How Good Is Our Healthcare?
 

The discussion got a little heated in another thread, with many participants claiming that the U.S. "has the best healthcare in the world", and that "government involvement in healthcare will both erode quality and increase costs".

In the interest of just putting the facts out there, consider these. There are are myriad of sources of facts regarding healthcare on the internet that anyone can check. I used studies done by Forbes magazine, the World Health Organization and The World Bank.

Maybe the best way to present my findings are in a series of brief statements. Any of these can be fact-checked and more extensive explanations provided.

-- In almost any of the studies done recently, the U.S. doesn't come close to being the healthiest country in the world. The Forbes article had us ranked 11th healthiest in the world. Their criteria included" life expectancy, infant motality, physician density, TB frequency, air and soil quality and access to healthy water and sanitation. The top countries in the Forbes study were Iceland, Sweden, Finland, Germany and Switzerland.

-- The U.S. is well down the list in life expectancy and we experience relatively high infant mortality. We ranked 50th in life expectancy and 26th in infant mortality among the industrialized countries.

-- Notwithstanding the results, the U.S. has by far the highest cost healthcare system in the world. Whether measured as per capita expenditures or as a percentage of GDP, the U.S. spends well more than twice the amount of the average of developed countries. On the WHO listing, our expenditures were 50% greater than the country with the second most expensive healthcare system (Switzerland). But in "bang for the buck" Switzerland won out, being ranked as being the 2nd healthiest country in the world by Forbes. The U.S. spends more than 2-1/2 times more on a per capita basis than the median average of the 14 most developed countries.

-- The U.S. was the only country included in any of the surveys that had a private healthcare system. All other countries had some form of government insurance or single-payer system. The analysis by the WHO indicated that the private system in the U.S. largely explained the high cost of healthcare in the U.S. The study by the WHO indicated that the high costs in the U.S. were mostly the result of the rising costs of medical technology, prescription drugs and particularly the high administrative costs resulting from the complex and multi-layered multiple payer system in the U.S. The WHO also noted that having almost 20% of it's population uninsured also contributes significantly to high costs. They note that "conditions among the uninsured that could have been prevented or treated inexpensively in the early stages often develop into health crises" and treatment at that stage becomes dramatically more expensive. WHO estimated that costs in the U.S. were in the range of 30-34% higher than necessary as the result of excessive administrative costs and profit for the providers.

-- The WHO noted that "the U.S. was the only country in the developed countries in the world except South Africa which does not provide health care for all of it's citizens." Their study noted that "the hodge-podge of multi-layered private companies that pay for healthcare insurance in the U.S. add dramatically to costs". They note in their study that the profit-driven "non-system" in the U.S. results in significant gaps in coverage, further adding to costs as the uninsured seek emergency room treatment.

-- The U.S. ranked next to last among the industrialized countries in the number of it's citizens who die while experiencing some form of disability. Only Denmark ranked lower.

-- The WHO study measured "fairness in financing", where the U.S. was ranked as the lowest (least fair) in distributing the contributions which fund healthcare across the population. The existence of healthcare "haves" and "have nots" was attributed to the absence of any central control of a system with a huge number of profit-driven providers.

-- One final study done by the WHO was a survey of citizens in the most industrialized countries, seeking to determine how satisfied the residents of the countries were with the healthcare provided to them. Most of the countries ranking high on the scale of having the best healthcare systems also had the most satisfied citizens. The satisfaction of the higher-rated countries was often in the 70-80% range among the healthiest countries. Notwithstanding the amount spent on healthcare in the U.S., our residents registered among the least satisfied with their healthcare, with only 41% of the U.S. survey participants registering satisfaction..
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As I said, there is a wealth of analytical information available on the internet. Everyone should take the time to do their own research on how our system of healthcare stacks up. Knowing that the expense of our system of healthcare is growing at a rate that is a multiple of inflation, and that the number of U.S. citizens that are uninsured is growing (a recent study says that 14,000 people per day are losing their health insurance, either because their employers stops offering it or because they can no longer afford it), makes our understanding of the situation important as we follow the reform legislation that is making it's way thru Congress.

Here is a link which refutes the assumption that the US has the best healthcare system in the world. Far from it.... http://www.huppi.com/kangaroo/L-healthcare.htm

The statistics are old, but I suspect they haven't changed much in the last 10 years or so.

For the sake of my question I will make an assumption
 

a question and a conclusion..
The assumption is: everything stated is 100% correct.

The question is: does anybody think/believe the legislation being proposed addresses the issues in the 100% correct list?

The conclusion: based on the fact it is a partisan rush reform, that most likely will not include a plan, timing, responsibilities or measures there is no way to expect correlation for the reform to solve the stated problems with the system.

Commentary:
All the bail outs to date lack a plan, timing, responsibilities or measures, therefore they have no idea if it is working, going to work or not or when.

