Editore"s Note
Tilting at Windmills

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June 7, 2007
By: Kevin Drum

THE REAL PROBLEM....What Ezra says. Medicare isn't the problem. Healthcare is the problem. If we don't figure out a way to contain the overall rise of medical spending, it really doesn't matter much exactly how those dollars get spent.

Needless to say, I think the only serious opportunity to rein in those costs without a revolt of the middle class comes from a universal system regulated by the feds. The liberal argument for this is that it provides decent healthcare to everyone and allows greater freedom of choice for consumers. The conservative argument is that it makes medical costs more transparent. Right now, consumers have essentially no say in the cost of health insurance. They just pay whatever their employer makes them pay and then use as much medical care as they want. A national system, however, is limited by how much people are willing to pay in taxes. That provides a stronger motivation for cost control than anything we have now.

Kevin Drum 3:15 PM Permalink | Trackbacks | Comments (65)

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Comments

I'm pretty sure people will continue to want everything and not pay for it, Kevin.

Posted by: mdw on June 7, 2007 at 3:25 PM | PERMALINK

Without fully nationalizing healthcare, can the gov't simply impose standard operating procedures for current HMO's?

My doctor says his biggest office nightmare is having to follow a completely different filing process for every HMO he submits to, along with completely different coverages and coverage levels for each patient from each HMO.

Posted by: wishIwuz2 on June 7, 2007 at 3:31 PM | PERMALINK

Ah mdw, the "Don't you know there's no such thing as a free lunch theory" -- is that it?

When I called the company that manages the Health Insurance for people in Kansas who are uninsurable (turned down by two companies) if she really thought paying almost $500 a month (for 2 people) for a $10,000/year deductable policy was AFFORDABLE (and I'm afraid I said it in all caps) -- that's what she said: "There's no such thing as a free lunch"

Well, I'm not looking for free. Just something that'll fit in my budget after I retire.

What I don't get is why the safety net that we've got (Medicare) can't be extended to everyone. I know we need & should have something better.

But, Jesus! Start sending The Chimp a Medicare for Everyone bill every month. And get the votes on record.

Posted by: katiebird on June 7, 2007 at 3:34 PM | PERMALINK

> Healthcare is the problem. If we don't
> figure out a way to contain the overall
> rise of medical spending, it really doesn't
> matter much exactly how those dollars get spent.

Why? Why is it bad for us to spend an increasing fraction of our GDP on health care, which after all is an internally closed economy, rather than big-screen TVs , which require us to send wealth to China? The US is getting older; it wants to spend more on feeling good and living longer. The problem with that is? Not enough cash left for defense contractors and CEO salaries in general?

Note that I am in favor of single-payer and abolishing the insurance industry which is for sure a dead weight. And I do think that efficiency can be gained by concentrating on primary care and accepting end-of-life. So my question stands in light of those positions.

Cranky

Posted by: Cranky Observer on June 7, 2007 at 3:36 PM | PERMALINK

Cranky,

I love this. It makes me feel good to read it!:

"Why? Why is it bad for us to spend an increasing fraction of our GDP on health care, which after all is an internally closed economy, rather than big-screen TVs , which require us to send wealth to China? The US is getting older; it wants to spend more on feeling good and living longer. The problem with that is? Not enough cash left for defense contractors and CEO salaries in general?"

Posted by: katiebird on June 7, 2007 at 3:41 PM | PERMALINK

What mdw said.

Posted by: ferd on June 7, 2007 at 3:45 PM | PERMALINK

Cranky

That was one of the best comments I have read a long time. I am going have to noodle your thought for a while.

Posted by: Ron Byers on June 7, 2007 at 3:53 PM | PERMALINK

Just wait until Michael Moore's, "Sicko" reaches general circulation. Even some of those with insurance have a hard time getting care. Afterall, insurance companies are in business to make a profit and the more people they stiff or deny, the more $$ they make.

Posted by: llamerolen on June 7, 2007 at 3:54 PM | PERMALINK

A lot of our problems have simpler solutions than listening to Republicans would indicate.

How are you going to bring our troops from Iraq, Mr. Presidential Candidate?

"In ships and planes" would be a good answer.

