The US Health Care System: The Real Infinite Crisis?

[Michael P]

Let's get this discussion started with two questions:

1. Is the current healthcare system in the United States untenable?

2. How can we remedy the current system so that as many people as possible get the medical care they need?

A linkiin' for some thinkin': http://www.nytimes.com/2005/06/13/opinion/13krugman.html?hp


The cost of health care is exploding, the number of uninsured is growing, and corporations that still provide employee coverage are groaning under the strain.

[Shellhead]

1. Yes, the current healthcare system in the U.S. is untenable. A lowball estimate of the annual increase in cost is 10% per year, which is rising much more quickly than wages. Housing costs are completely unreasonable right now, and the price of gasoline is going to force inflation across the board, so consumers aren't catching a break anywhere right now.

2. Universal coverage with some kind of incentives towards moderate usage are the only solution that I would recommend. Our current ad hoc system fails to cover more than 20% of americans right now, and yet those people still show up in the emergency room anyway when necessary. Those costs get passed on indirectly to everybody with coverage. Do we really want a system with unfair coverage for the poor and elderly and unfair costs for the middle-class and working-class?

[west3man]

Hell.

I replied to this earlier, but I guess the board ate it, that time. Sometimes the post still makes it on-board, even during an shut-down event.

Basically, I'm not sure I've got the proper perspective to assess the situation fairly. I'm glad I've got SOMEthing, but I really, really wouldn't mind if it were better.

[soda]

1. yes.

2. here is the problem. I think most people, no matter what side of the issue you're on, would agree that there's a major problem, the question is, how do you fix it? I don't really like the idea of state run health care, and I understand that there's a pinch on everybody, financially, in this current system. The biggest problem I have is this: every single solution I've heard of is a system that's rife with opportunities for abuse, and one thing about human beings, if a system can be abused, it will be abused. I think a health care system that simply closes opportunities for abuse would be a real upgrade, the system that Canada and some other countries have right now seems pretty good.

[Sheldon]

The US spends about 15% of their GDP on healthcare.
The other G8 developed countries spend roughly between 8-10% with better health outcomes. (The US has the highest infant mortality rates, and ranks poorly on life expectancy)

More recent projections expect that % will increase to 18% in the next few years. But while spending is increasing many predict that the health outcomes will not improve.

(I'm a doing a combined law/master of health administration program. Most of the figures are from memory from a course on international health care systems. If I have some more time this morning I'll see if I can dig up some hard numbers).

So yes there are some problems with the US health system, not to say that there aren't problems in every public system, but as the world's only superpower you would expect that they would take care of their own a bit better healthwise...

[Mike Smash!]

As you all know, I support Universal single payer health care. I think it's cheaper, more streamlined, eliminates for profit involvement in the system, so that every dollar goes towards healthcare and not towards drug advertising and corporate salaries. For profit healthcare is a system where the bottom lines means that insurance companies will look for any chance it can to deny you care.

I would also include universal preventive and emergency care, so that we can spend pennies to stop a problem before it begins instead of that same person having to seek public assistance to pay for it when it hits rock bottom and is horribly expensive and largely untreatable.

70% of bankruptcies come from medical emergencies and by reverting all HMOs into non-profits, while keeping them private, we can be certain that we can choose our own doctors, while having every penny we spend go to care and not to insurance companies and CEOs. And at the same time, I will not be afriad to seek medical care when something first pops up without fear that it will break the bank and put me into debt before that same ailment throws my life off of the tracks.

And since there are several models in the world, we can work from their basis and improve on them. No system is perfect, but we can work to fix the flaws in other countries' systems.

With our money being funneled into stock options and corporate salaries, we're already paying for a universal level of care, but just aren't getting it.

[Loren]

the system that Canada and some other countries have right now seems pretty good.

I learned the other day that Canada actually forbids (http://www.canada.com/national/nationalpost/news/editorialsletters/story.html?id=fc9e6da1-0f14-4b79-9bf3-2e32b5af4313) the purchase of private health insurance for necessary medical services. They socialized medicine and said 'doggone it you're gonna like it,' because they barred the citizenry from buying their own insurance.

Fortunately, the Canadian Supreme Court struck down Quebec's law banning private insurance last week, opening the door again for people who'd like to get better treatment.

