Health Care

[kuri]

Originally Posted by GqArtguy

Just to clarify, the US does not have a free-market system in health care. That bird has left the nest for quite some time.

I get you Manuel. That said I still think a for-profit system, whether it be the current one, or some sort of completely privatized free market system would not be in our best interest.

There is no other industrialized country that wants a system like ours, nor a free market system, and for good reason. It makes sense to study countries with better systems (U.S. ranks 50th now) and adopt what works.

[rwmct]

Originally Posted by russ

Rich----I would have to disagree with re: unnecessary tests.

Well, I am not in the field, and may be talking out of my fanny. But I am not sure about your example of the MRI. If I am having back trouble, why wouldn't I want to get an MRI? The X-rays can only show so much. It seems to me that gathering as much information as possible before figuring out what is wrong and how to fix it, makes the most sense.

[russ]

Originally Posted by rwmct

Well, I am not in the field, and may be talking out of my fanny. But I am not sure about your example of the MRI. If I am having back trouble, why wouldn't I want to get an MRI? The X-rays can only show so much. It seems to me that gathering as much information as possible before figuring out what is wrong and how to fix it, makes the most sense.

The problem, in this example, is that the results of MRI of the lumbar spine are very often non-contributory in terms of decisions regarding patient management. It is believed that roughly 75% of MRIs of the lumbar spine can't reasonably be expected, based on the patient's clinical history, to bring about any change in the management of a patient's condition. Moreover, the results of MRI of the lumbar spine often confuse rather than clarify, as there is a great deal of overlap between what one sees on MRI in symptomatic patients compared to asymptomatic patients, i.e., 2 patients canhave identical MRI studies, with one feeling perfectly and the other being highly symptomatic.

Getting as much info as possible is sometimes superfluous, and in many cases, confuses rather than clarifies.

The problem with viewing medical care purely as something to be bought and sold is that, IMHO, it tends to reward those who "sell" in higher volumes. More care is profitable, but isn't necessarily better care. A counterargument is that the market would correct for overtreatment via patient dissatisfaction. But that isn't entirely true; there's a tendency for patients to view more care as better care. It's a common perception, but not a reality, and it can apply to many types of treatment, be it aggressive medical management of cancer, or manual therapies for back pain. Clearly, there are times when aggressive care is the best option. There's a happy medium somewhere between the tendency to intervene to often and too aggressively and not intervening enough. The former is a bigger problem in American health care, I believe.

[kmwest]

Originally Posted by tkinsley

Yup, Ralph, we have medical technicians too. E5 or less, generally.

Good point on the military health care system enrolling young and healthy--but once these people reach retiree age, they have just as many problems as anyone else, and significantly cost the system beaucoup dinero.

And how many actually make it to 20 years? A very very small portion, less than 1% at least in the USMC. So overall in the military health system, you're looking at a population that is generally young, very healthy, and requires very few expensive procedures. Quite different than the graying, obese general population.

[tkinsley]

Nahhh. Not in my MTF. Lots of sick, old fatties. More than enough to go around.

[eastcoastsurfer]

Good opinion on the healthcare issue.

Aug. 3 (Bloomberg) -- President Barack Obama has been exhorting lawmakers to use the August recess to read health- care-reform bills currently before Congress.

In other words, if the president had gotten his way, members would have voted first and read second legislation to revamp one-sixth of the U.S. economy. No wonder public support for both Obama and his health-care plan is eroding, according to recent polls.

Yes, people are resistant to change, as the president noted, especially when it comes to something as important as their doctor. But maybe something else is at play: the growing realization that the numbers don’t add up.

I listened to Obama’s July 29 town hall meeting in Raleigh, North Carolina, hoping to understand how the government plans to deliver more for less, to cover most of the 46 million uninsured Americans while lowering premiums, limiting out-of-pocket expenses and requiring insurance companies to cover preventive care.

I heard Obama say a lot of people will get a lot more without anyone getting less.

I heard him say two-thirds of the cost of covering everyone in America can be paid for “by money that is already in the health-care system.”

I heard him say he favors a public option to increase competition and keep costs down.

I heard him say he “will not sign a health-care bill that is not deficit neutral” and that doesn’t lower health-care inflation over the long term.