The answer to how to contain health care spending can similarly reduced to simplicity, itself: Spend less.

Make the government the sole purchaser, and set a budget. Then, go about making administrative and organizational changes, which improve service delivery, within that budget.

The truth is, that government has a near-stranglehold on health care now. That's why Big Pharma spends so much on lobbying Congress and the Administration. So that government doesn't use its control of NIH medical research policy, medical education and training policy, drug patent policy, FDA policy, Customs policy, Medicare policy, Veterans Administration policy, etc. in a coordinated fashion to drive costs down.

Health care inflation is not just some mysterious outcome dropping from the sky. It is Republican policy.

You leave Iraq by leaving Iraq. You reduce health care costs by spending less on health care.

Posted by: Bruce Wilder on June 7, 2007 at 3:55 PM | PERMALINK

The real problem is income disparity. Income disparity is escalating rapidly, which is driving rapid inflation in costs of medical services, because the ultra wealthy will always pay whatever it costs - putting these goods and services out of reach of the bottom 95%.

Couple that pressure with the patent abuse of the pharmaceutical industry, monopolistic practices of the hospital megacorporations (like HCA), and the fraud and waste of the untouchable insurance industry, and the artificial supply-constraint on qualified personnel by the AMA, and you've got a recipe for runaway inflation.

Now; add this situation to a FED willing to stroke inflation numbers such that a crucial service like health care won't show up on the radar, and you start to understand the increasingly desperate situation the bottom 95% are in.

Posted by: osama_been_forgotten on June 7, 2007 at 3:59 PM | PERMALINK

My wife treats many people in the last few weeks or months of their lives. Entire estates and life savings are consumed to further a patient's existence by a matter of weeks. It seems to me a large percentage of the dollars spent on health care involve staving off pain and death when the game is up. Battles with mortality that in years past weren't fought are now waged for months on end. We can't put senior citizens and the hopelessly ill on an ice floe and shove them off to sea. Is there a humane equivilant? What's the answer?

Posted by: steve duncan on June 7, 2007 at 4:00 PM | PERMALINK

Cranky,

While you have a point, you overlook the fact that we get less good outcome per dollar than any other industrialized democracy on earth.

See, thing is, we are, by any rational measure, spending vastly more on health care than we should have to. If we simply had the ratio of good outcome to dollar that other economies enjoy, we'd have money to burn for all kinds of things. Maybe better and longer vacations or parental leaves. Maybe shorter working hours. Maybe, indeed, plasma TVs and iPhones.

But how we choose to use the money not wasted by unnecessary health care costs is an entirely different question.

Posted by: frankly0 on June 7, 2007 at 4:03 PM | PERMALINK

> While you have a point, you overlook the
> fact that we get less good outcome per dollar
> than any other industrialized democracy on
> earth.

I don't disagree with that. IMHO it stems from our incredibly inefficient and inefficiency-creating private insurance industry and the medical profession's devaluation of the primary care role (I may be bitter about that since I just lost my primary care physician to a job that was no doubt a good choice for him but was clearly also a much higher prestige role).

But I don't think that affects my point. By all accounts the French (and to a lesser extent the Germans) consume plenty of efficiently-provided medical services; those services just cost their economy less but the proportion is the same.

Cranky

Posted by: Cranky Observer on June 7, 2007 at 4:10 PM | PERMALINK

you overlook the fact that we get less good outcome per dollar than any other industrialized democracy on earth.

U! S! A!

U! S! A!

We're number ONE!

We're number ONE!

Posted by: patriotic dufus on June 7, 2007 at 4:12 PM | PERMALINK

But, frankly0 -- According to the posts and comments at Ezra's place, costs are rising all over the world. We're just starting from a higher spot. I think.

So, I understood Cranky's remark to be more general...that if health care is something people want to spend their money on -- that's not such a bad decision.

I guess didn't look at the whole picture deeply enough...So much for a bit of humor.

(slinking away)

Posted by: katiebird on June 7, 2007 at 4:13 PM | PERMALINK

> (slinking away)
> katiebird

katiebird,
By no means! We need more comments like your 3:41 above!

