There are about 43 million poeple that would argue with your "universal health care" assertation- since, you know, they have no health care

Seamus, we are used to some posters here, makin assertations and running away with no facts at all- but we are certainly NOT used to you doing this- by what benchmark do you make this claim?

I can't find a single study, with some basic indicators as shown by vermillion, that doesn't place us dead last in nearly every category compared to ANY westernized/developed countries, and BEHIND some third world countries.

Let's even discus totally immoral and unethical bodies that drive up health costs with NO benefit to the consumer- but lot's tothe insurance industry.

JACHO- possibly one group of poeple needing wholesale public canings if there ever was one

They are an "accredidation" group, run by a consortium of insurance companies- and they answer to no one but insurance companies- they have exactly 0 goverment oversite. They are not elected officials, nor are they appointed by elected officials, nor do they answer to elected officials.
There is this entire consultant industry,who's entire job is justifying thier jobs by making silly new rules and regulations, many having 0 basis in reality or helping hospitals be more safe- they usually add a few clip boards to your wards though

We had to hire about 1 full time Dr, not to treat patients, but to use as a "liason" between the consultants and jacho - and we had to hire two RNs, and one assistant- none of which do one damn thing for the hospital except justify thier positions by adding meaningless paperwork and new rules that only once again, justify thier hours, they don't make anything safer, they don't make anyone's job easier, it just simply generates meaningless paperwork. It is a totally parasitic body, that does NOTHING for healthcare except to generate paperwork for everyone.

In my experiance, goverment is no more idiotic or beaurocratic than big business, in fact, sometimes, many times it is far, far worse- private prisons and health care are two areas where the goverment is FAR better than the private sector in almost any measurable way.

Seamus- can you please tell us by what benchmark you make these statements?

I agree with all that is said here. But here is what we are leaving out. Why is the insurance system broken? Because it works on the same basic corporatist principles that the AMA does. Insurance companies are not quick to insure people because the cost of medical procedures and drugs are so high. Well WHY are the prices high? If the prices of these procedures went down, insurance companies would be more likely to insure more people for less. That's why it is important to utilize market forces to make the prices go DOWN. Currently, our healthcare system is hit with a bevy of anti-market forces that drive prices up and force insurance companies to charge high premiums and deny certain people access. We need to put and end to these anti-market forces and allow prices to drop.

Leder, I guess the question really is, can you guarantee that prices will drop if deregulation is further pursued? I know that you believe this to be true philosophically, but some evidence would lend credence to those beliefs.

I'm with you on most of this, Vermillion, but I don't see how the "US subsidizes drug development" point has been destroyed. I don't think it's a large part of what's wrong with the US healthcare system, but clearly we are paying more for drugs in the US than most other countries pay. The cost to manufacture the drugs is the same, so the extra money is subsidizing something. The authors of the Bioethics paper think it's going to marketing, but I don't see how they reach that conclusion. Their argument is basically hand-waving, and borderline economically illiterate: "If American prices were cut in half, research budgets would not have to suffer unless executives decided to cut them in favor of marketing, luxurious managerial allowances or high profits."

Of course! Cut prices in half, there's no reason to think research budgets would suffer. But why stop at the US market, or at 50%? Logically, you could cut prices worldwide by 75%, since research cost less than 25% of revenues. Honestly, the closer I read this Bioethics paper, the shoddier it looks. For instance: "Taxpayers pay for most research costs... Taxpayers also paid for all $18 billion in NIH funds, as well as for R&D funds in the Department of Defense and other public budgets. Most of that money went for basic research to discover breakthrough drugs."

The figures are true, but the narrative is very misleading. The average reader probably comes away with the impression that Big Pharma is swooping in and poaching many of their drugs from taxpayer-funded NIH studies. That's just not how it works. The NIH studies are crucial, and provide knowledge of biochemical pathways involved in disease, but they almost never produce any drug candidates. At best, they'll have a compound that works in vitro in a disease model, but it takes years to find a variant that passes toxicology screens, let alone one that actually gets to the target in the body. That work is overwhelmingly done by drug companies, because they're the ones with the skill set to do it.

As much as "socialized medicine" is demonized by some on the right, Big Pharma is demonized by others on the left -- including, I'd say, the authors of this paper.

But I should probably start a separate topic on that, because I agree it's only a small part of the healthcare problem in the US. Much worse is the inefficiency caused by all the various insurance companies fighting to avoid paying claims.

I never said the US is not helping subsidize drugs worldwide, there is SOME truth to that, though nowhere near as much as some on the right claim: in fact a great number of drugs come from Europe and Canada. Even the link cited by those who believe that say that 'two thirds of drugs are now patented in the US', as opposed to the other way around 10 years ago'. So there is a LOT of drug research in other countries, and the US being the majority is a very new thing. I can't say why, nor can anyone say it won't swing back the other way.

That was the FIRST way this assertion was destroyed.


The second way, and my main point, was that even if you accept that the US IS helping subsedise world drug prices, it is an UTTER FALSEHOOD to claim that this is the reason why the US pays more for healthcare.