Let’s see how some of these claims stack up:

1. Mind Your P’s and Q’s

Obama wants to insure more people and lower the total cost of care. In economic terms, he wants to control price (P) and quantity (Q). What makes Obama think he can repeal the law of supply and demand?

To achieve higher Q and lower P, the supply curve has to shift outward, to the right. How does the government plan to increase the supply of health care? By making it less attractive to young men and women with a passion for medicine and a desire for independence?

Obama says he wants to encourage medical students to become primary-care physicians via financial incentives, reversing the trend toward specialization, which is where the money is.

Easier said than done, says Paul Feldstein, professor of health-care management at the Paul Merage School of Business, University of California, Irvine. “It takes a long time to produce more doctors.”

Once the government starts to dictate budgets and salaries in an effort to control costs, medicine becomes a less attractive profession.

Rationing is inevitable, Feldstein says, and there are only two options: with price and free choice or with regulation. Surely Obama spent enough time at the University of Chicago to understand his P’s and Q’s.

2. Inefficiencies of Scale

Obama says his advisers have identified $500 billion to $600 billion of inefficiencies in the system that would pay for reforms. When was the last time the government wrung inefficiencies out of anything? Medicare is plagued with waste and fraud.

Health-care reform is long overdue. We need a system that offers wider choice, proper incentives (eliminating fee-for- service) and subsidies for those who can’t afford it.

We don’t need something that fails to cut costs and eliminates choice. Plan B anyone?

3. Enhanced Competition

Obama says the government needs to offer a public health- care option to encourage competition. This line of thinking leads “to the uncomfortable conclusion that the government must be a player in every industry,” says Cliff Asness, president of AQR Capital, a hedge fund in Greenwich, Connecticut, who debunks this and other health-care myths in a paper posted on his Web site.

How do other industries manage to be highly competitive without Uncle Sam’s interference?

Unless the public wants health-care outcomes akin to those of the nation’s schools -- another sector offering a “public option,” Asness points out -- Obama needs a better plan and a more convincing argument.

4. Measuring the Right Stuff

Obama has accused opponents of his health-care plan of “scaring everybody” with intimations of rationing. He scared back, telling his Raleigh audience last week that “if we do nothing, I can almost guarantee you your premiums will double.”

The high cost of health care is another myth skewered by Asness, in his paper, and Kenneth Arrow, Nobel Laureate in Economics, in an interview in the Atlantic.

The gist of their arguments: This ain’t your father’s health care. Innovations in diagnostic and surgical procedures cost money but allow for better and less invasive treatment.

What about the accusation that the U.S. spends more money on health care and boasts life-expectancy rates well below those of most developed countries?

A red herring. There’s a big difference between health and health care. If you eat too many Big Macs, smoke and drink, that’s a lifestyle choice.

Once you suffer a heart attack or are diagnosed with cancer, the survival rates in the U.S. -- especially for cancer -- are second to none. For all the hoopla over Canada’s socialized medicine, the cross-border flows aren’t south to north.

“The low longevity ranking of the United States is not likely to be a result of a poorly functioning health-care system,” according to a new study by University of Pennsylvania professors Samuel H. Preston and Jessica Y. Ho.

What’s the prognosis if ObamaCare is enacted?

“People have to get less or pay more,” Feldstein says.

As a group the elderly are the largest consumers of health- care services. If you want to cut costs, you have to go where it’s being spent.

The Eskimos had an efficient way of rationing: in some cases they simply sent the elderly out to sea on an ice floe. It’s not what Gram and Gramps envisioned for their golden years.

[gregl515]

Of course, considering what Wall Street has done to people's retirement, we don't need Democrats with ice bergs to abandon retired folks.

[eastcoastsurfer]

Originally Posted by gregl515

Of course, considering what Wall Street has done to people's retirement

Is this going to continue to be the argument even once the S&P passes it's old highs? Right now it's down ~30% from it's pre-crash highs. If people have been buying in over this whole time like they should have been, they are down less because their cost basis is lower.

[gregl515]

The major lesson of this crash is that there are insiders and there are outsiders. The insiders managed to somehow survive and even make a profit out of this mess. The outsiders got hosed.