Cranky

Posted by: Cranky Observer on June 7, 2007 at 4:16 PM | PERMALINK

not to be flippant steve duncan, but I think I may have an answer. One that won't be embraced or even seriously considered, but its benefits extend far beyond reducing healthcare costs.

We have to pay Afghan farmers about 10x the going rate for their opium crops, convince them to cut planting by 75% and devote acreage to subsistence crops, and encourage our hopelessly ill or advanced in age to spend their last months and weeks in an opiate cocoon.

Posted by: kenga on June 7, 2007 at 4:20 PM | PERMALINK

Thanks, Cranky!

I don't know why I take these conversations so seriously (sometimes.)

My congressman doesn't. Everytime I send a letter to him asking about health care, he sends me a form letter on a totally different subject! (first Iraq, yesterday: Gasoline Price Gouging)

If we can't get the guys in Washington to even answer a question -- we're for sure never going to get them to VOTE on it.

So, it's just people like us babbling about legislation and policies that won't ever go anywhere.

Posted by: katiebird on June 7, 2007 at 4:20 PM | PERMALINK

There is one problem and one problem only with our healthcare and that problem is Health Insurers. The fact that we keep trying to treat health insurance like car insurance is nothing short of foolish. Only a small number of people will ever have an auto accident and it makes sense to pool the risk. Find me someone - anyone - who never needs to see a doctor, especially when the joys of aging make themselves apparent. Trying to pool the risk of health care is doing nothing but making a lot of insurance CEO's very wealthy by...wait for it...RATIONING health care.

Posted by: arteclectic on June 7, 2007 at 4:24 PM | PERMALINK

I like Cranky's comment as well. I have been saying that we are the richest country in the world and we can afford health care for everyone. But I like Cranky's formulation better. Kind of funny and unexpected.

(I also am in favor of single payer)

Posted by: EmmaAnne on June 7, 2007 at 4:34 PM | PERMALINK

Health care policy:

1) Ban the sale of all tobacco products.

2) Provide Medicare coverage to everyone.

3) Open up VA hospitals to all Americans.

Posted by: ken on June 7, 2007 at 4:48 PM | PERMALINK

I have been living without health insurance for about four years now, and I am getting angry about it. VERY angry about it, as in, I just might shoot someone if it comes to me getting some kind of serious medical condition that will not be treated. I am self-employed and uninsurable at any cost, due to existing medical conditions. I was able to afford health insurance until it went over $400/mth in 2003, and that was without drug coverage. I moved 10 miles across the river, which happened to be in another state, and premiums jumped to $650/mth. I dropped my coverage--what could I do? I have looked for the last year and a half for a job with health insurance, but after 10+ years of self-employment I'm not exactly an attractive candidate and could find no job whatsoever. My only option is to be self-employed. Why does that mean I must go without health insurance.

I'm serious -- if I develop cancer or some serious medical condition and am refused treatment, I will take out a few doctors and politicians with me....

Posted by: Dan on June 7, 2007 at 5:02 PM | PERMALINK

I'm all in favor of nationalized health care, and making sure that even the poorest have access to it. However, I would like to point out that there is potentially a danger posed by "heroic measures" in health care, and paradoxically the problem becomes worse as medical science improves.

To illustrate the problem imagine that medical science advances to the point where anybody, no matter how ill, can be kept alive for another month by expending a million dollars on "heroic procedures": transplants, artificial organs, radiotherapy, dialysis, etc. Since this is a thought experiment, let's go ahead and assume that that month is quality time, in which the patient is free from pain, conscious, alert, able to do things and enjoy friends and family. But the downside, as I already mentioned, is that the expense for these heroic life-saving procedures can run a million dollars per month.

What would we do in those circumstances? We'd like to say that you can't put a price on a human life, and everyone who could benefit from such procedures should be able to get them. But can we really maintain that philosophy? It's already the case that, for the average person, the bulk of his medical expenses for his entire life come in the last few years of his life. But if million-dollar per month medical care becomes the norm for the last years of each person's life, then medical costs will bankrupt us all.

What's my solution? I don't have a solution. That's why I'm glad that I'm not the President or the King or God.

