Is America causing it's own pain on healthcare costs?

My own feeling is that the basic business model is just wrong—it’s insurance-based. Insurance should shield one from catastrophe, not provide a middle-man for routine transactions between a consumer and provider. The insurance industry’s presence distorts everything: what is coverable, how much should be paid by or to each party, it adds cost without adding value in most cases.

I think we really need a different model altogether, one that recognizes that while costs of healthcare are distributed unevenly between individuals, collectively they are predictable and manageable—and reducible with efficiency and value-per-dollar based efforts.

Well, something that is never mentioned in the debates are: Misuse of the ER. People go there for any little thing, expect to be seen right now, and complain loud enough to wake the dead. How much time and resources are these losers wasting? Multiply that by how many hospitals in how many cities 24 hours a day! There should be pits filled with starving, slavering leopards for people who go to the ER unnecessarily. The same can be said for ambulance frequent fliers. I was an EMT in the navy for 13 years and I can tell you that 80% of our calls were bulls*$t. We actually had people telling us to let “them off here” generally near a mall.
Another big thing is unnecessary lawsuits. People want to sue just to get money, but the frivolous suits are a huge blight and burden on the healthcare system. I don’t have numbers. I wish I did.
Anybody?

Here is a clue…...an aspirin in the hospital now costs $50.00.

I could not agree with you more @jerv
It seems this country is working hard and spending money to eleminate the lower class. The profitability of the healthcare industry must suffer some but I don’t see it ever happening.

I tend to believe that our type of health care needs help…but not total reform. Yes, universal health care has worked in many place, but this is the United States. We have (and need to keep) a capitalistic economy. So I think give the health care people a good kick in the rear (and I mean a hard one.) Let them know that if they don’t change something, repercussions happen. The only reason that isn’t working right now is because there wasn’t even a warning. Just a flat out proposal for reform.

yes and no

It is matter of actually reading your policy and knowing what coverage you have or do not have. An example if you want a tummy tuck and your plan does not cover it then pay for it out of pocket.
Another example is lawsuits for malpartice. In august is when all the doctors in training come onabroad. That is when the death rates are the highest.
Another issue is when the doctors know when you have the great coverage, and use you as lab rat .
it is both the medcial and the patients
THe only change I can really see happing if we the patients start asking the doctors and nurses a ton of questions
WHat foods to eat when we take meds?
How long have you been in Medicne? How many compliants do you have against you?
Wher did you go to school ? blah blah blah and most of time we do not.
and the doctors need to ask questions as well, what foods you had eaten? When was your last place you have been (ie work, scchool airport, Candan,Africa blah blah)

So when we start become more involed in our own care and taking care of the little things just maybe the health industry would work better.

@Trillian That seems to be the only way to get seen for some since the ER can’t turn people away the way a non-emergency doctor can (though they can bill them more ruthlessly). Maybe if we had more low-cost clinics available. I know I enjoy the sliding-scale fees that I couldn’t get back where I used to live.

@Maximillian What incentive do they have to change though? Change reduces profits, and thus must be imposed from outside… which leads to cries of “Socialism!” and all sorts of wailing and gnashing of teeth. They had their chance and look what happened! They could have changed any time they wanted to. And if you think that there was no warning, you haven’t seen a paper in the last decade.
Oh, and wait until I figure out how to word my upcoming question about the “free market”. You might like that too.

@therookie Policy? Ummm…. with unemployment on the rise and all, there are a growing number of people who lack a policy (most people are covered through their employer, and most who aren’t are rich enough that cost doesn’t prevent them from seeing a doctor) so that isn’t quite accurate.
Now, I agree with you about elective things such as non-reconstructive cosmetic surgery and about the “lab rat” phenomenon, but I think that expecting the average person on the street to be well-informed is asking a little much.

another thought,
there are folks in the health field that should not be in the health care field.

I feel that in order to work in most areas in health care that you have to be a people person.

@therookie Incompetence is universal, so why wouldn’t there be buffoons in the medical field as well?

Who is this America guy? I’d like to make him pay.

Um, yeah. I mean, who else? We’re the ones who create both supply and demand for health care, so who else is there to blame? The Russians?

