The best healthcare?

[tvashtarkatena]

Of course, I mean all of that in the very best sense, Jay.

[glassgowkiss]

BTW - where exactly is it illegal to turn a profit selling medical services (is this even true in practice in Canada any more since that court ruling a couple of years ago?)?

Having a hard time understanding the folks who feel a deep resonance with "Keep the Government Out of My Uterus" signs while simultaneously idealizing a system that grants the state a kind of veto-power over medical choices involving everything from your urethra to your amygdala.

and if this power belongs to private insurance company it's ok? reality check here, as so far this idolized private system is #1 cause filing for bankruptcies and leaves a quarter of workforce with no insurance!

regarding your first question it should be asking if it is ethical, not legal.

[prole]

[video:youtube]http://www.youtube.com/watch?v=TgqqSHr0wVA

 

Are we just about done here? Yeah, I think we are. Can someone cue up the Michael Steele/Cow Getting Run Over by the Train video? I never get tired of that these days.

[tvashtarkatena]

Shades of JayB's parroting the administration's 'we need to know more before we act' global warming stall tactic of 2 years ago or so.

 

Despite stark, nation-scale evidence of the across the board superiority of just about every other first world health care system over our own, there will always be a few morons who just can't seem to decipher the memo.

[olyclimber]

the earth could be wiped out by an asteroid tomorrow. lets party like its 1999, why waste time re-arrranging deck chairs on the titanic

[ivan]

more like dispensing single-payer paid for h1n1 vaccine shots on that there titanic deck

[G-spotter]

didn't you hear H1N1 vaccine is government mind control chip? DONT GET IT! better to die!

[JayB]

Shades of JayB's parroting the administration's 'we need to know more before we act' global warming stall tactic of 2 years ago or so.

 

Despite stark, nation-scale evidence of the across the board superiority of just about every other first world health care system over our own, there will always be a few morons who just can't seem to decipher the memo.

 

What specific evidence are you referring to here? Please share.

 

I'm happy to continue whatever conversation that we were having on global warming if you'd like to resume that debate instead of mischaracterizing my role in to.

 

 

 

[JayB]

* Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.

Keep in mind that includes inefficiencies and redundancies in each of the thousands of insurance companies which are themselves incredibly redundant in every respect, but especially so in claims processing. I'm guessing administrative and systems redundancies actually run more like 75-85% over a single payer clearing house.

 

And you would be wrong. the inefficiencies you speak of actually run, on average, about 350% higher in the U.S. verses all other industrialized countries who offer some form of public option: about 5% versus our 18%.

 

Look, the 'debate' is over. The experiment's been done since WWII in all industrialized countries including our own. Our employer based private health care system sucks ass: it's a joke to the rest of the civilized world, it's near the bottom overall regarding outcomes and stats (despite JayB's endless stream of 'my wife's fresh out of med school so I'm an expert complete and utter bullshit' and it's incredibly cruel. Witnessing what is happening to a large number of friends makes me an expert on that one.

 

We need a strong, not for profit, public option. The exact form doesn't matter than much: they all work fine elsewhere and herere where they are used.

 

As I said above, I'm more than happy to debate whatever stats and studies that you care to bring into the conversation that pertain to "outcomes and stats." There's lots of health systems in operation around the world, most of which have a mixture of public and private inputs. More than happy to participate in a discussion of their costs, performance, etc. If that's your objective.

 

Is it? Continuously mixing personal insults into an argument as a default is something that I find as persuasive as the next guy, but the insult to argument ratio is such that your principal aims might be better served by abandoning the pretense and leaving the argument out.

 

We've covered the 5% vs 18% numbers before. I've posted links that demonstrate that they don't actually cover the same functions before. I'll leave it at that unless someone decides they want to dig them up.

 

Unless your argument is that administrative costs are the most significant driver of total medical spending, that's an extremely odd number to fixate on. Total medical spending is the product of the cost per-treatment and the total number of treatments. Even if you eliminate administrative costs to zero, you've done absolutely nothing to constrain the primary drivers of spending growth - which boil down to more people seeking medical care more often and being treated with more expensive remedies. Even in a hypothetical zero administrative cost world, an aging, ever-fattening nation filled with people that have their use of medical resources constrained by only by the the weakest of incentives is quickly going to drive medical spending to a level that can't be financed by any method, even the massive borrowing that seems to be the current default.

 

Its an even stranger figure to use as a proxy for efficiency. Unless you are an accountant, the only meaningful measure of efficiency in medicine is the impact of a given treatment on a particular individual's health divided by the price of that treatment.