There are no individuals in the 545 that have the business ability to cause the needed reform....only lawyers that can wordsmith the feel good (we hope) document. None of them will be around when it is implemented, stated to take at least 10 years.

The effectiveness of the US Government is more broken than ANY other aspect affecting our lives. Acknowledged to be infiltrated with die hard partisans (both parties) who are incompetent. Is there information some of you are privy to that leads you to believe these same incompetents will miraculously get one right, this time.... FOR THE FIRST TIME?

I anxiously await the education that is hopefully forthcoming.

btk

It's about the plan....not the need for reform
 

Kahuna, I don't believe the American people and many of the posters here have a huge disagreement about the status of our health care or the need for reform. The crux of the issue for most people seems to be the Obama administration's overzealous and in some cases, suspicious rush for the government takeover of the entire system and its implications for citizens and taxpayers.

Why is medical tort reform, a major driver of medical costs, not a part of a comprehensive reform by Congress and the president? Tort reform would reduce insanely outrageous medical malpractice insurance our medical professionals must carry. Further, it may reduce current "defensive medicine" practices such as the superfluous, expensive and often unnecessary testing that now significantly escalate costs for doctors, patients, taxpayers and insurance companies.

The Pew Hispanic Center says there are 11.9 million "unauthorized immigrants" in the United States. The Federation of American Immigration Reform 2004 study says the annual cost for their medical care in California alone is $1.4 billion. Gee, could that be part of their financial problem?

Richard Wolf in USA Today wrote, "One thing is clear: Undocumented immigrants are driving up the number of people without health insurance. The Pew Hispanic Center estimates that 59% of the nation's illegal immigrants are uninsured, compared with 25% of legal immigrants and 14% of U.S. citizens. Illegal immigrants represent about 15% of the nation's 47 million uninsured people — and about 30% of the increase since 1980."

It is obvious that the cost of providing medical care for illegal immigrants is another driving factor influencing out of control costs for medical care. The current Obama plan exacerbates the problem by including all uninsured illegal aliens. The same Obama plan wants seniors to accept death, avoid costly testing and medical procedures and counsels them to "die with dignity". I believe many think "the plan" is mercenary cost cutting and shabby treatment for American senior citizens who have contributed so much to this country in so many ways. I feel empathy with the crying eagle icon I use. I have said before that I do not oppose inclusion of medical treatment on a true emergency basis for anyone. I do not believe illegal entries should be given a free ride at the expense and disadvantage American taxpayers. I suspect I am not alone in that belief.

There are many controversial absurdities in the Obama plan that hurt doctors, seniors and citizens. That is why I suggest to you that while your research is interesting, it is misdirected from the point of contention. That point being that the need for health care reform is not the issue......the plan being fast tracked by Congress and Obama is the issue. For the record, a Republican plan has recently been announced. I understand that one component is Tort Claim reform. That being said, from what I've seen of it, I'm not sure it is significantly different in many regards, than the Obama plan. My confidence level is not elevated by the GOP's late entry. More politics. I hope the interest of the American people rises above the instinct to play for votes, lobbyists, unions and special interests.

There are many other criticisms of the Obama plan that have been expressed by TOTV contributors. It's about the plan not the need for reform.

Thank you for your enlightening research.

xxxxxx

CBO Works on Saturday
 

xxxx

This is the first time I ever used those funny little icons but in this case...


:agree:

No Argument Here
 

No disagreement here, Cabo. As much as anything, I was putting some information out there for many of the people who post here whose analysis of the current situation regarding healthcare is hasn't gone beyond what we have is OK with them and whatever we do, any form of government involvement is a bad thing.

If I had my 'druthers, the Congress would take a good long time considering all the reforms that should be included in their legislation. And definitely, whatever bill they pass should not add to the deficit and national debt. My greatest fear is that the various members of the 435, responding to their own interests and special interests will cobble together a bill which creates a system as confusing, ineffective, inefficient and expensive as the one based on a myriad of private insurance companies that we have now.

Some of the things that I wouldn't resist if they were included in the proposed reform legislation would include...