Posted by: Daryl McCullough on June 7, 2007 at 5:06 PM | PERMALINK

Dan your questions: "My only option is to be self-employed. Why does that mean I must go without health insurance." are exactly what I've been asking my congressman. And what he's refused to answer.

I REALLY don't understand. Aren't congressmen and senators related or friends with anyone struggling with these problems? Are they really so protected?

This has GOT to change.

Posted by: katiebird on June 7, 2007 at 5:07 PM | PERMALINK

Ken,
Forgot step 4...
Health care policy:

1) Ban the sale of all tobacco products.

2) Provide Medicare coverage to everyone.

3) Open up VA hospitals to all Americans.

4) Open up wallet and remove cash and give to governmment

Posted by: Dave! on June 7, 2007 at 5:09 PM | PERMALINK

"What's my solution?"

Mine is to leave it up to doctors and patients. Not politicians or insurance clerks.

Don't try to fit everyone into a single answer.

Sometimes the heroic effort is the right thing to do. Taking the decision away from the on-the-scene-doctor would be wrong.

Posted by: katiebird on June 7, 2007 at 5:11 PM | PERMALINK

Daryl McCullough,
What would we do in those circumstances? We'd like to say that you can't put a price on a human life, and everyone who could benefit from such procedures should be able to get them. But can we really maintain that philosophy?...
What's my solution?

Let the cold, calculating, heartless insurance company make the decisions. It becomes too political when the government is making those decisions.

Posted by: Dave! on June 7, 2007 at 5:17 PM | PERMALINK

The most politically powerful folks in the country are in the top two tiers of our economic strata. If not overly happy, they are at least satisfied, with their current medical coverage.

They are warry of change and they will fight like hell in what they feel is a zero-sum game.

Posted by: Keith G on June 7, 2007 at 5:17 PM | PERMALINK

As an engineer, I find that I cannot effectively solve a problem until I can measure the problem accurately: if a program runs too slowly or requires too much memory, I need accurate measurements that show where the time and memory is being consumed.

It seems we lack clear information on health care finances. There's plenty of anecdotal evidence that drug costs and insurance company profits are going up, while doctor salaries are going down. But to control costs, we need to know where the money is going, and then figure out who is going to get less.

Posted by: Joe Buck on June 7, 2007 at 5:21 PM | PERMALINK

What problem? As Drum says, the phenomenon is global. And it seems apparent that any improvements will only reduce the size of the growth rate a little, not bring it down anywher near the general inflation rate. And lots of "solutions" might well cut care that's needed as much as they do care that might really be superfluous.

Fact is, we can afford more health care compared to other goods and services, and we want it. For the best of reasons.

Before propounding solutions, how about showing there's a problem and defining its dimensions?

Posted by: Complacent on June 7, 2007 at 5:25 PM | PERMALINK

One of the big sources of money waste in the healthcare system is caused by inefficiency in data sharing. Specialists, hospitals, and doctors seeing new patients often repeat tests, just because the prior results cannot be obtained in a timely manner from a previous doctor or hospital.

Posted by: jm on June 7, 2007 at 5:27 PM | PERMALINK

we need to know where the money is going,

insurance companies

and then figure out who is going to get less.

insurance companies

Posted by: Disputo on June 7, 2007 at 5:28 PM | PERMALINK

I'm serious -- if I develop cancer or some serious medical condition and am refused treatment, I will take out a few doctors and politicians with me....
Posted by: Dan on June 7, 2007 at 5:02 PM | PERMALINK

IF?

Dan, be serious. It's not IF, it's WHEN. I suggest weekly visits to the gun-range, in your case. Since I am neither a politician, nor a doctor, nor an insurance adjuster. I'd like to not get hit accidentally.

Posted by: osama_been_forgotten on June 7, 2007 at 5:29 PM | PERMALINK

> IF?
> Dan, be serious. It's not IF, it's WHEN.

Sort of the problem with the whole "incentivize and compete" theory of health care funding...

Cranky

Posted by: Cranky Observer on June 7, 2007 at 5:36 PM | PERMALINK

Meanwhile, medical cures get put on hold:

. . . the president said the bill means taxpayers would "be compelled to support the deliberate destruction of human embryos."

