salary by their facility and 2) are interested in research more than patient care. Making the market for medical services competitive will not necessarily drive frontline doctors to start a research lab in their basements on weekends.

Finally, medical services "don't work like" consumer goods. Certainly, many doctors are in it for the money, but conversely many doctors are in health care because they care about health care. Now, they're not immune to financial pressures, but there is a real cultural difference between doctors and, say, bond traders. That is to say, creating financial incentives for doctors doesn't have the same effect is does for commissioned sales people.

[/ QUOTE ]

We could also imprison a-holes like John Edwards who sue doctors into bankrupcy and raise malpractice premiums sky high. He has destroyed lives, and increased more risky C section deliveries because of his lawsuits. Some docs are so scared now, they grab the scapel way before they should just because of the legal fear he has created.

John Edwards is a criminal, who got rich by putting wealth ahead of truth. Anyone who thinks he is "for the little guy" is dumb, uninformed, lying to themselves, or all of the above.

[mjkidd]

Anyone who thinks medical malpractice lawsuits are a big problem in this country is dumb, uninformed, lying to themselves, or all of the above.

[pokerbobo]

[ QUOTE ]
Anyone who thinks medical malpractice lawsuits are a big problem in this country is dumb, uninformed, lying to themselves, or all of the above.

[/ QUOTE ]

Right....Doctors leaving the practice because the high insurance premiums caused by BS lawsuits, and the multi million dollar settlements awarded by idiotic juries is not a problem.

Putting pregnant women at greater risk by increasing the number of C-sections so John Edwards can live in a 30000 square foot home is not a problem. I have no problem with Edwards being rich, but to earn your money in a fraudulant way as he did, makes him no different than a thief to me.

The mentality of the masses in America is that all doctors are multi millionaires. The judgements levied against docs have been huge in many cases.

I generally dont think real highly of docs in respect to quick and accurate diagnosis, but in this case they are really getting screwed hard with no lube.

[Misfire]

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The willingness of other humans to cast aside themselves is scary.

[/ QUOTE ]

[bdk3clash]

Public Citizen: "Medical Malpractice Lawsuits Not the Cause of Health Care 'Crisis,' Public Citizen Report Shows"

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Despite claims by business and medical lobbying interests and the Bush administration, there is no medical malpractice lawsuit crisis in America, according to analysis released today by Public Citizen. The new report, “The Great Medical Malpractice Hoax,” dispels oft-repeated myths of dwindling doctors and spiraling insurance premiums used to support limits on the ability of injured patients to seek redress in the courts.

The real problems are a lack of attention to patient safety, the high incidence of preventable medical error and the lack of accountability for a small set of doctors who account for a majority of medical malpractice payments, the report reveals.

[/ QUOTE ]

[ QUOTE ]
According to the analysis [of data from federal government’s National Practitioner Data Bank (NPDB)], the total number of malpractice payments paid on behalf of doctors, with judgments and settlements, declined 15.4 percent between 1991 and 2005, and the number of payments per 100,000 people in the country declined more than 10 percent. In addition, the average payment for a medical malpractice verdict, adjusted for inflation, dropped eight percent in the same period.

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“Despite assertions by the medical and business lobbies that physicians are leaving practice because of burdensome malpractice lawsuits, the number of doctors is increasing faster than the population,” said Laura MacCleery, director of Public Citizen’s Congress Watch group. “In recent years, medical malpractice insurers have been reaping huge profits, not paying out excessive jury awards. The false claims of a malpractice lawsuit crisis are really about putting profits ahead of patients. They distract from real health care reform designed to improve patient safety, enhance efficiency and cut costs.”

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