• Significant tort reform
• Some sort of single payment system the could be designed and regulated by the government. I don't mean a system where the government makes the payments. Rather, I mean the establishment of a system or procedure with the objective of simplifying and standardizing the claim payment process, thereby reducing the overhead costs of healthcare insurance.
• The creation of some sort of "healthcare claims appeals" court or central adjudication process. Americans shouldn't be subjected to the whim and/or profit motivation of an army of privately-employed claims adjusters making the decision of what gets paid for and what doesn't. Whatever system we have should be consistent for everyone.
• Means testing for Medicare and VA benefits
• Healthcare insurance for all American citizens, whether they can afford to pay for it or not. That means that if someone can't produce citizenship or insurance documentation at a hospital emergency room they don't get treatment. More specifically, after the first illegal immigrants die on the stairs to hospitals, there will be be lot more of of those who entered the country illegally heading home. Note that I said "or insurance documentation". I mean that if employers want to hire illegal immigrants because they work hard and cheap, if they want to keep them here they should provide them with healthcare insurance. Of course, another alternative would be to secure our borders--but that's another whole different debate.
• A tax on the richest Americans to help pay for the program(s)
• Some serious regulation on what medical research gets paid for by the government or by individuals thru their insurance premiums. We shouldn't be paying for rocket science when a fast train will do. If medical research beyond that is desired, it should be funded privately. (If you want a pattern of what I mean, consider stem cell research. Stem cell research can be deemed to have significant potential--it's just that the government won't pay for it. If the potential of the research is so great, let private money pay for it.)
• Negotiation, probably by the government, of more reasonable prices for prescription drugs. Why should Americans be required to pay substantially more for the same drug that companies sell elsewhere in the world for far less? We all know the stories of our neighbors going to Canada or Mexico or Europe to buy drugs made here in the U.S. for deep discounts. Why? Along with that, some serious reductions of the period for which drug companies can prevent the introduction of generic drugs with their patents and copyrights.
• A hard look at whatever legislation further reduces payments to doctors. Medicare payments authorized by Congress have already been reduced to the point that about 40% of the doctors in the U.S. refuse to treat Medicare patients--and that number is growing! Maybe even take a long look at paying doctors who practice in the areas of greatest need more than those in areas where the doctor-patient ratio is already too high.
• Government regulation of the coverages, benefits and co-pays on company-provided health insurance. Just because a group of employees are represented by a particularly powerful union or work for a generous employer, shouldn't mean that they get "Cadillac" healthcare coverage at little or no cost while other U.S. citizens have no insurance or coverage that is less than "basic". The healthcare insurance playing field should be leveled--or at least the "tilt" reduced somewhat. If employers want to provide better than standard coverage for competitive purposes or because it is the result of a union contract, those benefits over and above a standard package should result in a tax on the employer.
• If after all the other stuff I like has been done, if the government wants to offer Medicare coverage to citizens instead of private insurance that may be available to them, that would be OK with me. There is a caveat however. The premiums of Medicare to those of less than "senior" age would have to be increased to cover the actual cost of healthcare treatment for those that choose the that option. Premiums for seniors should remain low, as they have paid into the funding for both Social Security and Medicare thru payroll taxes during their working years.
• Finally, whatever national healthcare insurance or standards that are created should apply to all members of the Congress and all government employees. The Congress and government employees should not be permitted a different, better or cheaper plan than that available to the citizens they represent or work for.

That's certainly not a complete list of stuff that I wouldn't mind seeing in reform legislation, just a few that I though of on a warm Sunday morning here in The Villages.

The government pass to do the legislation and the public/private
 

sector take care of the implementation.
NO government run anything in the new reform.

btk

As I read the posts of those of you who are disenchanted with President's health insurance proposal, here are some of the prominent objections and concerns: 1) How this complex, huge plan has been thrown together and is being pushed at a too rapid pace. 2) That it is incomplete, less than the 100% solution, with glaring omissions like tort reform. 3) That it will probably allow illegal immigrants to be included in the 'gravy train' (my words). 4) That it will actually increase health care costs for the 'average already tax-burdened citizen.

IMHO the first three don't take enough account of our history. The last one I think is speculative and is more convincing to those who have lost most or all faith in our ability to operate as an efficient nation.

Not to belabor the history thing, but the nature of our political system is fickle and fleeting. Opportunities for real progressive action and change are too rare, with the diversity, self-centeredness and lack of vision of many of our leaders. But the health insurance 'stars are finally crossing'- the system is terribly broken, the future is frightening, a leader who was widely ridiculed has been replaced by one who seems to be representing the concerns of the people, etc. That scenario has been repeated many times in our nation's history and when it happens we've had our best opportunity to progress.
The current administration started well before the election assembling what they believe is the best health insurance plan they can come up with and one they can get approved. There were extensive meetings and some understandings reached with health care providers, insurance company and pharmaceutical companies. The result is not just 1000 pages of drivel. I believe it is not 100% complete and purposely omits certain things, especially comprehensive tort reform, because if included, that might be the ingredient that would prevent it's passage. I don't think a 100% solution is in any way possible, even theoretically.
I also believe the President is correct in thinking the chance of passing the best an most comprehensive plan shrinks each day, as momentum decreases, and opponents amass more money and influence to block it, very often for shamefully selfish reasons. I fully support the President's speed of promoting even a less than perfect plan because if it doesn't get done soon, it will not get done or will become another Rube Goldberg boondoggle.
Our history is all about immigrants, legal and illegal. They have always been with us. When we say "give us your poor..." we have meant it, (I love that about us), and most of those people became productive members of our society is a short period of time. I'm proud of my ancestors who came here with nothing. Today the new illegals make a major contribution to our economy, collecting poverty wages and working dependably at jobs we vets don't want. I'm not in favor of a wholesale opening up our borders, but I am willing to accept the way things are, those who are here and allow them to receive some care which may prevent many from simply ending up in emergency rooms and shelters, completely on the dole.
As for the last objection, I think it's time to suspend our belief the worst is what we'll get. If the plan is designed to be deficit free, paid for by current fund reallocations and a surtax on those with annual incomes over $1 million, I can live with that. I've suggested elsewhere that, I can't come up with a better formula, I haven't read anyone's suggestion which seems better, so I support this one.
But to me, this job just needs to get done. If it improves things even somewhat, it could be the stepping stone to even more progress, real tort reform for example.
I think it's time to stay positive and supportive.