Canada's system also has its own significant flaws (http://www.detnews.com/2005/health/0504/05/A04-123561.htm):

The average Canadian family pays about 48 percent of its income in taxes each year, partly to fund the health care system. Rates vary from province to province, but Ontario, the most populous, spends roughly 40 percent of every tax dollar on health care...

The federal government and virtually every province acknowledge there's a crisis: a lack of physicians and nurses, state-of-the-art equipment and funding. In Ontario, more than 10,000 nurses and hospital workers are facing layoffs over the next two years unless the provincial government boosts funding,

Our system has its own problems, but I don't think that Canada is who we ought to emulate.

Loren

[Loren]

1. Is the current healthcare system in the United States untenable?

I'm inclined to believe that the current healthcare system anywhere is untenable. Some just moreso than others.

Our current system suffers from at least two big problems. First, a lack of real competition. Consumers of health care services almost never shop around for better deals, since it's almost always someone else who's footing the bill. So doctors just charge whatever they want to.

Second, and partly as a consequence of the first, is that the simple cost of health care has skyrocketed over the last hundred years. But the cost of machines and medicines and litigation has driven up the cost of even the most mundane health care activities. And a truly thorough investigation of what might be making a person ill can rack up enormous bills.


2. How can we remedy the current system so that as many people as possible get the medical care they need?

The funny thing about Universal single payer health care, to me, is that it doesn't solve either of the problems I listed above. Getting rid of private insurers and creating one giant government-run insurer won't result in people seeking out better deals or in doctors charging less. (That is, unless the gov't simply refuses to pay.) As much as people hate HMOs, I don't know why the giant federal HMO (GFHMO) would do any better. It has to start cutting corners eventually, or it ends up in the red itself.

I don't know what is best-suited to fix health care. I strongly believe that better competition would bring prices down (just as getting rid of competition inevitably drives prices up), but I'm unsure how to make that happen.

I suspect that it's almost inevitable that insurers (especially a universal federal insurer) to put a value on life. My great-grandma turns 100 next month. She's near-blind, lives in a nursing home, and doesn't remember an awful lot. If she were to have an accident that required $800,000 in medical services to remedy, and her health insurance premiums were paid up, then her insurer has a contractual obligation to fix her up.

But if it was a Universal single-payer system that was footing the bill, it'd be all but irrational for the feds to pay it. She hasn't paid taxes in decades, or made any tangible contribution at all to society in years. To spend that half-million would buy her *maybe* a few more years of feebleness in the home (assuming she even survived the operations), when it could have instead gone to pay for a young person's life-saving surgery. The GFHMO can't create money out of thin air; it has only finite resources. And it can't afford to provide every possible treatment to every needy patient without eventually bankrupting. Sooner or later, it has to start saying that certain stuff just isn't going to be covered.


A linkiin' for some thinkin': http://www.nytimes.com/2005/06/13/opinion/13krugman.html?hp

Wow, Krugman actually managed to lose me by the end of the first paragraph. "Social contract" is one of those phrases that make me grit my teeth. Then Krugman just idly dismisses one whole side of the health care debate, and declares that it's really an issue of whether health care reform should involve a big increase in government power or a massive increase in government power.

Loren

[Shellhead]

Loren has made some great points about the related problems. One that jumped out at me was that the simple cost of health care has gone up. All of the research and development that has resulted in better quality care and promising new procedures and pharmaceutical products has been expensive, and it's no longer practical to offer the best of everything to everybody. No matter how we configure the industry, there will be some opposing agendas involved.

Right now, we've got the doctors, the hospitals, the insurers, the patients, and the government. The patients want to get better, no matter what it costs. The doctors want the same, but the hospitals they work for want to get paid. The insurers must pay, but they will pay as little as necessary, challenging the doctors and hospitals to get by with less money. The government has a similar agenda to that of the insurers, only without a profit motive involved with Medicare/Medicaid and state equivalents, they are less vigilant about costs.

In a universal coverage plan, we would probably be looking at a tragedy-of- the-commons dilemma. Meaning each taxpayer wants to hold down overall costs while maximizing their own benefits from using the healthcare system. With some rationing of costs by the government, like denying surgery to a 100 year-old woman, the costs could be somewhat controlled, but there will always be pressure from the patients and their families for more treatments, more drugs.

