Health Care - can we have an honest discussion?

[jazzimov]

Let's be honest.

Most health issues can be cured if enough resources are thrown at it.

In a truly socialistic society, all health care issues and resources are controlled by the Government. Doctors, nurses, and researchers are employed by the Government. Therefore, the Government determines how much resources are diverted to Health Care.

In a Capitalistic society, "resources" are defined by "money". The money (resources) invested is offset by the potential money that they can receive based on their investment.

In the first scenario, potential health benefits are decided by the Government (if you have someone like Bush in office, you could be seriously screwed). In the second scenario, potential "geniuses" have more freedom to do their research as long as the potential results are financially feasible. Often, in the second scenario, many breakthroughs are discovered as result of potential return on investment although they turn out not to be finacially viable. However, the few that become financially viable pay for the ones that are not. Invetors cannot predict which is which, so they will finance all research in the hopes that one of them will give them a ROI that covers all.

The USA strongly supports the second scenario - to the point of providing grants to non-profit researchers whose work is later used to make a profit. That is why so many claim that the US has the greatest Health Care on earth - even though it is rated below many 3rd world countries. The US leads the world in research, and many of our doctors are excellent if you can afford them. But, much of the research involves the world, even though US citizens pay more to help subsidize the lower prices that other countries pay.

The disadvantage that is obvious is that if you have a rare condition, no one will research it because not enough people have the same issue to make it profitable.

So, in theory at least, we have 2 options. We can go with a truly socialistic option in which we don't pay anything except taxes - but the research and doctors we are paying for get low pay and, frankly, suck.

Or, we can go for a capitalist solution in which the research and doctors etc are top-notch but cost beau coup bucks. We can mitigate the costs by insurance. By far, the best insurance solution is a single-payer: for instance, Medicare. Unfortunatley, Medicare is only available for seniors - if we could extend Medicare for all, that would solve many of our issues.

I love the ACA because it is progress, it's definitely better than the fucked-up system we had before - but ultimately I would like to see Medicare for all. A lot of lobbyists will be against it, because Medical Insurance Companies will be bankrupt. Our government can absorb most of the jobs left open by getting rid of indendent insurers - except for those CEO's making millions of dollars per day, or minute. I have no sympathy for those guys, anyway.

[Hoyt]

1. Actually, insurers still have a place. They administer Medicare now, and handle Part D and Medicare

Advantage. They can still make money under Medicare for all, only not the premium for taking insurance risk. So, all is not lost for them. But, Medicare needs some serious changes too. Anyway, good post.

[Recursion]

2. I don't know of a single-payer system that *doesn't* provision through private insurers

Done right it can be a win-win.

[Spider Jerusalem]

10. the British NHS doesn't.

[Recursion]

11. UK doesn't have a single payer system

Single payer means private providers with one (generally public) insurer.

[Spider Jerusalem]

16. 1) yes it does, 2) no it doesn't.

Single-payer means that the government pays healthcare costs, whether the providers are contracted (as in Canada) or directly employed by the national health service (as in the UK).

On edit: many or most doctors who see NHS patients also take private patients (the number of NHS patients served by a single practice is limited and they'll close the books for new applications; you can still be seen as a private patient, however.) In practice the NHS operates as a single payer in much the same way something like Medicare does.

[pnwmom]

4. Insurers don't handle Medicare now. Some are involved in Medicare Advantage, an optional program

that turns out to cost more than regular Medicare without providing better care.

[Hoyt]

7. When your doc files a Medicare claim it goes to a subsidiary of BCBS, Cigna , etc.

Same for hospitals. They pay docs, etc. They talk to beneficiaries. Don't believe me? Tell me what state you live in and I'll give you the name. The government pays them an administrative fee. Similarly, many states contract out for Medicaid Admin. Medicare Advantage plans actually take some risks.

[pnwmom]

9. How is Medicare holding its administrative costs to 2% when it's contracting out some work

to private insurers?

http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/

Medicare Has Lower Administrative Costs Than Private Plans.
.
According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.
Insurance industry-funded studies exclude private plans’ marketing costs and profits from their calculation of administrative costs. Even so, Medicare’s overhead is dramatically lower.

Medicare administrative cost figures include the collection of Medicare taxes, fraud and abuse controls, and building costs.
So-called “competition” in the private health care market has driven costs up.
.
In most local markets, providers have monopoly power. Consequently, private insurers lack the bargaining power to contain prices.

In most areas, two or three dominant insurers dominate the regional market, limit competition and make it extremely difficult if not impossible for new insurers to enter the marketplace and stimulate price competition.

Medicare Advantage, which enrolls seniors in private health plans, has failed to deliver care more efficiently than traditional fee-for-service Medicare. Both the CBO and the Medicare Payment Advisory Commission (MedPAC), the commission which advises congress on Medicare’s finances, have calculated that Medicare Advantage plans covering the same care as traditional Medicare cost 12 percent more.

SNIP

[Recursion]

12. They did it to save money

Contracting out is part of how Medicare keeps their overhead low. BCBS/Cignus' overhead isn't included in that 2% figure. That's why they do it.

2% is, basically, the overhead for Medicare to deal with the insurers who actually take and pay the claims. Canada does basically the same thing.