Again, No Argument
 

Again, no argument here. Other than my thought that Medicare could be offered to people less than 65 as an option, the things I listed that I'd like to see in the proposed reform legislation are a lot of standard-setting and regulation, but doesn't have the government actually doing anything more than they're doing now.

Yep
 

Even though my inclination is for our elected representative to take care in designing the reforms being considered, I recognize the threat of the myriad of special interests influencing the process and the individual members of Congress with their money. That's a terrible thing to admit--but that's the way it is.

So in response to your thoughtful post...

:agree: :agree: :agree:

Why is it that people will analyze and theorize things to death but totally fail to consider two or thee simple truths?

I hear people taking quite a few pot shots at our health care system and frankly I never here BO say anything good about America in general... ever.

Just about every government program you can think of is bankrupt and ended up costing 10 times more than they told us it would.

There is more than meets the eye going on in the health care industry that is very positive. None of it has anything to do with government.

BO's plan will kill jobs and devastate delivery of health care.

Just a few simple questions.

When has a government social program ever lowered costs and raised standards?

What is it about the federal government that gives so many so much faith in their abilities?

Why do we so depend on politicians and bureaucrats (many of which are self serving liars) for our solutions?

In all circumstances, the countries mentioned are highly restrictive in their immigration policies, rarely take political asylees (except Sweden) and are geographically small (the largest, Sweden, is equal to California). The health condition of foreign visitors, students, temporary employees, asylees and many others (including border-jumpers) is not checked until they apply (if ever) for green-card "permanent resident" status. Their "pre-existing conditions" impact all health statistics.

We also have the worst diet and sedentary lifestyle, and high intentional infant mortality. You can't legislate what folk eat or make them exercise

the other 13 "developed countries" have high tariffs and other trade-protective mechanism to protect their economies and have positive balance-of-payments ratios. That affects all economic ratios, includeing health care to everything else.

WHO only compared medical-to-medical costs and did not factor other economic conditions. We can solve half the uninsured problem by resolving the illegal immigration factor.

The largest uninsured group in emergency rooms are illegal aliens. The citizenry issue is one thing - the "everybody here, legal or not" is another.

The USA is also has the greatest ethnic "melting pot.' The disability factor includes wounded veterans and those with genetic conditions. The former have protected just about everyone else, and the latter is due to our propensity to accept more of the world's desperate.

"Fairness in funding" is highly subjective.

Again, let's compare sizes. Florida residents may be very content with their coverage, while residents of Nevada may not. That would be the equivalent of Germans and Greeks in a European study. We seem to keep forgetting the USA is geographically as large as all of Europe (excluding Russia).
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When government keeps imposing higher overhead upon US employers, making them less competitive than the foreign goods/services providers who receive "most favored nation" trading status despite having nationalized, socialist-run industries, something has to give to keep the business doors open so they can keep employees. In this, we are our worst enemy.

The list is impressive, but in general indicates the government is the only solution. So far, there has been nothing concrete, proven workable, presented in HR 3200 - just a bunch of theoretical concepts with none having any record of trial or success.

I agree that immigration, border security and all that involves is worth a debate, as the predominate group filling this "uninsured" population are illegal aliens (yeah, "undocumented" is a lousy descriptive), followed closely by foreign long-term visitors who get rolled into most statistics. Fix this problem and the largest argument for changes to the health care system goes away, as this population impacts costs to a disparate degree.

When the economy is booming, competition for employees (recruiting and retention) solves the health care insurance issue. When domestic employers find themselves behind the business 8-ball due to government-directed business advantages given to foreign providers/suppliers of almost everything, to increase the domestic employers' cost-of-doing business will have only two results: 1) the employer goes under; or 2) wages are decreased to equalize the cost of government-directed employee compensation. There is no free lunch here.

It's always easy to tax the richest, but it's always only a starting point. This is one place where "trickle down" really happens.

The only "significant tort reform" that may reduce "defensive medicine" is blanket immunity from damages. There is no partial or cap that works, as already found where in place. Is that what folk really want?

So, for the most part, the problem is not the health care industry - it's everything which impacts the health care industry and every other industry in this country. Until the externals which impact the industry (and all others) are fixed, we are just applying an unproven and untested and highly expensive action (not even a solution) just for the sake of "change."