US per capita costs for helth care are 50% to 60% higher than those of socialised medicine countries, yet ALL Drug research in the US takes up less than 10% of all health care funding. Thats ALL of it. So if you wanted to reduce drug care spending to equal Europe, you would... what, halve current spending? That would lower overall US health care costs by less than 5%.

So do the maths. 60% difference, equalising Drug research would lead to MABYE a 5% reduction in costs. So clearly the 'subsidisation of drugs for the world' (which as shown above isn't really true anyways) is in no way relevant to the massively expensive US health care costs per capita, FAR more than ALL the nations with socialised systems. That is the reality, no matter how hard Quick tries to ignore it and any posts relating to it.

Yes, and I expect India and China to do more R&D in the future as well. But drugs developed in Europe, Canada, Japan, Singapore, India, or China all cost more in the US than they do anywhere else. To that extent, American consumers are subsidizing research wherever it's done. That's not always a bad thing. African countries get cheap AIDS drugs, subsidized by higher prices paid by Europeans as well as Americans.


I agree with this. It's not a major factor, but it's not a complete myth.

UJ, I can't guarantee that the sun will rise tomorrow. But there is some evidence that we can save a whole lot of money if we head towards deregulation. According to the CATO Institute, health care regulation imposes atleast a $169 Billion tax which:


The details in the analysis reveal quite a few important points about both FDA regulation and medical torts.

Other areas of deregulation is licensure and alternative therapies. As stated, the AMA controls the number of doctors who are able to enter the field. Giving this one organization reign to decide who can and cannot be a doctor limits the amount of choice that people have. If there were more doctors, then their salaries would fall because supply would come closer to demand. It may also increase the quality of care given because more doctors in a hospital mean that each has a smaller workload. Furthermore, the AMA controls what should and should not be mainstream medicine. Well I ask you what gave this private organization such authority? Maybe certain alternative medicines would work for the person. As long as all the available information is provided for them, why can't they make the individual choice for which procedure would be best? Finally, one way we can cut costs and allow people to afford health insurance is to CUT TAXES. If people had more usable income, then they would be better able to afford healthcare. We are taxing people at such a rate that the only way we can allow them to afford care is to tax them more!

There are many things that can be done to increase competition and utilize market forces. But there is such resistance due to special interests (you think pharmaceutical/insurance companies WANT more competition?) that it is unlikely anything will ever be tried. The large corporations WANT you to create government monopolies so that they can consolidate and hold onto their power.

I have to agree Leder- the most logical thing to do first is break up the AMA, and make licensure similar to any other country with reciprocity to the US- most western countries, and all former british commonwealths. WE don't really need the AMA to be doing that for us either.

Vermillion- I would be willing to bet the increase in American's coming up with new drugs are nothing more than re-formulations of other drugs- or drugs we don't even really need- like all the "tors" as I say- 30 different dang new cholesterol drugs. One would do, thanks -


I see Union health trust funds starting to sue drug companies- like Bristol Squib "we rapem' and how" over frivolous patent infringment suits over drugs like Taxol- WHICH WASN'T EVEN DEVELOPED BY THEM-(link posted in my former post)


http://prescriptionaccess.org/blog/?cat=7

Chemotherapy and other medicines administered in physician offices were covered under Medicare Part B, with patients in many instances paying 20 percent of those costs out of pocket. That meant any increase in the average wholesale price for Taxol could result in higher fees for patients on chemotherapy.

Saris will hold a hearing Aug. 9 to consider the Bristol settlement, according to a docket entry on her court’s Web site.

“Bristol-Myers Squibb is pleased to have reached a settlement of the Class 1 claims in the average wholesale price litigation,” Hortas said.

In an earlier case, Saris found that Bristol-Myers inflated AWP for five medications, including Taxol. The AWP price for the cancer drug was found to be as much as 500 percent higher than what was charged to doctors.

AWP, which is self-reported by drugmakers, was once used by government health programs such as Medicare to set reimbursement rates. Medicare has moved away from the system, though some private insurance plans, including Blue Cross, still use it.

http://www.kaisernetwork.org/health_cast/u...FamiliesUSA.pdf

a pdf, so I can't cut and paste- but once again, highlighting "big pharma" wrongdoing on a massive scale.

Look at page 7, where the drug loranzapam (Ativan we use as an anti-anxiety in my hospital for years, and had to stop due to the price spike)- it was inflated by 2000% - that is not typo- 2000%.!!

And so on- the first two things we need to do is riegn in big pharma, and dismantle the AMA- then we can see what happens after that- I am willing to bet we ALMOST come up to first world standards in our health care rankings.

Note this "first thing" talk is precisely why I extended this time frame to twenty years. We're looking for the main thing.

Single Payer health automatically shaves billions off our health cost by consolidation administration and overhead.

Link

Link

Firstly, do we not understand the unintended consequences of shutting down insurance companies or even changing them significantly? What about the people unemployed as a result and who lose their life savings in the market? Are we the people supposed to compensate them? How about the people who paid for their health insurance? Do they get their money back with the federal government getting the bill? Unbelievable hubris in thinking that we can just destroy such an enshrined industry.