It is a free market system as @Maximillian points out. It shouldn’t be—that defeats the whole notion of insurance in a system where hospitals can not turn anyone away by law. The only way competition can work is if providers are allowed to refuse to treat people. Otherwise, we all get care, only some of us pay a lot, and others nothing. We all subsidize those who pay nothing, but the insurance companies stay away from that by insuring only healthy people. The expensive people are paid for by all of us, through taxes. But I digress.

We do have choices because we want them. So we choose to value health care more than almost anything else, and we are spending more and more of our wealth on it. Twenty years ago maybe one in ten dollars went for health care, nationally. Today, it’s maybe one in six dollars. We like our health more and more.

If we want to reduce how much we spend on health care, we have a few choices. We can cut back on our own consumption (decrease demand, probably by raising prices); we can reduce the cost of services (either through efficiency improvements or by forcing providers to do the same work for less money); or reduce supply (drive providers out of the market).

Of these, efficiency is the easiest target because it appears to hurt the fewest people. With the other two methods we piss off patients or we piss off providers. So that’s why everyone is talking about things like digital records, and more tech in as many areas as they can be introduced.

Well, that’s all bullshit because providers already have a strong incentive to be as efficient as they can. You see, providers actually do compete. If they can be more efficient, they will be more profitable.

So really, the only way to reduce costs is to take it out of the hides of consumers and providers. You think that will fly? Dream on. But, some day, if we get serious about reducing costs, then we’ll implement a single payer system, and then we’ll be able to force hospitals and other providers to take less for the same services, and we’ll be able to force patients to use fewer and cheaper services.

The current so-called health care reform is a joke. It’s shouting and posturing and it amounts to nothing but bullshit, as far as cost control is concerned. The only good thing about it is that is moves us towards universal coverage—which, of course, raises health care spending. Wake me up when people get serious, ok?

@daloon “Well, that’s all bullshit because providers already have a strong incentive to be as efficient as they can. ”
Actually, they really don’t. They have incentive to rack up as much billable service as they can, which means that the insurance companies pay out more and thus have to recoup their losses from the premium-paying customers. Of course, it would be discrimination if they only racked up the bills for the insured, so that drives costs up across the board, meaning that poor, uninsured people can’t get care.

However, this seems to be a uniquely American thing. If India can do open-heart surgery for the same price as me getting an MRI on my knee after dropping 1500 pounds of sheetrock on it, I think that says something. And @john65pennington is exactly right; there is more cost-padding than youi are willng to acknowledge.

As for the supply and demand, the demand will always be there and in fact it will grow as our population does, especially the elderly who require more care per capita than the average person under 50. Maybe if we could get people to eat healthier and live healthier like they do in practically every other industrialized nation we could cut down on the obesity, heart disease, and diabetes, but I digress. (I should point out that as Japan becomes more “Western”, they are starting to have the same health issues we do while Europeans smoke like chimneys, eat fat and other stuff we are told to avoid, and still manage to outlive us.)

The supply is naturally going to grow slower (if at all) because education costs for a decade of schooling are somewhere between outrageous and outright sodomy (note that Cuba seems to have a lot of doctors though. Hmm….) and the cost of malpractice insurance drives/keeps many people from practicing anyways.

That leaves efficiency… which means charging $0.50 for Tylenol instead of $50. It means only giving out meds that are actually needed instead of whatever the pharmaceutical companies are offering commissions this month. This means not causing more medical issues (“First, do no harm…”) through fuck-ups. (I have a few first-hand horror stories about that sort of thing, but I suppose we all do.)

But that is just my take on things; more of an editorial than gospel.

@jerv We are looking at efficiency in different ways. You are looking at it in terms of demand. Physicians, as you probably know, drive demand. I am looking at it in terms of efficiency of providing services. Reduce your costs there, and you make more money.

Actually, I’m not sure your objection is related to efficiency. Providers want to sell as many services as possible. For them, it actually is more efficient to jack up demand. I think you are looking at efficiency from the consumer’s point of view. In that, of course, you are correct. We do not see providers trying to reduce the amount of services they provide just so we can pay less.

@jerv Capitalism is essential to this nation. Perhaps if our founding fathers started us out socialistic, we may have been better off. But the US would almost certainly suffer greatly in a transition. Yes, I misspoke about the no warning. Mea culpa. However, there must be other ways to keep the government out of places it shouldn’t be.