 

If a person walks into an ER for a chest cold, they get a full workup, and medicare pays the bill the administrative costs associated with that visit are certainly going to be low, but the medical efficiency of that particular intervention is going to be orders of magnitude lower than if they had simply walked into a Bartell's and purchased a packet of Sudafed.

 

The factors that affect the magnitude of the numerator (impact on health) and the denominator (total costs) vary dramatically in just about every case, but the number of cases where variations in the administrative portion of the denominator are meaningful are vanishingly small.

 

Maybe you can explain why your emphatic defense of administrative costs as a principal, or the principal, driver of medical efficiency?

[JayB]

As someone who gets more or less daily reports about what transpires in emergency rooms, and as someone who doesn't carry comprehensive insurance - I can tell you that people who are spending their own money on medical care can and do engage in a dialogue with physicians about costs, benefits, and risks associated with a particular course of action.

 

I participate in medicaid hearings on a regular basis. Today I had a hearing concerning the costs, benefits, and risks associated with a particular course of action. I have also been making my own healthcare decisions for decades and am familiar with the decisions made by friends and families over the years. I have also had a lot of experience with private paid services and private paid insurance coverage. I don't know if you are an expert or not, but I must certainly have had a different set of experiences than you.

 

That's certainly possible. It's certainly not an easy system to negotiate on your own under the current regimen, at least not in those realms where third-party payment schemes are the norm.

 

Not that I expect an answer to any of these questions but, but I'm still curious as to whether you read the entire article, particularly the part with the single-payer mechanism that he discussed, and why it's essential that profits should be eliminated in the medical economy.

 

Most people I know value medical services by considering the impact that a particular treatment has on their health by the cost, and the profit portion of the cost matters much less than how well it works and what the total price is.

 

There are plenty of cases where a more effective, less invasive, less painful procedure with a much more rapid recovery time has supplanted an existing technique that is likely to have higher total costs. Does the fact that the newer procedure generates a greater profit for the practitioner (and would likely have never come into being without the incentive effects of profits) than the older procedure mean that patients would be better served by opting for the treatment that generates the least profits for the practitioner? How about drugs that are both more expensive, and more effective than the treatments that they replaced like, say, Enbrel in the case of a significant percentage of rheumatoid arthritis patients?

 

 

[JayB]

BTW - where exactly is it illegal to turn a profit selling medical services (is this even true in practice in Canada any more since that court ruling a couple of years ago?)?

Having a hard time understanding the folks who feel a deep resonance with "Keep the Government Out of My Uterus" signs while simultaneously idealizing a system that grants the state a kind of veto-power over medical choices involving everything from your urethra to your amygdala.

and if this power belongs to private insurance company it's ok? reality check here, as so far this idolized private system is #1 cause filing for bankruptcies and leaves a quarter of workforce with no insurance!

regarding your first question it should be asking if it is ethical, not legal.

 

Bob I'd think that you of all people would realize that it's also possible for the interests of the state to conflict with the interests of the citizens.

 

Both private insurance companies and the state have significant expenses to ration care, but the state's capacity to do so is dramatically higher. This is one of the reasons why I favor a system that eliminates third party payers from the decision making process in as many situations as possible.

 

Medical bankruptcies are a tragedy, but it doesn't follow that a single-payer system is necessarily the best way to reduce or eliminate them.

 

You might also want to look into the effect that lost income during or permanent disability after a catastrophic medical event contributes to bankruptcies. The number of people who insure their homes, but don't even look into insuring what is actually their most valuable asset - their earning power - is always surprising to me.

 

 

[mattp]

Jay,

 

While you have for a second time criticized me for not reading your article all the way to the end I believe you have not read my reply all the way through either - or at least not stopped to think about what I said rather than look for an angle to criticize it. In a nutshell, what I said was that you raise a point that I agree with, but I don't agree with your conclusion.

 

I agree with the idea that our current system distorts any rational analysis of outcomes vs. cost, and that the proposed "reforms" being discussed in Congress do not directly address that. I believe a public option has potential to do so, but only if it is widely subscribed to and only if the government bureaucracy that you decry actually does its job (I'd give you 3 to one they'll do a better job than private insurance, though).

 

And, lest I simply give you an opportunity to jab more and discuss less, I'll concede that I did slightly overstate my case on the "for-profit" thing. Obviously, it is legal in France for a doctor to make a profit on a hernia operation. It is systemic profiteering that is illegal.