Don't get me wrong. I have no problem fixing anything that is broken. What I do have a problem with is saying we'll buy an expensive "fix" when we have no proof that these "fixes" have worked anywhere or will work on any scale or magnitude. It's like saying I don't like my car, so give me a new way to get around (Beam me up, Scotty) that has never been tried and charge me 100 times what the car costs to get it.

SteveZ,

Like others. I appreciate your deep research and neutral tone in the political forum. But you seem to be overly committed to two pillars of Republican (or call it what you will), philosophy.

Your response to the elements of Kahuna's proposed health plan was thoughtful and accurate, but also paradoxical. You lump those ideas together and rebut them because they suggest "the government is the only solution". But then you mention how things are here and in other nations and you recognize those very big things only governments have fixed, or can seem to fix. The health insurance plan itself, related tort reform, uncontrolled 'medical' research, immigration, tariffs, etc. You seem to agree that tight, comprehensive regulation sprinkled liberally over free enterprise is the solution. In some circles you'd be called a 'commie', like I've been.

In the same way that it's too simplistic to say "the less government we have the better off we are", the other traditional axiom of free enterprise, the 'trickle down' effect, is demonstrably superficial. You suggest that 'taxing the rich', the proposed means by which a part of the new health insurance plan will be paid for, will have serious negative affects on businesses, unemployment, etc., because the wealthy will be disinclined to invest. What greater proof do we need that the wealthy will do nothing outside of their self-interest than what has happened with the current economic crisis. Investors, corporate and individual, are sitting on their billions, not because of a new pesky little mosquito-like health care surtax, but because the markets were not properly regulated and those who raised greed to a whole new level were able to bring the whole house down. There we go with that 'r' word again. I guess you just have to get used to being called a 'commie' if you think government regulation needs to be sprinkled liberally over free enterprise. Why not join the club?

Couldn't it just be that alot of business stagnation can be attributed to a POTUS who scares the heck out of everybody especially when he is armed with the majority congress and a motto that says something about "not wanting a crisis go to waste?"

Then let me try to clarify:

1. In our quest to butt-kiss China and others, we have handed our manufacturing capacity on a silver platter to them by giving them free access to our markets while they pay slave wages to their people and ignore what we consider normal as OSHA and environment control, AND THEN keep raising the overheads of American businesses so they can't compete. The result is a depressed economy, wages going down, job loss and all the resultant harm from borrowing to eat with no chance of payback. THAT is what has made a mess of health care, because when the economy is cooking, there's jobs, health care for employees, and discretionary funds for research. ANY plan to change health care IN ISOLATION of repairing the damage to the economy is useless, expensive and just sending us deeper into a financial abyss.

2. It is too easy to hand problems over to elected officials who have no idea what any of it is about, or too lazy or ignorant of the subject matter to read the legislation (let alone intelligently vote on it). Just "passing the buck" to government to be mother, father, and boss never has solved anything. I don't see government as the omnipotent protector of all facets of life, and am afraid to death when government (meaning the people in office) see themselves in demi-god roles.

3. Germany, the U.K., France, Sweden, Spain, Italy, Greece, and all the rest of the European countries are no bigger than American states. So, if something works in Germany or the U.K., means maybe it would also work in New York or Illinois. It does not mean it will work across the entire USA. SIZE DOES MATTER in trying to implement anything, and the immense size of the USA and its internal diversity must indeed be considered before anything is conceptualized for national implementation. There's a reason why the European Union has not attempted to impose an EU Health Plan, and that is that each one of the countries have unique concerns and situations, just like each of the USA States do. So, what works in a country of 30-80 million in a land mass smaller than Montana may not indeed work in a country of 305 Million in a land mass the size of all of Europe.

4. Per you, "You seem to agree that tight, comprehensive regulation sprinkled liberally over free enterprise is the solution. In some circles you'd be called a 'commie', like I've been." Far from it. In fact, the reverse. The problem with regulators is that they operate so divorced from the system they regulate, they just don't understand it. They may understand the regulations, but have no idea how they really impact the affected industries. I saw that first-hand when I went from private industry to spend five years within the government entity which regulated my industry. When changes in regulations are proposed, it's normally to help the regulators, not make the industry more efficient or safer or cleaner or better. It's government for government's sake.

The Founding Fathers were sharp dudes. They envisioned a federal government whose responsibility was to be the collective for defense of the member states, provide a unified voice when dealing with outsiders, and provide those inter-connective services (e.g., waterways, postal service, etc.) that were truly interstate in nature. They ALL warned about the dangers of too strong a federal presence, as that's what they revolted from. The goal was to let the states be the states, except for those limited and necessary items which crossed state lines.