I think it will be hard for many people to put their money back into the market because they learned that lesson.

Besides, if the increase does not really represent an increase in production, manufacturing, sales or anything real, what is it? Is it like the tech boom where people invested in companies that didn't do anything or make anything but got pumped up by Wall Street Investment Bankers until they crashed.

[Axis]

I want to lose about 40 lbs of fat, add 100 lbs to my 1RM bench press, squat and deadlift, improve my conditioning and my vertical for basketball and my general flexibility.

What program should I do?

I'm not posting in the wrong thread. I just realized what bothers me the most about the current health care debate. It's the idea that the whole system has to be rebuilt in one fell swoop.

It's clear that the political will isn't there for a nationalized system, so, it seems, to some degree, we have to dance with the one that brung us.

There are multiple things wrong (and some things right) with the current system. Wouldn't it be wiser and less politically flammable to tackle the problems one at a time and try to shape the solutions in a way that minimizes the impact on what we do well?

The Democrats have a filibuster-proof majority for at least the next 15 months. It seems to me that they could propose solutions in separate bills without having to exhaust the political (and real) capital that this one colossal bill seems to require. It would also, in my opinion, spur real debate on the merits of individual plans.

Below is my list of problems (along with some potential solutions but I'm sure the experts can come up with more) that I think could be addressed in separate legislation.

1. Greater access to insurance - subsidies/tax credits, co-ops, removal of state-line restrictions, mandate greater selection of policies from insurers

2. Defensive medicine - tort reform, government trust fund overseen by a board of medical experts to cover malpractice complaints

3. End of life care -

4. Administrative inefficiencies - electronic medical records


2-4 obviously cover the overall problem of rising costs. Passing any one would certainly help the issue without tanking the whole thing in an all-or-none proposal.

[eastcoastsurfer]

Originally Posted by Axis

I want to lose about 40 lbs of fat, add 100 lbs to my 1RM bench press, squat and deadlift, improve my conditioning and my vertical for basketball and my general flexibility.

What program should I do?

I'm not posting in the wrong thread. I just realized what bothers me the most about the current health care debate. It's the idea that the whole system has to be rebuilt in one fell swoop.

It's clear that the political will isn't there for a nationalized system, so, it seems, to some degree, we have to dance with the one that brung us.

There are multiple things wrong (and some things right) with the current system. Wouldn't it be wiser and less politically flammable to tackle the problems one at a time and try to shape the solutions in a way that minimizes the impact on what we do well?

The Democrats have a filibuster-proof majority for at least the next 15 months. It seems to me that they could propose solutions in separate bills without having to exhaust the political (and real) capital that this one colossal bill seems to require. It would also, in my opinion, spur real debate on the merits of individual plans.

Below is my list of problems (along with some potential solutions but I'm sure the experts can come up with more) that I think could be addressed in separate legislation.

1. Greater access to insurance - subsidies/tax credits, co-ops, removal of state-line restrictions, mandate greater selection of policies from insurers

2. Defensive medicine - tort reform, government trust fund overseen by a board of medical experts to cover malpractice complaints

3. End of life care -

4. Administrative inefficiencies - electronic medical records


2-4 obviously cover the overall problem of rising costs. Passing any one would certainly help the issue without tanking the whole thing in an all-or-none proposal.

+1

What you propose makes too much sense. The problem is that both sides have invested in the 'we are right, they are wrong' mentality regardless of what the topic is or the facts are.

[RobLL]

Axis - I think there is a lot to be said to a piece meal approach. Against it may be the political belief that the Democrats fear they may get only one bite off the cake.

[Axis]

Originally Posted by RobLL

Axis - I think there is a lot to be said to a piece meal approach. Against it may be the political belief that the Democrats fear they may get only one bite off the cake.

I'm sure that's the case, but when one party has all of the power and tries to majorly overhaul a large institution, I think the public gets a bit jumpy. Every time it has been tried in the past 20 years, it's bitten the party in power in the ass; health care with Clinton, Social Security with Bush, and likely health care, again, with Obama.

I think Democrats misread frustration with perpetually increasing premiums and co-pays as dissatisfaction with the system as a whole. Polls seem to be showing that a large majority are happy with the coverage they have. I'm sure everybody would love for more people to be covered, but generally voters are going to look out for their self interest.