 

no other industrialized country has a profit mechanism built into the finance of basic health care coverage. Many other countries mandate universal coverage, but provide either a single payor, Medicare like system, or payment by regulated, non profit enterprises.

blog

 

 

The first overriding difference between U.S. and European healthcare systems is one of philosophy. The various European healthcare systems put people and their health before profits -- la santé d'abord, "health comes first," as the French are fond of saying.

It is the difference between health care run mostly as a non-profit venture with the goal of keeping people healthy and productive -- or running it as a for-profit commercial enterprise. It's no coincidence that, as the United States tries to grapple with soaring healthcare costs and lack of universal coverage, UnitedHealth Group CEO William McGuire received a staggering $124.8 million in compensation in 2005. He is just one of many grossly overcompensated kingpins of the U.S. healthcare industry.

New America Foundation

 

I'll give you 3 to 1 odds that a government agency won't be as motivated by profit as private insurance, too. Here's a little light reading on this topic though it is not, as you might request, based on peer reviewed studies. It also acknowledges that a government-paid system can support profiteering and, at the end, the author concludes that government funded health care is not "the" answer to expensive health care. I find this persuasive, and this is one reason why I find your original link, at the start of this discussion, interesting. I don't subscribe to the idea that you may think some on the left do that all we need is single payor. I think we need a different reimbursement scale as well.

 

NewYorker "

[ivan]

if nothing else, our current HC system is excellent for curing insomnia - even if you can't afford an hmo, you can always start a conversation about their very nature that oughta quickly do the trick!

[glassgowkiss]

BTW - where exactly is it illegal to turn a profit selling medical services (is this even true in practice in Canada any more since that court ruling a couple of years ago?)?

Having a hard time understanding the folks who feel a deep resonance with "Keep the Government Out of My Uterus" signs while simultaneously idealizing a system that grants the state a kind of veto-power over medical choices involving everything from your urethra to your amygdala.

and if this power belongs to private insurance company it's ok? reality check here, as so far this idolized private system is #1 cause filing for bankruptcies and leaves a quarter of workforce with no insurance!

regarding your first question it should be asking if it is ethical, not legal.

 

Bob I'd think that you of all people would realize that it's also possible for the interests of the state to conflict with the interests of the citizens.

 

Both private insurance companies and the state have significant expenses to ration care, but the state's capacity to do so is dramatically higher. This is one of the reasons why I favor a system that eliminates third party payers from the decision making process in as many situations as possible.

 

Medical bankruptcies are a tragedy, but it doesn't follow that a single-payer system is necessarily the best way to reduce or eliminate them.

 

You might also want to look into the effect that lost income during or permanent disability after a catastrophic medical event contributes to bankruptcies. The number of people who insure their homes, but don't even look into insuring what is actually their most valuable asset - their earning power - is always surprising to me.

 

Jay, I see your points. However you must realize what's happening here is a complete breakdown of the system, and if left alone in 5-7 years there is going to be no healthcare to speak off. On my own example- Regence raised their rates over $140 per months in one year- that's over $1600 per year increase for one person. I am not less healthy then a year ago, so why is my rate going up to the extent I can no longer afford it? While the rates are going up, the coverage is going down. We deal with Medicare at our office daily and I must say Medicare is one of the best insurances to pay on time. Also Medicare has very clear what is covered and what is not, so there are no surprises when it comes to billing. On the other hand try to get a straight answer from Regence, lifewise or Premera- good luck! When our office calls to verify the coverage you always get the line: "But this is not guarantee of the payment"- so you never know if the service will be covered or not.

[tvashtarkatena]

if nothing else, our current HC system is excellent for curing insomnia - even if you can't afford an hmo, you can always start a conversation about their very nature that oughta quickly do the trick!

 

Our HC system is curing insomnia in another important way: it's producing a record number of new make-work jobs in billing departments nationwide. How anyone could stay awake while spending their days finding the right billing code for the right procedure for the right insurance company for the right provider is beyond me. Have you seen Brazil? Our HC system is that office.

[mattp]

If you suffer insomnia, you'll pay the doctor ten times as much for repeat visits and new treatments and stuff that doesn't work as opposed to if you actually got the right diagnosis and a simple cure on the first visit. Along the way, you might try a bunch of "alternative" therapies that on any objective scale show no signs of benefit, and much of this will be based on payment rather than outcome. How sensible is that?

[j_b]

I suspect that we'll wind up with that kind of system eventually, but only after insolvency and third-party rationing drive us to it.

 

???? many (if not most) are already insolvent and health care is already effectively rationed for the great majority of Americans (via un-affordability, pre-existing conditions, ..), and it is the privatize everything, deregulate everything, consolidate everything ideology that took us where we are. Yet, somehow, the same ideologues advocate more of the same.