@Maximillian I think that the best way to keep government out of places it doesn’t belong is not to fuck up to the point where the general population is being harmed. When commerce/trade crosses the line to become exploitation, then somebody has to step in, and since there isn’t much self-regulation going on, the only ones powerful enough to change things is the government.
Actually, it’s not quite taht simple, but my real thoughts are to complex for me to put into words right now.

@Maximillian – if Capitalism is essential to the nation, we should probably do away with all the socialistic things we’ve gotten used to, then, like public schools, police and fire protection, medicare and social security, etc. Or, we could just accept that we have some things we do for the public good whether they’re capitalistic or not, and move on.

@laureth I have always wondered about that hypocrisy.

@laureth Socialism and simple services are two different things. I personally think No Child Left Behind was the biggest mistake in the education field. But it is the requirement of the government to provide services. ie fire rescue, police enforcement, military, hospitals (not necessarily health care), roads, those things. These requirements are for al countries: its the whole point of having a government.

OK, how are you defining socialism then, @Maximillian?

Socialism is the “over-intervention” of the government. For example, monopolies, or government run industries. Simple services are exactly that. Service to the people that are basic and needed.

@Maximillian In otherwords, the government must interfere when you want something you are not willing to pay for yourself like roads or national defense, but then has to crawl back in to the cellar and stay away at all other times, eh?

Or are you saying that healthcare is not a basic need? That if a poor person breaks a bone then they are S.O.L. ? That hospitals (even the ER) are a luxury that only the rich/insured are entitled to?

I am not trying to be difficult here, but that makes no sense to me, and only makes it seem more hypocritical.

You are twisting what I say. Roads have been supplied to the people since the Roman Empire. And the government is required by law to give you service when you break your bone. Money or no money. And Congress doesn’t stay in their cellar. Another basic need is the law. And that is what the Congress does. Makes laws.

That’s a unique definition of “socialism” you’ve got there. It’s hard to tell where “simple services” end and “government control” begins, eh? And “over-intervention” is a state that I’m sure everyone has a different opinion on. Socialism is an economic system where the means of production are run by the people as a whole (by their representative, the government). Last I heard, anyway. ;)

No, in a socialism, the people do not run it. Thats an illusion. Simple services is saving your life, keeping the bad guys locked away, and getting you from point A to point B.

@Maximillian You’re not citing the actual system of Socialism, but rather the misnamed Socialist regimes that are currently in existence. A true Socialist Society relies on cooperation and voluntary contribution for the betterment of the society, rather than personal gain.

@Maximillian – so things like “running the airlines” is part of the Government’s job?

The government doesn’t run the airlines. They regulate safety and procedures…which is a simple service.
@YARNLADY Perhaps what I say isn’t the true socialist society. But it doesn’t neglect the fact that the US wouldn’t change into it. The US is not going for that. And as I said earlier, a transition into socialism would be detrimental. As you have said, true socialism relies upon cooperation and voluntary contribution. The US has been a capitalism for too long to let that kind of thing happen. Americans like their money too much.

@Maximillian…as millions of starving people in America can attest to.

I think that is where it falls down; in order for there to be a few big winners, there have to be a whole lot of losers. Yet, there are some that think that any government intervention is too much, even mandating nutritional information on packages.

Can it really be a free market if a large percentage of the market can’t even afford to get to the store, let alone buy anything once they get there?

@jerv disingenious misuse of the word “market” renders your response useless. A “free market” capitalism has nothing to do with the individual consumers ability to purchase goods.

@YARNLADY If you are referring to my last sentence, you are correct; I used the wrong word there, or at least an ambiguous one. Maybe “consumers” would’ve been a better word, but it would’ve also been inaccurate since you cannot consume what you cannot buy. As is often the case, I had a thought that I could not articulate.

Or are you saying that we can have a perfectly healthy economy even if 90% of Americans are penniless, homeless, and starving, and it will be okay so long as the other 10% are buying and selling like mad?

Maybe here would be a better place do discuss the matter, lest we accidentally threadjack.

@Maximillian – if part of the government’s job is to get you “from point A to point B,” it sounds like they should run the buses and airlines much like they run Amtrak. Similarly, if part of the government’s business is “saving your life,” maybe their job is health care. You seem to have a definition (not just of “socialism” but also) of “simple services” that is convenient and varies according to what you want it to mean.

@jerv Thank you, you have clarified you comment well. Thanks for the question link.