Secondly, this lady who wrote the article is living in a fantasy land. Medicare efficient? The prescription durg benefit bill passed by congress will only exacerbate a program GOING BROKE. Medicare controls prices which negatively effects the market. It does nothing to lower actual price.



link

But there is still a question if Medicare is even effective at controling price passed onto the consumer (the actual purpose of the program):



link

Those mere shavings you quote are merely a fraction of the overall cost of maintaing and actually increasing programs like Medicare and Medicaid.

I work on the "front lines" of emergency care - as an ILS EMT on the rescue squad. You are partially correct about health care already being universal - in a sense. It is part of the ethics of medicine that the injured person can't be denied life saving care. However, the cost of that care is borne by the patient (in the form of wage garnishment if it comes to that stage), by the insurance company if they have one, by the public at large if the cost is unrecoverable. And here's where it gets interesting.

I see more than a few cases where an ounce of prevention would have been worth a ton of acute care. The system as it is discourages the uninsured from any sort of preventive health care. As a rule, they visit the hospital only when the situation has become dire. In the case of the indigent patient, the cost - to society - of regular preventive care would have been far less than the expensive treatment of an advanced ailment. You say we have universal care, but why would you deliberately choose a kind of system that costs all of us much more than necessary? Wouldn't it make more sense to fund the much lower cost of solid preventive care than to continually have to externalize the cost of preventable acute care?

If you're a homeless person and you need to visit an emergency room, you might just be that "lucky duck" (term chosen with proper cynicism) that gets care and is not bothered by the economic aftermath. But if you are a poor working guy with no insurance who visits an ER, you're in for trouble. You will get billed. And when you cannot pay, the hospital will seek and get a judgement against you and garnish your wages. You may be paying that hospital bill for the next fifteen years, or longer. Your credit rating will go down the tubes, and your small paycheck will be even smaller.

So yeah, we have "universal" care at the moment, but it's a joke. It's economically a disaster, and instead of promoting health it promotes poor people not visiting doctors until they simply have to. And as I said before, this focus on acute care ultimately has its cost externalized to the rest of us anyway. Why wouldn't it make more sense to have substantive, preventive care be the emphasis of the cost we all bear? It would be cheaper. And it would be more humane. How is that not a win-win situation?

It's been done before all around the world. It would be difficult for them in the short-run but better for all in the long run.


Marcia Angell

Efficiency is different from solvency. Medicare faces financial issues because funding increases have not kept pace with a rapidly aging population. It's a political issue not a systemic problem.


My links hid nothing. That quote even admits that Medicare has controlled costs better, it simply quibbles about the reason, blaming the "generosity" (HA!) of private insurance carriers.

Where has it been done on such a large scale? It is touted that there are about 40-42 million uninsured Americans. Know what that means? There are about 240 million insured Americans. Show me a situation where such a massive systematic change worked out well? You cannot do it because any country that even comes close to us in terms of population (Western European countries) already had firm socialist institutions in place. There never was a strong private sector. Are we to repay all 240 million Americans in full or do we tell them that the money that they worked for is no longer theirs? Because the second that a piece of legislation is passed that nationalizes healthcare and puts health insurance out of business, the entire industry will go bankrupt. Please attempt to deny this.



It faces financial issues BECAUSE of needed funding increases...



We are obviosuly reading different things because that's not what it says.



"Generosity" is not meant in the sense that they handed out free candy but rather that they were willing to cover more and more of expenditures.

That just isn't true....

Canada, Australia, the UK, and many others had private insurance carriers.


No, we simply insure all Americans. If they want to provide additional services that aren't covered, let them.

...and when the lay-offs start, everyone fired will still have health care.


Precisely, it has nothing to do with efficiency and everything to do with being starved of funding by a government unwilling to fund its mandates.


Medicare is still more efficient....

...and full single payer will be more efficient still according to the GAO.

When the UK implemented NHS, it had a population of maybe 50 million. When Australia implemented its system, maybe 12 million. When Canada implemented its system, maybe 18 million. The size and scope of the change would not be nearly as large as it would be in the US with currently 260 million people with insurance and an overall population for just over 300 million.



Everyone fired already had healthcare, now they are just jobless and broke.



I question your definition of efficiency turnea. A program that will one day engulf our entire entitlement budget and cost us trillions, yes trillions, of dollars is not something I deem"efficient." An efficient system does not have the prospects of the US going broke from its use



Efficient at what? Again i ask. I have not seen any efficiency, I have only seen a rising dollar amount on that blank check you expect Congress to sign.



No, thats not what the GAO is saying. What they said was that costs unrelated to healthcare would go down, which I dont dispute. But those costs would be offset and overcome immensely by other costs imposed by limitless system that cannot possibly be paid for.

A matter of proportion, nothing says that just because we are a bigger country it can't be done. We are also richer per capita.


Other industries have been eclipsed by the march of time, it's not the end of the world. These are skilled workers, are you saying they can't "pull themselves up by their bootstraps?"


Efficient means use of the resources one is alloted. Medicare spend proportionally more on service and less on overhead, therefore they are more efficient.

When people choose not to fund a program, it doesn't mean it's inefficient.