The president is perfectly willing to force an overwhelming majority of American taxpayers to foot the bill for a futile Iraq war that serves no national security interests and pay to have our own soldiers killed, but rants, pants, and bellows at forcing a small minority of American taxpayers to foot the bill for medical research that will not destroy a single embryo that would not otherwise be destroyed.

Bush is a man with absolutely no moral perspective at all.

Posted by: anonymous on June 7, 2007 at 5:38 PM | PERMALINK

katiebird,

Yeah, but... (as Garrison Keillor says "Now for the yeah-buttal...")

I'm assuming, for the sake of my thought experiment, that the doctor and the patient both agree that it is worthwhile for the patient to receive the heroic measures (in real life, sometimes it's questionable). The issue is whether locally "best" decision adds up to a best policy, overall, if the money comes out of a national fund. The doctor and the patient presumably are only weighing the pros and cons from the standpoint of the patient, but if it is paid for out of taxes, then it has an impact on more people that just the patient and his or her family. Money spent on health care is money not spent on education, crime prevention, environmental protection, etc.

Posted by: Daryl McCullough on June 7, 2007 at 5:40 PM | PERMALINK

One of the big sources of money waste in the healthcare system is caused by inefficiency in data sharing. .
Posted by: jm on June 7, 2007 at 5:27 PM | PERMALINK

I'm not sure I want them to be more efficient at data sharing.

For example, I don't want my next potential insurer to look at the MRI that was taken of my spine last year. Because more likely than not, it would be used to deny me coverage, rather than to clear a referral to a specialist.

What, you say? There are rules against that sort of thing? Yeah, right.

Posted by: osama_been_forgotten on June 7, 2007 at 5:47 PM | PERMALINK

I read Klein's post, I read Leonhardt's article, and I looked at Orszag's graph. If I understand everything, the projected spending on Medicare and Medicaid will be growing faster than one (Orszag) would expect to be caused by the aging population alone. First, can anyone point me to where, exactly, Leonhardt got this "similar" graph. The queerest thing about it is that it shows no upward inflection caused by the soon-to- happen increasing rate of new Medicare beneficiaries. In other words, I don't see how the graph for Medicare/Medicaid expenditure due to aging alone can be linear the way it is shown in the NY Times article. The only paper/presentation given by Orszag recently that contained a graph anything close to that recreated by Leonhardt, simply showed projected spending using three different cost differentials for Medicare/Medicaid (2.5% above CPI, 1% above CPI, and 0.1% above, IIRC). Also, going back to the linearity of the "aging-only" projection, I think it pretty non-controversial that the older you get, the more rapidly you consume healthcare resources, so again, where is the expected upward inflection?

Finally, the assertion that a universal system of healthcare would lower Medicare and Medicaid costs seems iffy to me. Which way do the present subsidies go? Is it the case that Medicare/Medicaid is cheaper today than it would be if non-Medicare/Medicaid healthcare consumers were not indirectly bearing some of the cost, or is it the other way around? A lot of doctors and hospitals claim they are being under-compensated by the federal programs.

It appears to me that the projected lower costs of universal coverage rests on the assumption that we will save the difference between what insurance companies collect in premiums vs what they pay out in claims today. In addition, there seems to be some belief that costs can be contained by government fiat. For example, Leonhardt's article seems to imply that "useless" medical procedures like the lumbar fusion will be stopped by government bureaucrats. However, if this is true, why can't Medicare and Medicaid control their escalating costs today by fiat? What would be different in universal care vs Medicare and Medicaid today? If the government were to set guidelines for the care it would pay for, how is it going to prevent the private market from providing for the uncovered things, like "useless" lumbar fusion, thus consuming the resources that universal care was trying to save in the first place? Are we going to outlaw any procedure or treatment the government deems it doesn't want to pay for? Are we going to mandate that doctors accept only government payments for medical care? Are we going to outlaw the private provision of medical care altogether?

Posted by: Yancey Ward on June 7, 2007 at 6:05 PM | PERMALINK

Are we going to outlaw any procedure or treatment the government deems it doesn't want to pay for? Are we going to mandate that doctors accept only government payments for medical care? Are we going to outlaw the private provision of medical care altogether?