[MacQuarrie]

2. How can we remedy the current system so that as many people as possible get the medical care they need?

By getting the government completely out of it, abolishing medical insurance entirely, and putting doctors in the position of having to respond to actual market forces the way they did back when they made house calls and took chickens in trade for services.

Parkinson's Law indicates that as money is made available for medical services, the cost of those serives will escalate to absorb it. Subsidies and insurance programs drive up the cost, putting the screws to the poor.

Same is true of college tuition. The idea of working one's way through college is now impossible. Instead, graduates leave school with a debt load equal to the price of a house. Mostly because of all the misfired attempts at making college more affordable.

But I digress.

Medical insurance was invented during WWII as an end-run around the wage freeze of the time. What it accomplished was driving up the price of medical care and at the same time increasing the demand, which drove up the cost even more.

Once that's done, ban advertisements for prescription drugs, as was the law up until about 15-20 years ago. All ads do is increase demand for prescriptions that a lot of people don't need. "Ask your doctor about Damitol" indeed. Your doctor knows about it, and if you needed it, he'd tell you. But now hypochondriacs can stomp in and demand the drug based on the diagnosis arrived at from a 30-second spot that ran during Survivor. Stupid.

Most suggestions for alleviating the health care crisis will only serve to make it worse in the long (and short) run.

[west3man]

I'm inclined to believe that the current healthcare system anywhere is untenable. Some just moreso than others.

Our current system suffers from at least two big problems. First, a lack of real competition. Consumers of health care services almost never shop around for better deals, since it's almost always someone else who's footing the bill. So doctors just charge whatever they want to.[snip]

Loren
There's also the fact that many of them need medical services when they need'em, not just when they find a cheaper provider.

[Sheldon]

Canada's system does have problems....part of the problem in fixing it, is that Canadians take it for granted. Even though we pay a ton in taxes, many still have a disconnect and think healthcare is "free". As a result the system operates inefficiently. For example People show up to the ER with the Flu rather than setup an appointment with their family doctor, clogging up the ER and wasting hospital funds.

Since people take it for granted you can never keep up with demand. Many Canadians expect the best service when they can get it, and continue to smoke, not exercise etc...they don't take ownership of their health.

One of the biggest problems is that there will always be areas without enough doctors, nurses, equipment, etc. In Canada the only solution the government ever comes up with is provide more money, but there will never be enough...because the money more often than not gets eaten up in salaries and not any new reforms. In Canada the federal government provides guidelines but leaves the administration of the system to each individual provinces. One problem has been that the provinces have not been held accountable for how they spend their healthcare dollars. One example is a recent federal fund earmarked for new diagnostic equipment (MRI, PET, etc). After an audit, one province was found to have spent the money on new lawnmowers, and rennovating executive suites and physicians lounges, yet nothing really has been done to hold them accountable. I don't envy the feds at all, as dealing with the provinces is like working with 10 bratty kids, who want to do whatever the hell they want to do.

Anyway's I don't want to complain too much about it...its just that the system could work much more smoothly...but a public perception and an inefficient government are shooting themselves in the foot.

[Loren]

2. How can we remedy the current system so that as many people as possible get the medical care they need?

By getting the government completely out of it, abolishing medical insurance entirely, and putting doctors in the position of having to respond to actual market forces the way they did back when they made house calls and took chickens in trade for services.

I gotta disagree with you on getting rid of insurance entirely. Market forces can only bring prices down so low, and for some medical procedures and products, they will remain prohibitively expensively for most people to pay out-of-pocket.

I think the key might be in taking health insurance back to what it originally was intended to do: to pay for unexpected, expensive medical bills. Look at other types of insurance, particular home and auto insurance. Auto insurance doesn't tend to cover the piddly fixups like oil changes and new tires. Little problems like dents are usually paid by the owner. And how often does auto insurance cover stuff that happens when the car just gets old and parts start failing?

No, auto insurance is there for when you have big accidents that incur massive bills. Similarly, homeowner's insurance isn't there for routine repairs, but for those big disasters that you can't predict and which the damage from which you can't afford. People buy auto insurance because they need a means to protect against a sudden need for $20,000.