Lol turnea this is almost to the point of comical. Is there not a difference between an industry being phased out by competition or new technology over the course of decades and an entire industry collapsing on a single day? Its like passing a law tomorrow outlawing flying on airplanes, or purchasing automobiles.



You want to give Medicare unlimited resources! The price of the program keeps going up and we keep trying to fund it. If we do not find ways to cut the actual costs of healthcare, then eventually it will engulf our entire entitlement budget. Please turnea, let me know if I am unclear on this in any way. Medicare, Medicaid, National Health Insurance...how does it decrease the cost of service? You do not decrease actual costs by price controls...any economics 101 textbook will tell you that.

Did any other country collapse the industry in a single day?

Why would we have to?


Take a look at whythe US spends so much more than any other country per capita and it all points to one factor... overhead.

Single-payer reduces the biggest drain on our efficiency.

Exactly. And the idea that Medicare has lower “administrative costs” is another illusion. As k doctors and hospitals who’s staff has to fill out the mountains of paperwork.

AND the fraud is staggering and would increase proportionally if we had universal healthcare where a bunch of bureaucrats in DC sent out checks based on filled out from.

I guessing you can back some of that with evidence?

I mean calling the stats an "illusion"....

Everybody else seem to be able to handle the bureaucrats...

All of this talk about administrative costs got me thinking about an article I read a while back about healthcare. Finally, after some research, I found what I was looking for.:

How to Cure Health Care by Milton Friedman



The system is broken and its BECAUSE of government bureaucracy and BECAUSE of government regulations that we have gotten to this point.

*edited to fix quoted text to conform with forum copyright Rules

Let's give it a look-see.


Just to quibble this is because retailers are the third party, they buy in bulk from the direct suppliers... but let's go on


That's because tax cuts aren't spending, conservatives don't call them spending when Bush is doling out...


That's what we've been saying, clearly government spending isn't the main problem because everyone else has government involved to the extreme.

This article changes nothing, it's just someone repeating the same old disproven talking points. Friedman is talking about eliminationg the role of insurance companies (and he doesn't seem to mind the people put out of work either) but offers a lack luster substitute.

The typical American won't be better off simply saving for their own health. When an emergency occurs you've likely paid less in premiums than the insurance company will need to cough up. They hedge their bets on the sheer volume of people who don't need money right now.

It's a disaster waiting to happen, even insurance companies are better than leaving people to hang themselves with their own rope.

This IS the perfect difference between Conservatives and Liberals.

Liberals literally believe that people cannot survive without or be healthy/happy without government or 3rd party intervention.

Conservatives believe that necessity is the mother of invention.

It IS A FACT that having insurance companies in the middle causes inflated health care costs. Consider the number of people that it takes in a hospital to process the claims, the number of government employees that have to process medicare, and the number of claims that hospitals have to make for non-citizens, the indigent, etc. It's a racket in the billions.

How much per $1 spent goes to this administration?

What if we had direct payment? Doctors and patients could agree on fees, and poverty work etc would be part of major hospitals' roles.

What happened before medical insurance? Did people just die? of course not. It's absurd Turnea that you believe that the amount of money paid into insurance companies wouldn't be saved/spent in some other fashion, creating other industry.

I realize, your experience is limited. I'll open your eyes to the cost of health insurance for the employer.

A two-person (husband/wife) policy with our current provider runs the employee about $140/pay period, with the company paying about $280. That means that there's a total expenditure of over $10,000/year in this case.

How much do you spend in overall health care? Why can dentists charge literally a fraction in insurance?

Think of it this way. What if hospitals allowed people to pay into a savings program that was interest bearing. What if a couple could throw in $250/month and when something happened, like maybe a surgery, it was drastically discounted and could be paid off w/ the $250? What if you could pay a drug store $50/month and get cheap drugs? Don't you think CVS or Walgreens would want this? Of course.

The fact that the government and insurance companies are in the middle is a LARGE part of why healthcare is so expensive on the back end.

Doctor's could still make tons of money. Nurses could still make tons of money. The people that work at Cigna or Aetna would find other jobs because disposable income in the US would skyrocket.

I'll use a micro-economic example... let's say Minden Louisiana. The town has roughly 15,000 people, and let's say that each person paid $125/month to Minden General. That would mean that the hospital would make $1,875,000 in recurring revenue. If all the employers who WERE paying the co-pay added 3/4 the savings to the wages, the people would be making MORE money, specifically if their insurance was in the same vain as mine, they'd make about $225 more each month. Even if they had to pay the hospital an extra $50-75/month over my suggestion, that would leave them over $150 ahead. The hospital also would be well over $2M/month in a little town like that. THEN- people get sick, right? The hospital could augment income w/ a prescription plan, a payment plan for people who have surgeries, etc. This would all cut the insurance companies 100% out of the loop, and probably even reduce the staffing necessary for the billing dept in the hospital (maybe, but surely not increase it). Because they don't have to process a number of claims, etc, procedures could also become cheaper. It also would force hospitals to disclose costs ahead of time and be subject to true market conditions.