It's hard for the 70-80% that like their coverage to look at the legislation that's currently proposed and conclude that it will in any way reduce their premiums, which was their major concern in the first place. In fact, it's reasonable for them to assume that eventually it will result in increased taxes, too.

So, people get nervous, which turns into real grassroots anger, which gets harnessed by groups that organize opposition. I'm sure the organizing of townhall 'mobs' is funded by companies that benefit from the current system, but the people there are real citizens. You can't get that many people to get off there ass unless there is real concern.

[GqArtguy]

Originally Posted by Axis

1. Greater access to insurance - subsidies/tax credits, co-ops, removal of state-line restrictions, mandate greater selection of policies from insurers

Greater policy selection will not fix the adverse selection problem. People will sort into the most advantageous policy for them, not the one that maximizes the profit of the insurance company. Co-ops will not allow for negotiation of prices, so that changes nothing. Given the agglomeration in the insurance industry, Im not convinced that removing state line restrictions will allow for greater competition among insurers.

That leaves subsidies and tax credits: so you let the insurance companies make even more money by subsidizing care for everyone who doesnt have it. The employer tax-exclusion 1) keeps people from realizing the full cost of health care, 2) allows for higher demands than if the full costs were observed, 3) less willingness to reform, and 4) is more expensive than just funding health care reform. As Greg said, wait until you have a fucked up illness, or get kicked out of your plan for some BS reason, then health care reform seems like a sweet idea.

The biggest crux with the government system vs the insurance companies is whether one believes insurance companies actually add anything of value. Another issue is that they are more efficient and cheaper than a government program. I believe it was Krugman that said Medicare Advantage ended up being more expensive than just simple medicare (to be fair, he made no mention of the quality of care or any benefits that would justify a higher cost so Id like to hear any Drs here that can answer that).

2. Defensive medicine - tort reform, government trust fund overseen by a board of medical experts to cover malpractice complaints

Ill let some of the Drs here expand on their views of that, but at face value Im leaning towards this.

4. Administrative inefficiencies - electronic medical records

Im for that, but I dont think its going to address the short-run costs or long-term trends. Seems like it will only shift costs downward in the long run (not a bad thing, just not a panacea).

[RobLL]

From Wednesday's NYT

Mr. Summers said the top priority in overhauling Social Security would be to make sure that people could rely on their benefits. President Bush tried and failed to overhaul Social Security, in part by letting people divert some of their payroll taxes into individual retirement accounts and by scaling back the growth in future benefits.

Mr. Summers seemed intent on signaling that Mr. Obama’s idea of “reform” would be to strengthen the program rather rather than to partly privatize it.

But Mr. Summers said the big cost problems for the government are in
health care. Reducing the growth of Medicare costs by just a few tenths of
a percent per year, he said, would over a period of decades save enough
money to fill the projected shortfall for Social Security.

Note the last paragraph, it seems to indicate that Medicare is not that far out of balance.

[gregl515]

Letting the program negotiate drug costs would be a start.

[Charger]

http://online.wsj.com/article/SB1000...072865070.html

The CEO of Whole Foods, John Mackey, had an intresting op-ed in the Wall Street Journal. While I don't agree with all of it, there are some really good ideas. High deductible insurance programs and HSA's make alot of sense. People spend their own money much more frugally than they spend other's, but this still has the ability to pay for the large medical expenses that tend to bankrupt many people. Though I would also add in Flexible Spending Accounts (FSA's) should be available to everyone as well, not just those who have have employers that set them up. More competition for insurance providers that allow the customers to decide what is and what is not covered would help as well. I really like the idea of more transparent billing in the medical industry. If food producers have to list their ingredients in a simple regular way, why should the medical industry be any different.

[OldGuy]

Recent scientific and medical evidence shows that a diet consisting of foods that are plant-based, nutrient dense and low-fat will help prevent and often reverse most degenerative diseases that kill us and are expensive to treat. We should be able to live largely disease-free lives until we are well into our 90s and even past 100 years of age.

This would have killed if he had added "bring this editorial and receive 20% off your next purchase at Whole Foods".