[pnwmom]

13. There goes one of the arguments for single payer then. The administrative costs

aren't low if they're just hiding them that way.

[Recursion]

14. Because the provisioners aren't taking a risk, they don't "profit" per se

BCBS et al get basically a fixed fee for doing it. Plus the schedule for provisioning gets bid out, so there's a downward pressure on the fee. But because it's fixed, it's hard to assign it as a percent of spending.

[Spazito]

3. There is no 'perfect' system, imo...

but, if I had to choose, the government one has more potential than the capitalist one for the average citizen. Once the citizens have decent, not perfect, healthcare provided by the federal or state government, through taxes, it is much harder to remove because the elected representatives know their 'seat' depends on the votes of the very citizens who, once having decent healthcare, would not support them taking it away.

Thanks for this OP which opens up a discussion based on honest debate about how best to deliver healthcare to the populace with the least interference. I hope you get more responses from those who truly care about the issue.

[mucifer]

5. Most Single Payer Countries Don't Let People Who Are Dying Stay

on ventilators with IV drips in the ICUs for long long periods of time. The ventilators are getting more and more powerful.

I'm sorry. I know it sounds very cold. But, in most countries the doctors are allowed to say "I'm sorry there is nothing more we can do". In the USA families have to allow the hospitals to stop the aggressive treatments. Sometimes tests will be done to prove the person is brain dead. Sometimes the person isn't even stable enough to have a CT scan to prove the brain isn't functioning. I have seen this happen. CPR isn't going to cure end stage metastatic cancer when all chemotherapies have failed and the doctors have no more treatment options.

People often leave this out of the equation when discussing medical cost in the USA vs single payer elsewhere.

[Hoyt]

8. Good point. Here, both right and left wingers would yell, "death panels."

[nationalize the fed]

6. Germany has managed to mingle public and private insurance

Everyone must participate but no one has to worry about deductibles

Germany has a universal[1] multi-payer health care system with two main types of health insurance: "Law-enforced health insurance" (Gesetzliche Krankenversicherung) known as sickness funds and "Private" (Private Krankenversicherung).[2][3][4]

Compulsory insurance applies to those below a set income level and is provided through private non-profit "sickness funds" at common rates for all members, and is paid for with joint employer-employee contributions...

Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. (nearly 16% of GDP)

http://en.wikipedia.org/wiki/Health_in_Germany

The Obama administration (IIRC) wanted something "Uniquely American". Well they got it. Profit Profit Profit and not much Non Profit

[Recursion]

15. Every exchange must have a nonprofit or co-op provider

If you're right, they should beat the for-profit options hands down.

However, I've had both for profit and non profit health insurance in the past and never particularly noticed a price difference.

[LWolf]

17. Your thinking seems limited.

For example, you don't allow the potential for research in your socialistic system. Publicly funded research is part of that picture. Frankly, I often wonder what direction research might take us in the journey to improve health and care if we were funding research for the sake of advancing health rather than profits.

Also, in a socialistic society, education is also going to be public and tax-payer funded; there wouldn't be the investment in, and debt for, medical degrees. Doctors wouldn't need to make as much money. Frankly, in our current capitalistic system, much of the pay for the working class "sucks."

The systems, and our options, are really not as simplistic as you've suggested.

You can probably tell, lol, that I'd prefer a socialistic system, for health care AND other vital services. I think Medicare for all IS the compromise I wanted.

The ACA? It doesn't make care more affordable for many of us. It makes insurance more affordable for some, but often the price is higher copays and deductibles that keep actual care out of reach. It's not more affordable for me, for my senior citizen mother, or for my adult sons. We're all demographically different, yet none of us are getting more, better, or more affordable care under the ACA. Some of us have seen our copays and deductibles increase significantly. Why? Because it's still about the insurance industry, not care.

[DanTex]

18. Umm, government funded and not-for-profit research doesn't "suck".

Internet, molecular structure of DNA, polio vaccine...

[Glitterati]

19. "doctors we are paying for get low pay and, frankly, suck"

I'm sorry, but I have to disagree with you on this - vehemently.

This is because my first hand experience shows me the exact opposite.

After years of dealing with my husband's illness, and now years with my own chronic illness, the only doctors who give a shit, who care first and foremost about the patient, are the ones who are not in medicine to make a profit.

There are 2 types of medical professionals - those who don't give a damn because there's no money (insurance) in caring for them, and those who put the money last and ask patients to pay only what they can afford.

I'll give you just one recent example I experienced first hand. 18 months ago I was hospitalized critically ill and needed an endocrinologist. The endo came in my hospital room, suggested surgery and when I said I was uninsured, left. Just turned around and walked out of the hospital room. For that 10 minute privilege I was charged $380.00 by this endo - over and above the hospital bill.

Once I was discharged from the hospital, I saw an endo who is part of a practice serving the underserved, she laid out several treatment options. And, quite frankly recommended anything BUT surgery. Surgery for this endo, would be a last resort only. I paid $25.00 per visit for this endo, including lab work, every time I saw her (initially weekly, then bi-weekly, then monthly, then every 3 months over more than a year) as we worked together to get my illness under control.

You cannot support that statement, and there are lots of folks who will testify to the opposite.