Overall, if you said that the town was more like 5X the size, and garnered $200pp, you'd have a hospital earning $15M/month before one procedure is carried out. Let's say a liberal % of people in this town go to the hospital each month, let's say 3% (which really is quite high). That's 2250 people. If the average direct cost (nurses, doctors, etc) is $500pp, you're still at $1.12M. Even double that would be $2.25M. Seriously, that's still an overall profit of $12.75M. It's simple math really, just on a micro-scale.

It wouldn't work perfectly, but does the system now? Who is truly paying the cost? We are turnea, those gainfully employed and earning. Who's getting rich?

Health Insurance Providers. http://www.weissratings.com/News/Ins_General/20040922lh.htm

It's easy to understand. If people in town X have an additional $150/month, they'll be buying more TV's, eating out more, buying bigger cars and homes. The money gets filtered back into the community, and now health care is subject to true capitalism.

Statistics after statistics prove that government run systems aren't better. They're different alright. Just not better. People with money still get the better care and the poor still wait. It's how it works... it's human nature.

Universal government coverage? What kind?

In the various threads on this question, I have seen numerous proposals which outline the 'potential' for cost savings in such a system, but none that have actually identified, at least to anywhere near my satisfaction, how these savings would actually come about. There is strong reason to believe such would not be the case. As is frequently cited, there are tens of millions of people without health insurance currently. Well, health insurance isn't free, so there is defacto going to be a tremendous cost involved in provided it to such people, particularly if done so by the government. That cost would be borne by the taxpayer. As such a taxpayer, I have to ask what benefit I would accrue from this expenditure. I only see one...coverage provided for me when I am out of work. I think that the cost in tax increases will not be worth that benefit to me. I further suspect, based on, well, the entire history of our government, that the actual cost of such coverage, if provided by the government, will be far higher than it should be, and the coverage provided far lower. This further reduces my desire for such a system. It would simply become a way for me to pay more for less coverage. I'd prefer the status quo.

Another issue which ties into any universal governmental coverage program is what about illegal immigrants? Would they also be covered? If so, I think this further increases the cost of such coverage, which is my major objection in the first place. If it excludes such coverage, wouldn't it violate the fundamental tenet of such a system, that being that everyone is entitled to such coverage? Also, if excluded, then wouldn't the various cost inefficiences that having non covered people in the system accrues (such as people having to go to the emergency room for routine care) then not continue, making the removal of those inefficiencies which are frequently cited as the cost savings that having universal would bring about a pipe dream, and therefore demonstrate that such a system would indeed increase costs significantly? I'm not sure that either answer to this particular aspect of universal coverage is a good one, at least not until the issue of the massive number of illegal immigrants in this country is addressed.

Universal private coverage? What kind? I might be more interested in this, as it would take the government out of the equation, making it less likely to be burdened with the excess bureacracy which would lead to the reduced coverage at the increased expense. However, I'm far from sure I'd prefer this to the status quo either.

Non-universal coverage? What kind?

Most pushes for universal coverage, whether public or private, make the assumption that the current system is broken and that the main issue to be addressed is providing everyone with coverage. As one who has coverage, I tend to disagree with that assumption. The status quo has lots of room for improvement, certainly, but yet it's not nearly so broken as to require any radical change. Hence my skepticism of any plan that introduces major change. The real issue to me is not lack of coverage, as I am covered as are the vast majority of Americans, but the rising cost of health care which makes such coverage expensive. Therefore, I am more interested in anything that would reduce the cost of health care (and therefore the associated cost of health insurance) than I am in any program pushing universal coverage. If universal coverage can be part of a program addressing health care costs, then great. But if I had to pick one over the other, then I'll pick reduced health care costs just about every single time. Selfish? Maybe. But I contend that for anyone, the health and well being of their own family does indeed take precedence over the health and well being of anyone else. Any system that potentially detracts from my family's health or well being, as any system that either reduces coverage or service or increases costs would do, is indeed therefore bad and to be avoided.



Actually, the typical American would be if they could participate in a program that combines the elements of health insurance with a savings program, called a Health Savings Account (HSA) Such a system is available to those self-employed or working for small companies, but you can't get it if you work for a larger company, as you would almost certainly not have a high deductible insurance plan. This addresses one of the main issues with health insurance--most people don't use it as insurance against the relatively rare but extremely expensive issues, rather they view it as a way to prepay for routine care. Routine care is, well, routine and common, and therefore its costs are incurred much more frequently. This is in large part what makes traditional health 'insurance' so expensive. Imagine how much auto insurance would cost if it also covered gas and oil changes, rather than just accidents. Same concept.

I would argue that liberals are logical and recognize the inherent economic advantages of negotiating in numbers and from a position of strength.


Far more in the private sector than under Medicare.

Do you really want to compare historical life expectancy to the current era?

Yes, often time people just died.


It's been done.

The problem is individuals cannot band together under such a system to present a "strong buyer" in the economics sense. When one hasn't paid enough in, which in cases like cancer is pretty much a given for the average American then there's no one to pick up the slack.


As opposed to false capitalism? HMOs are what true capitalism leads us to, there were all over the western world until people got sick of it.


What statistics? Most show government run systems are a lot better, it's why we're 37th in the world on the WHO rankings.