@laureth I said that the government is required to do simple services. The extent of how for these simple services are is up to them. They’ll get you to point B one way or another. So they use Amtrak. It does the job. Same with hospitals. They are required by law to take care of you, no matter the payroll. They save you, and there you go. Sorry that the government is too lazy for you.
@jerv The way capitalism works is cruel and is indeed harsh. You’re right, there are many losers.
But, that wasn’t what I was pertaining to. The people who do win aren’t willing to give up their money. And if there is no cooperation, then the transition would be too much for the society to handle.
But it doesn’t matter. From what I heard last, the healthcare bill may not even make it. The Senate bypassed the normal procedures relating to the Joint Committee. If the bill has to go through a second overhaul in the Senate, it probably won’t survive.

@Maximillian – I do believe the level of “simple services” that the government provides is (perhaps indirectly) up to the people, who (in our case) vote the government into place. One end of the continuum of “simple services” is socialism. That’s all I’m sayin’.

The nearest situation that I can think of to pure capitalism (which you say is essential) is what’s going on in Somalia. I prefer a little socialism mixed in with my capitalism, thanks.

@laureth Well, the US isn’t pure capitalism. Its a mixed economy. We just call it capitalism. What I’m saying is is that going from what we have now to something else would be bad. We do, in fact, have some socialism (if thats what you want to call it) in our economy. the government regulates safety and health. Food companies and drug companies must pass federal examinations to ensure the safety and health of the people.

@laureth If only our political system wasn’t a two-party one. It would be nice if I could vote for a candidate that shared at least half of my beliefs and expect them to actually get into office instead of having every vote I cast be deciding between the lesser of two evils.

@Maximillian – first thing I’ve agreed with all day. ;)

@jerv – you can thank the Founding Fathers for the two-party system. It’s one of the unintended consequences of the way the Constitution was written.

Two party system is kind of unavoidable in a democratic government. As much as I agree with you (which I do) it would have happened anyways.

Odd. There are many other places that hold elections (often Parliamentary) but are multi-party systems. In fact, the US used to have multiple parties.

Well, the US kind of screwed that up….again.

The United State does have multiple parties, but apparently some people are unaware of that.

@YARNLADY – I think we’re aware, but have yet to see a third party in our lifetime who has posed a legitimate threat to the Demmican/Republicrat oligarchy.

@YARNLADY Like laureth said, we do have many parties. A lot more, I believe. But again, there hasn’t been a threat to the Democrat/Republican for a while.

Many members of the Libertarian party hold elective offices through out the United States, and the Green Party (Ralph Nader) had a lot of votes in the last national election.

I agree. And if a third party is going to produce a winning President, those two are my guesses as the most likely. However, for either of them to unseat the Democrats or Republicans would take a very, very large effort. Basically, one of the two majors would have to fold for a third party to win.

In a Parliamentary system, you can have a dozen or more parties all win, because the seats are distributed by the way people vote. In the U.S., it’s winner-take-all, which means that the voters tend to lump themselves into two loose coalitions that vote for the major candidate that is less seemingly bad than the other guy. (If everyone who really felt “Green,” for example, really voted for Nader, there’s a good chance that the most progressive of the two majors (Democrats) would lose, enabling the ickier Republican to take office. Reverse this for Libertarian voters.)

This is why third parties have a much better chance of winning local elections, like mayoral or school board or city council positions, but nary a chance of winning the Presidency. (Nader got “a lot” of votes, but I don’t think he made the necessary 5% to get campaign funding. He’d need about 51% of the vote to unseat the other two.) And if they can catch hold in local elections, they might win some state elections. And after winning a bunch of state elections, and fielding a Presidential candidate that people aren’t afraid to vote for in numbers big enough to challenge the Other Two, then the oligarchy might crumble.

Or, we could have election reform. :) To do that, we’d have to change the U.S. Constitution. To do that, we generally need to have a Constitutional Convention. To do that, we need the members of Congress to start the ball rolling. Which they probably won’t do for this cause, because they are Democrats and Republicans with an interest in staying in power, and no incentive to reform the elections so that people can feel better about voting for third parties. It’s a neat little circle like that.

At best, working within the Electoral College system, we could go with the Maine-Nebraska way of divvying things up, and that would help third parties – if they could get a majority of a third of a state like Nebraska.

Sorry for the topic drift, though – back to America causing it’s own pain on healthcare costs. <blush>