We have gotten state-lazy and federal-dependent. That's probably an offshoot of having national radio and television networks and a national print media. It's too easy to see ourselves as only Americans at the expense of being Floridians, Illini, Nebraskans and the like. If we are going to seek social change in any manner - be that in how we receive health care or distribute bread - the place to do that is at the local (state) level first. If we want to emulate how the Brits or Germans do things, we must remember that those nations are at best no bigger than a State or two here.

Change is a wonderful thing - as long as the change is managed with logic and science to confirm that the change will do good rather than make things worse. WE HAVE NO DATA that says any facet of this health care bill will work - only guesses and promises BUT NO DATA. I spent too many years in a system management environment to rely on guesses and promises. I's skeptical of Santa Claus promises and won't accept blilnd faith which only rewards political grandstanders.

Medical Costs
 

No component , man-made or biological, can physically maintain a growth rate in the 10-15% range before completely overwhelming the system in which it lives. The medical system is no exception, and at it's current growth rate will consume our whole GDP in a short few years. Yet what group in the U.S. is in favor of reduced medical spending? Not drug companies that continually charge higher & higher prices for drugs that in many cases are no better than generics. Not hospitals, who are always complaining about loosing money while at the same time adding yet another new wing. Not physicians, who are paid ridiculous amounts of money for performing more & more procedures, 30-50% of which are known to be unnecessary. Not insurance companies, who (much like Las Vegas) make money by skimming a percentage of the total "pot"- bigger expenses = bigger premiums= bigger profits. Not the consumer, who generally pays little if any of the bill anyway and equates more care with better care.

It seems that there is no one who is at all interested in lowering costs at all. Indeed, the government instead proposes to spend a trillion or so more to "reduce costs". Two proposals come to mind that might create a group that has an interest in reducing costs:

A. Create a cadre of physicians paid a salary plus a bonus based on providing good outcomes at a cost less than the prevailing rate spent on that particular disease. The existing procedure rate would drop at least 30% immediately, along with the associated costs.

B. Structure medical insurance with, say, a $2,000 deductible of which the unused portion is refunded to the consumer every year. If you spend $700 on medical care then you would get a $1,300 refund that year. Now, the patient may ask "Is this really necessary?' or "What are my other options?" At present, these questions are rarely asked or even considered.

These two would definately result in some major group interested in reducing costs. Other ideas may be just as or more effective. However there is absolutely no discussion of any substantive ways to reduce costs. Anyone with some other good ideas? :shrug:
Steve S

There are many good ideas. Doesn't it make sense to try a variety of things at the state level before trying to implement it all at once on 305 million people? If we have never done it at the 1-20 million people level successfully, what makes us think that we can just jump into the 305 million people level with success?

Every manufacturer or system developer prototypes and Beta tests before going into mass production of anything. Why is this different?

Alternatives?
 

I agree with all of your statements, but I'm still left with a problem...the problem.

We've all agreed, I think, that we have a serious problem with the cost of healthcare in the U.S. Measured as either cost per capita or as a percentage of GDP, it's increasing at an unsustainable rate. It will both "break" us while at the same time reducing healthcare insurance coverage for millions of Americans. I heard a statistic this morning that as recently as 2000, 61% of American businesses provided some form of health insurance for their employees. This year's statistic shows that only 38% of employers do so today. The problem we're facing is serious. Both the citizens of the U.S. and our elected representatives have been ignoring the problem(s) for years.

We also seem to agree that a big chunk of the cost problem is the cost of caring for those with no insurance. A lot of those people are illegal immigrants. Both the numbers of illegals and simply uninsured Americans are growing rapidly. Again, we're back to the growing cost problem with no apparent solution. The immigration problem in particular has proven to have no politically acceptable solution within our government--or even among our citizens!.

We would all like to believe that the principles laid down by our Founding Fathers would work. Over the very long term, they have. But right now we're facing a serious problem with the cost of healthcare that has to be fixed in the short term, not the long. The "enemy" isn't just forming up on the horizon, they're coming in over the edge of our foxhole!

I'd like to believe that the free enterprise system could bail us out of this one. But who's going to do it? Will the drug companies give in? Will the insurance companies get together and agree on standardized coverages and claim processing? Will they voluntarily agree to maybe reduce their profit margins? Will hospitals voluntarily reduce their costs? Will the trial lawyers agree to stop suing for millions and hoping just to settle out of court? Will the firms doing medical research voluntarily slow down their efforts because as a country we can't afford to continue to fund them? Will the doctors agree to work for what they would earn if they worked in Europe? Will U.S. citizens who can afford to do so volunteer to pay for their own healthcare rather than use Medicare? The Brits have an answer for these types of questions...not bloody likely, they'd say.

No, this is like the recent Chrysler and GM bankruptcies. Both companies could not survive with the cost structures they had in place. But there was no way that the creditors and stakeholders could or would agree on who's ox was going to get gored the worst in the bankruptcy. So the government stepped in and played hard ball with them all. I don't agree with all the settlements that the government demanded, but I know that GM and Chrysler would be in liquidation today without the government's intervention.