Which is disproven by a litany of countries where this is not the case.


France, Spain and other countries simply say, no. They would simply have to live with the status quo. Even if they were, they already contribute more in taxes than the take in services.

Not to any length. We could save on cost by denying Medicare to the elderly or repealing mandatory emergency service too.

Sorry to splice your post and just address this one sentence, but I've heard this argument about universal care before so I thought I'd address it now. I don't think this is a reasonable comparison (gas especially). We don't expect healthcare to include everyone's grocery bill....but, in order to continue to capitalize on my car warranty, I am obliged to bring my car in for periodic checkups (paid for by the company). They send me a little reminder in the mail and I take my car in. This protects them by ensuring that problems do not go unfixed for too long and end up costing them a lot of money. It think universal coverage offers the same protections. Most countries that have this offer periodic checkups. In fact, I think my cousin told me that women have exams more frequently, and more comprehensively, in Italy where everything is paid for than here. Yet the overall cost of healthcare is less overall. Preventative medicine works (which Quark brought up).

I will add that in order to cover everyone there would have to be some serious tort reforms, which I believe are most responsible for the high prices of medicine today. They have such limitations to liability in countries that offer universal healthcare. They have to.

Actually, even big mean medical insurance companies themselves realized that it is in their best interest to pay for cost of preventive care to save money in the long run. My dental insurance doesn't charge copays for semi-annual cleanings and check-ups; my regular medical insurance treats all preventive procedures as copay free. Routine care is routine and common, but it also costs next to nothing on the big scheme of things when compared to consequences of not having one.



First of all, about 16 percent of the population do not have any coverage, which is a fairly high number IMO. But even those who are in the 84 percent of "covered" - some coverages are so barebone that it's ridiculous. A friend of mine has "insurance" - which covered the original visit to a doctor, but not the bloodwork and not the follow-up visit. I think that a fairly large percentage in the "covered" total has one of those "emergency only" coverages which worth next to nothing in non-emergency situations.

No, it isn't (the quality of care and service provided in these countries is currently a subject of much debate), and not one of those other governments or systems would necessarily have relevance to our own even if it were. This goes back to the difference pointed out earlier. Essentially, you have far more faith in our government to handle this correctly than I do, and my skepticism is borne out not by a litany of other countries, but by pretty much the entire history of our own government. Consider just prescription drugs, which is but one aspect of the problem. We are already seeing projections of additional hundreds of billions of dollars needed to fund this program, and it is but a couple of years old. You can cite examples of other countries until you're blue in the face, and it won't do anything to convince me it wouldn't add significantly to cost in our system. You need to present conclusive evidence applied directly to our system.



That would indeed be one potential way to handle this, but it would carry with it the continuing problems of the uninsured that leads to the debate in the first place. In short, the solution would then have the very same problems cited as the need for change of the existing system, calling the solution into question.

Certainly no one thinks the Canadians are dropping dead...

Still this is a bit silly. You are essentially asking me to prove that something won't happen. I can point to examples of where it didn't. There is nothing essentially unique about the United States. I've already listed GAO estimates of billions in savings.

Can I whip out a crystal ball?

No. But on balance my evidence is a lot stronger than the reverse case.

Yes, I am indeed asking you (and others advocating universal health care) to prove that this won't happen. This is the burden of those advocating change. More importantly, it is necessary to get my approval, and those of tens (hundreds?) of millions more like me. We are very concerned that we will simply be paying more for less coverage, and as I have indicated, we have the entire history of our government to back our fears up, in addition to the simple adage that you can't get something for nothing, and we're discussing providing insurance to about 40 million additional people. So, absolutely, you do indeed have to prove that this won't happen. And you have to prove that it will be the case HERE, not somewhere else. Somewhere else might have relevance and be included in the argument, but it is far from conclusive evidence, particularly when, as I have noted, the quality of care in many of those countries (yes, even Canada, although less so) is in question. I am not dead set against universal coverage, but I AM deadset against squandering billions of dollars on something until this has indeed been proven, in our system. There is indeed also something unique about the United States. It is inherently less socialized than the other countries you would cite. Our entire system is therefore more free market driven, and the change you advocate would be more radical, and hence more disruptive, in our system than it would be elsewhere. It would also therefore require more proof before implementing.

Let me perhaps put it another way. You say on balance your evidence is stronger. Are you willing to sign a paper stating that you will personally reimburse me, and anyone else, who's costs rise as a result of this legislation, or for obtaining any level of care that would decrease as a result (such as having to wait longer for a doctor)? If not, then I propose that your evidence hasn't even fully convinced yourself, much less others. At the very least, it would indicate that our concerns are indeed valid, and in fact shared at least partially by yourself. It would also form that basis for a more substantive debate, because to deny that such a system will neither raise costs nor lower service simply flies in the face of reality. The cost issue might indeed be true (or it might be horribly, terribly wrong), but EVERY socialized system has reduced service, in wait time if nothing else. The debate then should focus on whether or not that would be worth it, not on whether or not that would be the case.