No, Chicken Little. The sky is not falling.

Posted by: Disputo on June 7, 2007 at 6:16 PM | PERMALINK
It appears to me that the projected lower costs of universal coverage rests on the assumption that we will save the difference between what insurance companies collect in premiums vs what they pay out in claims today.

No, it is based on the observed fact that developed nations with universal healthcare pay substantially less than the US for healthcare (measured either per capita or per GDP), while providing universal access to high quality healthcare, a point on which the US fails.

Posted by: cmdicely on June 7, 2007 at 6:33 PM | PERMALINK

Several thoughts on savings:

First, national healthcare would mean, or should mean, standardized paperwork, whether we have a single-payer system, or let insurance companies be part of the game, or whatever. Big administrative savings right there, I think.

Second, if it means the government regulating the amount of fMRI machines in a certain area, or saying that it's only going to be a payer to 12 out of 17 hospitals in a major metropolitan area that have fMRI equipment, so be it.

Let's go further and think of this in terms of medical market care pooling in broader ways.

Third, that in turn may drive some doctors away from some specialties. But, many doctors go down that road in the first place to recoup the high U.S. cost of medical school. This backdoor pressure itself wouldn't be enough to drive down med school costs, perhaps. Maybe other things would, such as higher student loan rates for specialization, or to flip that, lower student loan rates for non-specialization. Expansion of programs, such as working in Indian Health Service hospitals, to ameliorate loans, could be part of this.

Fourth, national healthcare, to me, implies at least some degree of national regulatory standards superceding state ones, such as state insurance boards (at least the health insurance regulatory part; a national insurance regulatory system in general might be a good idea but that's neither here nor there).

Things like this are why any Ron Wyden-type proposal doesn't well meet my smell test.

Posted by: SocraticGadfly on June 7, 2007 at 6:43 PM | PERMALINK

This bit about the last month of life is really a red herring. That's already covered, because hospitals don't stop treating someone when they can't pay and allow them to die.

What we're really talking about with universal single-payer is the first ten years of life, when timely interventions are extremely cost effective. We're talking about the next 30 years of life, when people pay way more than they should for a series of annual physicals they don't need. And we're talking about 50-year-olds who would live another 25 years if they could get some problem treated when it's small, but will die in two or three years if they can't afford $200 for a clinic visit and some tests.

And, of course, we're talking about the 5% of our GDP that is our excess spending compared with other economies like us which have universal coverage. A fair chunk of change, enough to finance a complete conversion to renewable energy over the next 30 years.

As somebody said upthread, we already have the tools to manage our healthcare. Part of our problem is that right now those tools are mostly used against us rather than for us.

Posted by: serial catowner on June 7, 2007 at 6:49 PM | PERMALINK

>A national system, however, is limited by how much people are willing to pay in taxes.

Absolutely true. You can have a well-funded system if you let people with money spend as much as they want on themselves; they will be strangely reluctant to spend very much on anyone else.

>That provides a stronger motivation for cost control than anything we have now.

Yes, and the favoured "cost control" measures are rationing and de-listing. Look north. Much of what people would buy if they could is legislatively denied via the provisions of the Canada Health Act; provinces have responded by limiting some services and entirely de-insuring others.

Add to that the guild mentality of the physicians' colleges and nurses' unions, which have worked so successfully for over three decades to ensure a seller's market for labour that they now complain of overwork (long hours).

Posted by: VRWC on June 7, 2007 at 7:16 PM | PERMALINK

osama been forgotten wrote:
> IF?
>
> Dan, be serious. It's not IF, it's WHEN. I
> suggest weekly visits to the gun-range, in
> your case. Since I am neither a politician,
> nor a doctor, nor an insurance adjuster.
> I'd like to not get hit accidentally.

OBF: I'm already quite competent at the gun range, thank you though for thinking about me. But I'm very serious: if I am about to die because society has decided that I am not worthy of medical care (which I am more than willing to purchase at a reasonable price), then I will take out doctors (for their silence), politicians (for their cowardice), and insurance company employees (for their cowardice and complicity). I should be able to do most of that in one day, probably about three hours with a little planning. I will leave a long, detailed note, with a reference to my Web site, and you will read about it in the NYT and on the major cable stations -- remember me.