Medical insurance needs to go back to being about the big, unpredictable stuff. Not doctor's visits, not prescriptions, probably not even outpatient surgery. It ought to be for those situations where most people would have to take out a second mortgage to pay a particular bill. Massive surgeries, specialists, and long stays in the hospital come to mind, particularly those that crop up unexpected. (I have arthritis that may require me to get a hip replacement one day; since I know this, I ought to start planning for that contingency).

And when you mentioned government, it reminded me of what a universally crummy job government has always done in providing insurance. I can think of four current examples of insurance provided by our federal government. Three are of the "universal, single-payer" variety, and one actually has premiums:

Medicare - Takes 2.9% of everyone's earnings, to pay for the health care of about 12% of the population. And it's scheduled to go broke in 14 years.

Social Security Retirement - A form of insurance that no private company would sell, in a form that is illegal for a private company to sell. It takes 10% of income, and provides pitiful benefits equivalent to about 1/4 of one's yearly earnings. Scheduled to go broke in a few decades.

Social Security Disability - Scheduled to go broke sometime in the next decade, I believe. I actually have no idea how they botched this up, since this is the only insurance the gov't deals in that should actually work.

National Flood Insurance Program - Or as John Stossel (http://abcnews.go.com/Business/Insurance/story?id=94181) calls it, 'welfare for the rich.' The feds will give you a dirt-cheap premium to insure a house you build from flooding, even if you build it on a beach in a hurricane zone. This program virtually *encourages* risky behavior.

The government has a terrible track record in running insurance. I can't imagine that they'd suddenly get their act together if handed the reins to an even bigger insurance program.


Medical insurance was invented during WWII as an end-run around the wage freeze of the time.

I thought it was employer-provided health insurance that sprung up around that time. I presumed that individually-owned policies predated the war.

Loren

[Gnarl]

While this thread is four years old, I felt that it deserved another look in view of the recent debate. It is interesting to note that cost increases have gone exactly like Sheldon predicted.

[carabas]

I suspect that it's almost inevitable that insurers (especially a universal federal insurer) to put a value on life. My great-grandma turns 100 next month. She's near-blind, lives in a nursing home, and doesn't remember an awful lot. If she were to have an accident that required $800,000 in medical services to remedy, and her health insurance premiums were paid up, then her insurer has a contractual obligation to fix her up.

But if it was a Universal single-payer system that was footing the bill, it'd be all but irrational for the feds to pay it. She hasn't paid taxes in decades, or made any tangible contribution at all to society in years. To spend that half-million would buy her *maybe* a few more years of feebleness in the home (assuming she even survived the operations), when it could have instead gone to pay for a young person's life-saving surgery. The GFHMO can't create money out of thin air; it has only finite resources. And it can't afford to provide every possible treatment to every needy patient without eventually bankrupting. Sooner or later, it has to start saying that certain stuff just isn't going to be covered.
I didn't know Sarah Palin mined ancient CBR threads for her rantings.

[Kees_L]

I'm inclined to believe that the current healthcare system anywhere is untenable. Some just moreso than others.

I'm inclined to disagree.
The way how things work per country will have stuff be affordible or cheap or expensive. Things like (general) taxes, funding/investing, inspection, insurance, legislation, liability and all that.

I believe that in European countries, with notably less expensive yet better-rated healthcare, they might be dealing with stuff differently than anywhere else.
More intricately so than 'private vs. government' or 'private vs socialized' or even 'government vs. commercial / free market'.

I believe that in my country private clinics aren't soon illegal or anything, but they do get the same obligations as the government was given:
a) prove perfectly how you do and go about stuff;
b) don't be commercial but rather be most cost-effective.
Which might be why any need for private healthcarers is low or lower. There is no point in having two healthcare systems as it were.
It might also be why medication import, medication or medical apparatus trademarking and insurance of hospitals and doctors themselves gets "special treatment".

And here's a question: isn't personal medical insurance quite a different thing than the actual healthcare given? Insurance companies might calculate different margins on things.
In my country it's not that we would be all *social* about everything. But we do have stuff be monitored and inspected to a height. And we might be particular about the free market working itself in certain fields.

In Holland we seem to not mind handing our government certain expertise provided it be transparent on stuff. That's what a government and its taxes are for I would think.