Dude. Turnea. Come on man. Post one friggin link. One source. Something. Help yourself out for once.

http://www.cahi.org/cahi_contents/resource...Publication.pdf
Medicare accounting is a farce. It's absurd. We get abused.

Life expectancy? What does that have to do w/ America before insurance? Umm... Turnea, medicine was drastically different back then. That was a definitely wild stab in the dark.

Liberals are more WHAT? Dude. Don't tell me you just said logical and used economics in the same sentence.
http://www.theadvocates.org/freeman/8903lemi.html

Come on Turnea. Come on.
Here's a great quote.

I've posted many links here. I'm not reposting them Check the earlier pages if you want to seen where my assertions come from.

Even after making all kinds of allowances for "hidden costs" you link to (from an admitted group of privatization advocates, lobbyists, and insurance companies) still acknowledged Medicare spends less on administration than the private sector.

Link

For Pete's sake there are counting the Congressional salaries


...yeah, that sounds scientific.

Wild? No.

It simply means you can't produce evidence that states that Americans were just as well of before private insurance... because, for whatever reasons, they weren't.

Only if you don’t count the billions of pieces of paper and millions of hours spent by doctors and healthcare provides filling out the forms.

And on top of that the fraud is outrageous.

A model we do not want to emulate anywhere else in the healthcare system.

I've already asked for any actual evidence to the contrary of the link I posted. Not exactly seeing a lot of detailed peer reviewed study. Just plenty of the usual conjecture.

Fraud is illegal, the solution is tougher enforcement. I'm still trying to figure out why we are assuming America is uniquely incompetent in this regard.

Simply impossible to compile. Medicare is such a disaster even the liberal candidates don’t allude to any system that would resemble it.

DISASTER.

A recent American Medical Association survey found one-third of doctors spend one hour on Medicare paperwork for every four hours of patient care.
It's "charity care for Medicare," said Dr. Paul Buehrens, medical director of the Lakeshore Clinic in Kirkland, whose group doesn't take new Medicare patients. "Let's put it this way: The complexity of getting paid makes the complexity of medicine pale in comparison."
http://archives.seattletimes.nwsource.com/...;query=medicare


Medicare Fraud Rampant in LA, Miami

“Thousands of elderly and disabled beneficiaries in those two regions have received power wheelchairs, walkers and other items they did not require. In other cases, sham businesses billed Medicare for equipment never ordered by a doctor nor delivered to a patient.
The fraud is believed to run into the hundreds of millions of dollars. In one case, a supplier billed the government $2 million for the same wheelchair. They billed Medicare repeatedly, but each time on behalf of a different beneficiary”.
http://www.townhall.com/news/politics-elec...nt_in_la,_miami

http://www.consumeraffairs.com/news04/2005...drug_fraud.html


Cost of Rampant Mental Health Care Fraud Soars in Medicare
“Federal officials said today that they were expelling 80 community mental health centers from Medicare after finding that the program to provide psychiatric services to the elderly was riddled with fraud.

June Gibbs Brown, inspector general of the Department of Health and Human Services, said that the cost of such care soared to $349 million in 1997, from $60 million in 1993, and that she found that 91 percent of the payments last year were for ''unallowable and highly questionable services.''
Moreover, she said, Medicare payments to community mental health centers averaged $10,352 a patient last year, up from $1,642 in 1993.”
http://query.nytimes.com/gst/fullpage.html...75AC0A96E958260

The wholesale Medicare bashing is beside the point. As many problems as the Medicare system has, it is still more efficient than private insurers.

Let's check that first link...

Everyone has paper work, the trouble here is that the Medicare programs funding is not tied directly to need but to GDP... for some reason.

As for fraud. People cheat. Not a shock. It is a law enforcement issue that can be tackled, it's hardly a big enough problem to make up for the billions in overhead costs associated with private insurance carriers.

Fraud is mostly a problem when private billing methods are blended with a bureaucratic payer system, -- a problem which commonly occurs both in government run payer systems as well as private payer systems such as private insurance. Whenever you thrust entrepreneurial incentives on medical practitioners, by definition you will get a certain amount of fraud. Medicare is not an exclusive victim of this weakness. Whether other private payer bureaucracies such as those run by insurance companies do a better job at weeding out fraud is debatable, and certainly they would like you and their shareholders to believe that, but my observation of the healthcare industry suggests the bad apples out there don't care who they defraud, as long as they think they can get away with it. Medicare may seem to stick out only because there is quite a bit of public scrutiny about the efficiency of its operation, moreover, private companies have a vested interest to keep such embarassments under wraps. So I believe it is misleading for the people debating this issue to single out Medicare. It is a problem in any health care system designed to allow practitioners to directly bill a bureaucratic entity, -- whether such an entity is public or private is not a very useful distinction to make.

I believe the recent arrest of 3 doctors in California this May who bilked $30 million dollars from private, not public, insurance companies, to perform unnecessary surgeries on hundreds of patients is a typical and timely example of this. There are many other similar examples which routinely crop up, so this is far from being an isolated case. I would argue the problem is not with the bureaucratic administrative processes of either private or public payer systems, but the fact that entreprenurial incentives are the rule for a profession which should be motivated by ethical incentives. To some extent, these two types of incentives are not necessarily exclusive, however, I believe that over time there has been a cultural shift which has widened the chasm between them.