Posted by: Dan on June 7, 2007 at 7:57 PM | PERMALINK

OBF: I'm already quite competent at the gun range, thank you though for thinking about me.
Posted by: Dan on June 7, 2007 at 7:57 PM | PERMALINK

Nope. I was thinking about me. :)

Posted by: osama_been_forgotten on June 7, 2007 at 8:27 PM | PERMALINK

Medical administrative costs in the U.S. are 30% of expenditures. This is many times that of other industrialized countries-- and Medicare for that matter.

Also consider the free rein given our pharmaceutical industry. After using Federal funds to develop new drugs, (we're talking billions of dollars) these companies market them at prices/year that in many instances exceed the median and average incomes in this country. No other system accepts such pricing and it's another example of why our expenditures are 30-70% higher than in other industrialized countries.

www.medicynic.com

Posted by: Cycledoc on June 7, 2007 at 10:31 PM | PERMALINK

Ultimately, the only way to contain health care costs is through rationing. Either you can't afford a treatment or it is denied to you.

At the moment of death everyone's life is infinitely valuable to them.

If price is truly no option I'm willing to keep on researching medical interventions no matter how marginal the return.

Posted by: Adam on June 7, 2007 at 10:41 PM | PERMALINK

Ultimately, the only way to contain health care costs is through rationing. Either you can't afford a treatment or it is denied to you.

At the moment of death everyone's life is infinitely valuable to them.

If price is truly no option I'm willing to keep on researching medical interventions no matter how marginal the return.

Posted by: Adam on June 7, 2007 at 10:41 PM | PERMALINK

Kevin, I think your comments obscure this issue just like the less enlightened mainstream media. You mention the "rise of medical spending" and then go on to talk mainly about the cost of insurance. There is a HUGE difference between the cost of providing healthcare (i.e., what hospitals and doctors do) and the cost of health insurance. I assure you that the cost of insurance to the consuming public is rising WAY faster than what hospitals and doctors spend to provide healthcare. Hospitals are struggling to survive, doctors are making less than they ever have, and insurance company profits are at all-time highs ... and the public gets screwed.

Posted by: Cy on June 7, 2007 at 11:36 PM | PERMALINK

Don't shoot the doctors. In many cases (particularly in the non-surgical specialties), they are on the losing end of this transaction.

My difficulty with the profit motive and insurance companies can be summarized in one sentence, spoken by an internist of my acquaintance after another frustrating go-round with an insurance company trying to get approval for some treatment.

"From their [the insurance company's] point of view, It's **always** cheaper to let them die".

Posted by: divF on June 8, 2007 at 1:21 AM | PERMALINK

"From their [the insurance company's] point of view, It's **always** cheaper to let them die".

There is a simple solution to that, have your medical insurance and life insurance be provided by the same company.

Posted by: boomin on June 8, 2007 at 11:48 AM | PERMALINK

Need to start fixing this somehow and soon. You could leave the private insurors alive for now, but impose:
1) Community rating

2) You can't refuse anybody.

and couple this with:
3) Lowering the eligibility age of Medicare to 55, fund it with higher payroll/corporate taxes.

That should help reduce age-discrimination by employers looking to cut costs, and the rest couldn't be denied coverage for pre-existing conditions or be price-gouged for them. Further lowering of the eligibility age of Medicare could incrementally phase out private medical insurance for most except the very wealthy.

Posted by: Doc at the Radar Station on June 8, 2007 at 12:53 PM | PERMALINK

Originally posted by mdw:
I'm pretty sure people will continue to want everything and not pay for it, Kevin.
---------------------------------------

Absolutely. You think deficit spending is a problem now?


Posted by: matt on June 8, 2007 at 1:13 PM | PERMALINK

On the subject of administrative costs---the reduction of which is one of the prime advantages of single payer programs---my brother in law is an orthopedic surgeon. In his clinic, with a total of 4 surgeons---there are 2.5 manyears of personnel soley devoted to handling insurance claims. The main problem, no standardization...each company has its own forms. Get rid of that and you lower the admin costs considerably.

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