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America

Wait a minute - you mean this wasn't somewhere in the back of the Founder's minds?

[russ]

From Mackey's Op-Ed:

Even in countries like Canada and the U.K., there is no intrinsic right to health care.Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them.

What's he smoking? It would be nice if he were to provide evidence that this is the case, but I think this statement is basically complete bullshit. Beaurocrats are involved in the decisions as to what will be covered---not sure how it's any different from insurance companies deciding what they will or won't cover.

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America

What tortured reasoning he displays.

Health care probably didn't exist anywhere else in the world as a "right" in the late 18th century. I guess that the massive changes in the ability to provide meaningful health care that have occurred over the past 100 years or so should have little influence on how we choose to deliver it in well-to-do nations.

Perhaps the founding fathers said nothing about health care as a right because health care as we know it didn't even exist at the time?

[RedLefty]

Originally Posted by russ

Perhaps the founding fathers said nothing about health care as a right because health care as we know it didn't even exist at the time?

But they had legal slavery and chicks who couldn't vote.

We've obviously lost our way since then.

[Charger]

Originally Posted by russ

Perhaps the founding fathers said nothing about health care as a right because health care as we know it didn't even exist at the time?

Poor people existed, but they did not mandate giving them anything.

[RobLL]

Just a note regarding health care in the "old days", the old days essentially date to the general availability of antibiotics AFTER WWII. A couple months after I was born in 1940 I contracted whooping cough, after a couple days in the hospital they sent me home to die, there was nothing they could do for it. My dad took time off for work, and spent most of his time feeding me over ripe bananas (that was the recommendation in those olden days). Obviously I survivied.

My point, until sometime between 1950 and 1970 for the most part we did not have or need medical insurance. In large part because expensive medical procedures did not exist/ did not do all that much good. And where they did surgeons and hospital would generally work out some sort of payment that would not bankrupt families. My dad's union job (he was an official) as was typical of union jobs and the west coast did provide medical insurance, although it was no where near such a high figure as today.

My clergy job did not provide medical insurance until the late 70s. I made a point to have our first two kids while I was in the military.

[Tintomara]

The people I've talked to who lived and/or grew up in Europe have told not to believe th hype about how great their system is. At best they have said they liked the EU types of systems for the simple things like a cold, but if they were really sick (cancer or something serious) the US is the place to be.

I second this.
The cancer treatment that saved my husband's life over the last year isn't yet available through the government-run health care system in Sweden, where I come from.

And then there's the waiting times. My father, who lives over there (and is costing the system a whole bunch of money because he smoked for 35 years and ended up with emphysema) gets his oxygen bottles delivered to his house for free -- but sometimes, it takes him three weeks of trying every day to get his doctor on the phone. My mother waited 2 1/2 years for knee-replacement surgery, because she was retired and not considered "productive" for society. Some years ago, doctors in Sweden approached the politicians about getting a formalized "prioritization list" (for lack of a better word), because they end up prioritizing every day, based on their best judgment. The politicians were shocked at the concept. And yet, the practice is there, just not codified.

I'm not saying this is evil and awful -- just that there are downsides to that system, too. And it doesn't in any way encourage personal responsibility.

I don't know what the solution is. I know that the system as it was set up in Sweden worked very well in a homogenous society where people didn't use the system more than absolutely necessary. For about 2 generations. Then came my generation, who ran to the doctor for every sniffle and maxed out the free prescription drugs, and didn't have the sense of every visit actually costing us, the tax payers, money.

I have a feeling, judging from how people behave with the cash for clunkers program, that we'd have that same problem here: People jumping at the chance of getting something for free, and using the system whether they really need it or not.

[russ]

Originally Posted by Charger

Poor people existed, but they did not mandate giving them anything.

Universal health care isn't the same as madating giving the poor anything. The issue surrounding universal health care is whether or not a basic level of quality health care should be considered right or a privilege in modern, wealthy nations. In the Western world outside of the US, it is generally viewed as a right. Universal systems take on various forms and most allow a large chunk of health care to be delivered by the private sector.