So again, we need the government to step in and re-form the health care industry. I guess I should say the re-form the cost structure of the healthcare industry; I think we'd all be willing to let the things that would show us to be a healthier country wait for longer term solutions. The industry itself is incapable of doing it without the intervention of a third party.

Our government has done nothing to earn our trust in recent years. But unfortunately, they're the only ones who can solve this problem. All we can hope for is that our government will assure that "the change is managed with logic and science to confirm that the change will do good rather than make things worse". What other alternative do we have?

But that does not change the fact that so far the efforts by various states have been marginal, or have failed. If we can't get it right at the state level yet, what makes anyone think a top-down federal "system" comprising of totally untried concepts won't make things worse?

"There's never the time to do it right, but always the time (at even more money) to do it over." - that's one rule we all learned. For some reason, when politicians are involved and there is charisma attached to the attempt, logic goes out the window.

I agree that all of this is serious business, but it's being treated like a turn at the roulette wheel.

If this system - HR 3200 - is so good, then what's wrong with trying it first in Massachusetts, or all of New England, or California, with even a different plan tried in Texas or Illinois? Better still, fix one of the state systems with federal assistance and then expand it if/when it works to a greater number of states or an entire region. Prototype and Beta Test!

This is a $Trillion roll of the roulette wheel, and we have to borrow the money to lay the bet down. Why not prototype and beta test? What's the fear? Is there that much trust in politicians who have no experience in developing any service-and-delivery system, who can't understand what's in the written "plan," but are great salespersons?

Many a good con game starts with, "there's not enough time to...." That's the cynic in me, and I don't take out a mortgage and lay down the money on a hope and a prayer. Why should I trust a person/people with no credentials in the health care industry, but really good at spending other people's money for their party's cronies, when they say, "we gotta get it done by August...." when they don't even know or understand what it is?

No time to do it right......but we can always borrow more money to do it over.

And yes, if GM and Chrysler went in liquidation, their circumstance would not be any different. They still have bloated inventories, are still building-to-inventory, and no one is buying the product. There is an inevitability to that situation, and we all know it.

Solace?
 

Too bad you and I aren't in charge, Steve. If I was the benevolent dictator and you were my consigliore--or vice versa--a state-by-state or region-by-region test might be an OK idea. Then you and I could choose where it would be tried out and for how long. But we've got "the 435" involved in this thing, and they'd all want the test to be in their district or their state.

To some extent, whatever reforms are finally agreed to will wind up getting rolled out over an extended period of time. I've read somewhere that whatever changes are agreed to might not take effect until as late as 2015. That would be plenty of time for people to disect the programs and demand changes. Heck, we'll have a presidential election and three Congressional elections before then. I'm looking for some small solace in how long implementation might actually take.

Even if NO changes ("reform" indicates a positive) occur in the next ten years, the government agency to manage/oversee/fiddle this action will have been created, funded, contractors hired in lieu of employees to fill offices, write regulations and procedural documents, design a new logo and issue new business cards and signs, make titles, provide political appointee jobs, go on fact-finding missions, establish and staff field offices, and SPEND MONEY on all of the overhead activities to "be ready" to do something. What a waste!

This wouldn't be so idiotic if just half the congressfolk and either the President or Vice President had any credentials, experience and understanding in delivery of consumer services. - any kind of consumer service! It's like a group of short-order cooks deciding federal railroad policies.

We elect representatives (President, Congressfolk. et al) to act as our legislative and administrative agents. When they are not knowledgeable about the subject at hand, their responsibility is to get smart about it before acting. That includes full dissection of the bill in front of them section-by-section, meeting with experts to acquire any mission knowledge, and voting only when fully knowledgeable about the pros and cons. Anything less is poor performance, and any other agent we have who acted poorly would be immediatgely discharged. I would rather have a representative/agent vote "abstain" if the rep didn't understand fully what was before him/her, than vote Yea or Nay out of ignorance. What this action, as many others before it, show is that the representative is not the voter's agent, but rather is the party's agent - save for a few who still believe in the Constitution.

Even if the program is scrapped, the new "health care reform" federal agency shall continue to breathe, be fed, and "be ready" just in case. Both parties will insure that the political appointee slots remain no matter what, and the contractors will continue to fill positions in lieu of.

Fire them all in 2010 (House and 1/3 Senate), and the rest in 2012.

:beer3::beer3::beer3:

This paragraph should be the route thought of the bulk of our political debate, but, the political parties have high jacked the hearts and minds of the American public to the extent that too many people look towards government as the answer to all problems in our lives.

I know many here might be tired of me saying "Free To Choose", but the late Milton Friedman in his book and documentary series of the same name, point out the same things that SteveZ is saying in this paragraph. The Nobel Prize winning economist, Mr Friedman, has a way of cutting away the layers of an issue, to expose the simple facts of Government involvement in our lives. He explains how our Government, though well intended, creates a mess with it's laws and regulations. You'll better understand where I'm coming from in my posts after watching Friedmans inciting series.