Wellness is a complex goal which at first seems obvious, but is actually far less clear to the lay public, in other words, the majority of the health care consumers. Financial reward can be linked to wellness, but you can not expect most people to be able to evaluate it objectively. I consider the explosion of interest and consumption of elective cosmetic surgery to be a natural consequence of this. Just 30 years ago much of the elective surgery done today in this regard would have been considered unethical and tantamount to malpractice. There are many risks to any surgery, risks which typically are hidden in fine print and fast talk.

I remember 20 years ago mulling over this issue when I read the American Society of Plastic and Reconstructive Surgeons wanted the AMA to declare small-breastedness a disease called micromastia: "There is a substantial and enlarging body of medical information and opinion to the effect that these deformities are really a disease." The ulterior motive of course through such action would be to force insurance companies to include coverage for breast augmentation. Any thinking person however would immediately ask the question, if the basis for establishing micromastia as a problem stems from a problem of self-image, then is not the solution psychology not surgery? Just last week I read what might be a belated confirmation of those suspicions: women who get breast augmentation are more likely also to commit suicide.

What also bothers me is that some of the most opportunistic, self-serving doctors who have been arrested for fraud also had some of the nicest bedside manners. Like the crooked car dealer, they can rob you with a winning smile. The main basis by which consumers typically do judge performance and reward practitioners with their business, is therefore unreliable. I would argue a practitioner responsible for other people's health can not just be governed by the financial motivations as a used car salesman. I have been reading a number of blogs by medical practitioners, especially younger practitioners, and I do notice a distinct and growing lack of respect for basic ethics when it comes into conflict with profit. Perhaps it is telling that most medical schools today make the Hippocratic oath optional, according to the NIH. To encourage greater wellness, doctors must hold ethics first, profits second. Simply relying on punitive laws to control abuse is no better than closing the barn door after the animals have bolted: the damage has already been done.

I would beg to differ. Individual health problems have lots of collective implications.

1. The problem of contagion. Polio was highly contagious and because of that required a public health response to wipe it out. Simple flue symptoms require the school nurse to send the sick kid to the infirmary and then home to prevent other kids from catching it.

2. Ambulance services and Emergency Care. Are we going to, for instance, leave the uninsured, bleeding and laying by the side of the road. Such services are collective public insurance against say the consequences of accidents we might encounter.

3. Chronic sickness or disability untreated leads to more costly emergency conditions plus additional costs due to the patient being incapacitated and requiring additional public support due to that incapacity. Catching medical problems early saves social costs.

4. Much of our medical problems are environmental or involve problems with contaminated food. This requires a public regulatory intervention.

5. Public disaster situations like a terrorist attack all necessarily involve a public health care response. What is the libertarian free market medical solution to a terrorist attack?

6. Yes there are individual medical conditions that may on the face of it not have much effect on others but even at the headache and stomach ache level these may be symptomatic of something which could have broader public implications. And anyway most aspirin level problems aren't going to result in a visit to the doctor. And just for the sake of argument, why not hire private security if your neighborhood or a business wants protection? Why use a socialistic force?

Like with the police, everything done is not of broader public import. Hauling marijuana users off to jail has little meaning where I live. They aren't going to rip me off. But the state of public health like the rule of law has so many collective implications that yes, we do need a base level comprehensive public health care system.

And anyway they work for most at the least cost, unlike the pie in the sky free market abstractions that are continually floated with their forever pure ideology perfume that come unaccompanied by working examples. By the way, do the libertarians want us to abandon the VA?

NOT 20% of the time spent with patients. This is the difference in the “efficiency” calculations that are so bogus it is laughable.


Hey its easy top be efficient – just put the burden on someone else.

This system is also THE source of the fraud since Medicare/Medicaid are “forms based” systems – fill out the form and get money.

Trouble is many providers lie and get away with it – and get paid.

Bottom line is a nation system covering everyone based on this model would be a DISASTER and everyone knows it – and this is why it will not even be proposed – ever.

Which is why it works in every first world nation... except ours...

It makes no sense Ted. Fraud is an issue with all carriers public and private. Sure the private system is more stringent, but also less efficient and more prone to deny reasonable service.

When the GAO says we could save billions with a singe-payer system, I'm inclined to listen.

When insurance companies cry the sky is falling while Canadians get great care for less, I'm a lot more skeptical.

An interesting question is how much public health care fraud and paperwork would be eliminated if it wasn't operating in a private health insurance environment. A couple of cases provide examples.

http://www.michaelmoore.com/sicko/checkup/

Works?? A very vague and general term. If you think waiting as much as years for treatment is “working” then……..




SHOW me where they have included the billions of hours spent by doctors and hospitals in their calculations??




There will be fraud in any system. But in Medicare we are talking billions not millions and the reason is simple – when the provider and insured are close and monitor activities the opportunity for fraud is far lower. When the “payer” is in a big building in DC – far from the activities the opportunity for fraud is multiplied.

I read that Medicare fraud was so big and profitable that the Mafia has been into it for decades.