My own belief is that basic quality health care is a right, not merely a privilege, but I don't demand that others agree with me. Individualism is deeply ingrained into the American psyche (I tend to refer back to the concept of "rugged individualism", which is central to American history and folklore), and large scale governement intervention tends to be eschewed. As such, the notion of universal health care may be a a bit of an anathema to many in the US. And I would add that there is, IMHO, much good that has come from America's core values stressing individual achievement; the US didn't become a superpower by accident, and there is nowhere in the world that I know of that so actively encourages ingenuity and innovation.

FWIW, I think much of the phenomenon of man-made climate change denialism seen in certain ideological circles is the other side of the same coin, i.e., any counterattack to man-made climate change would likely involve massive government intervention, so those who oppose such find their best best tactic is to deny that the problem exists.

That being said, health care delivery to the average American is below standard compared to much of the Western world (keep in mind that I've already stated that I'm quite convinced that the best available health care in the world is that which is available in the US, to those who can afford it). I don't see how this is tolerable, regardless of one's political orientation.

[chris_f]

Russ, your comments on American individualism reminded me of this talk on TED: http://www.ted.com/talks/alain_de_bo...f_success.html

Definitely worth a watch!

[russ]

Thanks for the link Chris. I'm going to watch it later today.

[chris_f]

Originally Posted by russ

Thanks for the link Chris. I'm going to watch it later today.

Thanks, and sorry for not providing any context. The speaker discusses how the Western (and particularly American) idea that we all are in total control over our success or failure has some pretty severe psychological consequences. Short and interesting!

[PowerManDL]

An interesting perspective on this particular topic (and really applicable in a more global sense):

http://scienceblogs.com/cortex/2009/08/information.php

[Charger]

Originally Posted by russ

Universal health care isn't the same as madating giving the poor anything. The issue surrounding universal health care is whether or not a basic level of quality health care should be considered right or a privilege in modern, wealthy nations.

The founding fathers didn't think food or shelter was a right. It's logical to think they would have felt the same about health care. Since the gov't creates nothing by itself, the only way to get food, shelter, or health care would be to take the money from someone.

[russ]

Originally Posted by Charger

The founding fathers didn't think food or shelter was a right. It's logical to think they would have felt the same about health care. Since the gov't creates nothing by itself, the only way to get food, shelter, or health care would be to take the money from someone.

The founding fathers lived almost two and a half centuries ago, in a time where the very notion that any of those things could be provided in a manner that isn't overly onerous on the populous would likely not have made sense. As well, those same founding fathers might look at other Western nations and note that they pay signifcantly less for health care than Americans do, yet achieve slightly better results for the population as a whole (once again, keeping in mind that those at the top of the food chain in the US probably do get better care than anywhere else in the world)---the apparent cost savings might well have appealed to them.

The founding fathers weren't infallible---their reasoning was based on late 18th century standards which may not hold true today. OTOH, I've already stated that I believe that much ingenuity and innovation is related to America's focus on individual achievement, so I can understand why the notion of universal health care is foreign or unappealing to many Americans.

Supposing that you could be convinced that a system providing universal health care to Americans could produce equivalent or superior results at about 60% of the cost (most Western nations spend roughly 40% less of their GDP on health care compared to Americans), would you go for it? I'll up the ante by adding a clause that abortion won't be funded within the context of universal coverage. It seems to me that opposing a less costly and equally effective plan based on ideologic leanings is a way of biting off your nose to spite your face.

You may find these articles to be of interest:

http://newsweek.washingtonpost.com/o...alth_care.html

The Catholic Church teaches that health care is best viewed as a right and recent events demonstrate the wisdom of that teaching. Health care as a right is the Pro-Life position.

http://www.usccb.org/healthcare/


"The Catholic bishops of the United States offer the following criteria for fair and just health care reform. Health care reform needs to reflect basic ethical principles. We offer these as a guide:
■ a truly universal health policy with respect for human life and dignity;
■ access for all with a special concern for the poor and inclusion of legal immigrants;

pursuing the common good and preserving pluralism including freedom of conscience and variety of options

restraining costs and applying them equitably across the spectrum of payers

http://www.catholic.org/politics/story.php?id=34181

The above presents an interesting clash of opinions.

The above links are US based sources, but, FWIW, some google searching on the topic leaves me with the impression that the Catholic Church outside of the US is strongly in favour of universal health care systems.