Here, Here!!:beer3::beer3::beer3:

Problem
 

The problem I have with this part is look how the IRS system has been "simplified and standardized" and what a mess it is. I really don't see how they could handle the healthcare system any better based on their track record there.

But...
 

Say what we will about not liking more government involvement in the healthcare system, the conundrum remains...

HOW DO WE STOP THE SKYROCKETING COST OF HEALTHCARE IN THE U.S.? IT IS UNAFFORDABLE AS IT IS AND THE RESULT IS THAT MORE AND MORE CITIZENS ARE FINDING THEMSELVES WITH NO HEALTH INSURANCE. THAT INCREASES THE COST FOR THE REMAINING PEOPLE WHO HAVE INSURANCE AS WELL AS THE OVERALL COST.

IF NOT THE GOVERNMENT, SOMEONE PRESENT A RATIONAL SUGGESTION OF WHO CAN AND WILL TAKE THE ACTIONS TO ACCOMPLISH THE COST REDUCTIONS?

Funny Medical Headline
 

Then we need to fix the root cause of the problem - a downed economy with fewer jobs which provide health care due to inability to compete with cheap goods/services from communist/socialist countries.

Now, that may seem off-base, but when the economy is on the rise, unemployment is low, wages and benefits are high, and all of these "it costs too much" problems are minimal.

We all know of businesses which have closed because of foreign (especially from communist/socialist countries) competition. All of the other Western industrialized nations have significant tariff/trade protections so that their domestic industries remain vibrant. We don't. That disparity keeps gnawing on the US' ability to keep the domestic workforce from being fully employed, resulting in lowered wages and/or reduced benefits. The more employers have to reduce employee compensation (especially benefits such as health care) to compete, the more people find themselves with higher out-of-pocket health care costs. That's the cause and effect which created the conundrum. If I'm wrong, please correct me.

So, we need to recognize that higher medical costs are a symptom of a much bigger problem, and that trying to nationalize medical care won't make health care any better or more affordable. HR 3200 is an economic placebo which many folk believe may cure what ails them, when in fact the real economic cancer continues to grow.

So, if the politicians are correct, and that the bailouts will spur the economy, then HR 3200 should be superfluous. If they are wrong, then other broad economic measures, such as tariffs and import taxes just like other countries have, are needed to backstop domestic manufacturers and service providers. When people are employed at good jobs that pay well (like they used too), we all win.

Cause and Effect. We seem to want to ignore what these are.

We agree on a lot of things, Steve, but not this one. When a country spends almost twice as much for healthcare on a per capita basis or as a percentage of GDP than other developed countries and still leaves 20% of the population without coverage it's a helluva lot more than a symtom.

However, I do agree with you on the need to attack root causes. But my question was "...who can and will" take the actions necessary to reverse the escalation of healthcare costs? Who is it that will correct the problem of "a downed economy with fewer jobs which provide health care due to inability to compete with cheap goods/services from communist/socialist countries" that you cite? Who is it that will put in place "tariff/trade protections so that...domestic industries remain vibrant" so that we can reverse the problem of "the domestic workforce...being fully employed" so that "employers (don't) have to reduce employee compensation (especially benefits such as health care) to compete"? Even you and I might not agree that protectionism will work. If anything, the professional economists seem to have reached a consensus, saying that protectionism will not work.

I might even throw in the problem of growing illegal immigration. Whatever the number...20, 30 or 40 million...the rest of us are paying for healthcare for all these illegal immigrants. HR 3200 would make that practice the law of the land. Who will fix that problem? Has there been any consensus whatsoever among our elected representatives on how to address illegal immigration? On one hand the employer special interests lobby to keep our borders porous so they can enjoy cheap labor. Then there are those who argue that nothing should be done if it results in "amnesty" for the illegals who have successfully crossed our borders. Bottom line...nothing is happening or can be expected to happen on this expensive "cause" of the problem.

So, while I can't disagree with you on some of the "cause and effect" issues, our elected reps have shown no inclination to address the causal factors. Given that "the problem" is real and is growing, what alternative do we have other than to agree that our elected reps address themselves to the effect by reforming the healthcare system itself?

Will I argue that we should trust "the 435" to do a good job in "re-forming" U.S. healthcare? Do I agree with all the elements of HR 3200? Heck no to both questions! What has Congress done to earn our trust and confidence lately? But maybe conceding that the only answer is to let them work on the effect is an easier proposition than expecting them to fix the cause(s).

In the end, we don't have a choice. They will do what they do, take the bows once it's done, and hopefully will be voted out of office in 2010. In many ways, the deal is already done, and they are just planning to have it fall when it can be "quickly forgotten news."

:agree::cus: