Health Care

[OldGuy]

One area I am in solid agreement with the President is that health care is, and will continue to be, the biggest burden on the U.S. economy. IMO health care reform will be the toughest part of the President's agenda. The idea of providing care for all Americans while reducing the costs of the system do not juxtapose well.

Knowing this forum I think it's safe to say we all know something needs to be done. But what to do? The administration, legislators, doctors and other health care providers, hospitals and their owners, insurers, drug companies, patients - there are a lot of players who will be asked to give up something to improve the system. Understandably they will be looking to protect what interests they have earned up to this point. We have to wear both shoes when looking at this issue.

I'm throwing up this thread as a place to have discussions, articles, essays, ideas, opinions as it relates to the health care issue. I thinks it's a topic we can discuss without the rancor that rears up in other threads.

Manuel posted a link to this excellent article on another forum. It tries to look at differences in Medicare payments across similar and dissimilar demographics. One area it hits on is extensive use of testing as a substantial reason for the disparity. And that this disparity in payments does not lead to better health care. Legally I can understand why doctors would want to have all bases covered (rumors abound that the President may consider putting a cap on malpractice suit awards).

Admittedly I'm not a doctor so I don't know their side of the issue - my only point of reference are articles like this one. I know we have a few here so I'd be interested in their take on this. And from others, too - we're all players in this game in some form or other.

[3sweeties]

Seeing how inefficient the government runs medicare and medicaid, I'm unwilling to support government run health care. I've been of the mind that if the government want to do something they should offer health insurance coverage to people with the premiums based on income. This would help out those who make to much to be on medicaid but it is a stretch to buy their own private coverage. Plus it gives people freedom of choice which I think is utlimately very important.

We have had private insurance for 20 years because we are self-employed. This has its own set of problems which have caused us some difficulty. I wish there was an answer that ultimately left the consumer with a choice with out being left at the mercy of the government or the insurance company.

[RobLL]

Originally Posted by 3sweeties

Seeing how inefficient the government runs medicare and medicaid, I'm unwilling to support government run health care. I've been of the mind that if the government want to do something they should offer health insurance coverage to people with the premiums based on income. This would help out those who make to much to be on medicaid but it is a stretch to buy their own private coverage. Plus it gives people freedom of choice which I think is utlimately very important.

We have had private insurance for 20 years because we are self-employed. This has its own set of problems which have caused us some difficulty. I wish there was an answer that ultimately left the consumer with a choice with out being left at the mercy of the government or the insurance company.

This post is simply uninformed from beginning to end. Medicare, Medicaid, and VA are not without problems. The entire medical financial system is in crisis.

[eastcoastsurfer]

I think the first thing you must do is get to the root of the problem. Just why are costs so high and going up? It's easy to point at the evil insurance companies, but what they charge is simply the result of underlying issues.

Could it have something to do with the obesity crisis in the US? As a % of GDP the US pays more than any other country, but we're also the fattest in the world by far.

The problem is that neither side wants to talk about the real issue - how to manage risk. Should the smoker who is 100lbs overweight pay the same amount as someone who is considered healthy?

If you think about it, the entire problem can be boiled all the way back down to personal responsibility. Without somehow bringing that back (the last administration didn't try and the current one wants to remove even more) the problem will never be solved. We will simply limp along as the US declines.

*EDIT* Found more recent obesity information(2007). It's even worse now.

[OldGuy]

I think the insurance companies are doing a good job managing risk. They are quite profitable.

Should the smoker who is 100lbs overweight pay the same amount as someone who is considered healthy?

Since they can do it with auto insurance why not base health premiums on behaviors? You can even use it as a selling point - quit smoking, we take $2 a month off your premium - for every 5 points your BMI goes down that's another $2 - you're a surfer? Ooh, we need to add back $2. ;). Should annual health assessments be required and premiums adjusted according to results? Would this translate into overall cost savings while providing quality care?

[gregl515]

My brother's employer gives its employees pedometers and pays them to walk 10,000 steps a day. The company benefits by lower premiums and the employees get some pocket money and better health.

[eastcoastsurfer]

Originally Posted by OldGuy

I think the insurance companies are doing a good job managing risk. They are quite profitable.

Market cap wise United Healthcare is the largest insurance provider. They have an estimated ~$3 EPS for '09. That's not huge, but is stable, and based on their stock price it's not expected to grow very much in the future. I hope they are good at managing risk, since that is what insurance companies are supposed to do. *cough*AIG*cough*

Originally Posted by OldGuy

Since they can do it with auto insurance why not base health premiums on behaviors? You can even use it as a selling point - quit smoking, we take $2 a month off your premium - for every 5 points your BMI goes down that's another $2 - you're a surfer? Ooh, we need to add back $2. ;). Should annual health assessments be required and premiums adjusted according to results? Would this translate into overall cost savings while providing quality care?

You do know a lot of people get denied auto insurance because of their behaviors? Is everyone okay to start denying people health insurance for behavior? I wonder how long it will take once we have nationalized healthcare before quarterly check ups are required in an effort to bring down costs. Next would be banning of certain foods. Kids are pricey, maybe people should have to apply to have one. Inf fact, I might support this for other reasons lol. Final part might be trying to cut the costs for EOL care. This is an older article, but shows just how much the last year of life cost.

Estimates show that about 27% of Medicare's annual $327 billion budget goes to care for patients in their final year of life.

I think what's going to happen at the end of the day is that the republicans will stay in the insurance companies pockets and the democrats will keep chanting 'free' healthcare. Neither solution is going to work and neither addresses the real root problems.

[RobLL]

Demand for health care will always outpace funds for health care

Medical advances tend to be highly technological and expensive

Generally given the two previous, health care cost will always go up, or at least that has been the unintended result of technology so far. A way has to be devised to ration health care

There are people and areas of the country who/which abuse health care, and unnecessarily boost costs.

Rationing does not have to be as unfair as it seems, because for the most part rationing health care, per the European and Japanese model does not seem to affect life span, nor for the most part quality of life.

Smokers tend to die early enough that their all over health care may be lower than the non smoking population. Deciding who not to cover (smokers, obese, dare devils, those with risky sexual behavior) is likely not to be practical nor politically possible (and perhaps not even effective)

The government already is the biggest consumer IIRC of medical services in the US. What it does to keep costs under control is crucial. And for insurance and pharmacy companies who make huge profits, keeping this from happening is crucial.

Primary care physicians are widely believed to be underpayed. I am embarassed as a Medicare Recipient at how poorly my doctor is reimbursed, and it is illegal to do anything about it.

I myself think that we all can do something about those horrendous last year or two (or even months) of life, which boost medical costs. When its time for me to check out I intend to do so. And one does not have to be extreme about it and take advantage of 'Death with Dignity' solutions. There is simple refusal of medical care except for pain and comfort medications.

Oregon originally was going to use a set amount of money and cover everyone with procedures and practices which were known effective. They would not cover other procedures unless they had the money. Russ had some objections to this system, which as I remember he did not write a post about. Maybe he would give a longer answer.

I spent most of my life with gold plated medical coverage. Medicare and my retirement supplement is a step or two down, but that is OK with me, I really would rather see my kids and grandkids, and younger friends covered, and don't mind the co-pays I now have. I picture everyone not with a gold or silver plated plan, but an OK galvanized one. That plan would do what was essential, ration services with co-pays. Private insurance would offer upgrades, botique doctors, organ transplants, no co-pays, a lot more non-generic drugs etc.

[OldGuy]

You do know a lot of people get denied auto insurance because of their behaviors?

Yes, I do know that. I also know that if turned down you can go into an assigned risk pool where you will end up paying premiums that are 4-5x higher than those who pose less risk.

BTW, I'm not advocating for required yearly check ups and high risk pool medical insurance. Just throwing stuff out there to see what sticks.

Cynicism won't solve this either. And I'm probably more cynical than the next guy.

I think what's going to happen at the end of the day is that the republicans will stay in the insurance companies pockets and the democrats will keep chanting 'free' healthcare. Neither solution is going to work and neither addresses the real root problems.

While you spoke earlier about personal responsibility this last comment touches on the fiduciary responsibilities of the players involved. Some of the players have several that they must take into account. Balancing those responsibilities can be quite a task.

[Patricia]

Ko's brother is a lifelong Republican and an ER doctor. He wants Universal Healthcare in this country. He's also in agreement with me when I say we don't have "healthcare" in this country, but "diseasecare".

If anything, he's witnessed first hand for the last ten years, the effects of our for-profit health industry. I've also talked with several other medical professionals and a few retired docs - they're all for reform. Right now, as its been, insurance administrators have more say as to how they're to treat their patients. Doctors have to hire a middle person just to deal with insurance companies alone.

I'd LOVE to have that gold-standard healthcare that my Congress critters receive on my dime. They all seem to enjoy the benefits of a government sponsored healthcare and have never complained about it as well.

[NotForLong]

I feel like playing on the other side of the table tonight. TAX THE SHIT OUT OF THE RICH!

God, that felt great.

But on to more pressing matters...I'm not a doctor. Given that mea culpa, is it actually true that smokers and fat people cost more? As an example, I have 98 and 97 year old grandparents who are still doing quite well, are thin, and except for the fact that my Scottish grandma gave up 2 scotch and waters every day at the age of 90, have lived very healthy lives. They have also been on prescription medication for damn near 1000 things for 20 years now. I'm actually unsure if they aren't a far greater strain on the system than a smoker who dies at 55.

I mean, we ALL die...and with fat people and smokers dying earlier, are there up front costs that much higher than the people who get parkinsons, have heart problems, blah blah for 25 more years?

Uninformed question, but it just seems like we compare the costs of a smoker dying against a healthy person as though that person will never die, be on drugs for years, go through 5 years of chemo and hospice, etc.

[OldGuy]

There are a lot of people who are going to be taxed on this one. A value-added tax is being floated by some Democrats as a means to pay for health care reform. That will affect all classes but to greater effect on the middle and lower income classes. Is the value being added worth the reward?

[3sweeties]

Ron Paul on health care http://www.ronpaul.com/2009-06-15/ro...gs-much-worse/

[tkinsley]

Originally Posted by NotForLong

I feel like playing on the other side of the table tonight. TAX THE SHIT OUT OF THE RICH!

God, that felt great.

But on to more pressing matters...I'm not a doctor. Given that mea culpa, is it actually true that smokers and fat people cost more? As an example, I have 98 and 97 year old grandparents who are still doing quite well, are thin, and except for the fact that my Scottish grandma gave up 2 scotch and waters every day at the age of 90, have lived very healthy lives. They have also been on prescription medication for damn near 1000 things for 20 years now. I'm actually unsure if they aren't a far greater strain on the system than a smoker who dies at 55.

I mean, we ALL die...and with fat people and smokers dying earlier, are there up front costs that much higher than the people who get parkinsons, have heart problems, blah blah for 25 more years?

Uninformed question, but it just seems like we compare the costs of a smoker dying against a healthy person as though that person will never die, be on drugs for years, go through 5 years of chemo and hospice, etc.

Smoking does indeed increase cost on average to provide care, Eric--there are many additional things that smokers are prone to developing aside from lung cancer. Rob, they do die earlier, but often cost the healthcare system beaucoup dinero before that occurs. Poorly controlled diabetes also costs the system enormous amounts.

One of the main problems in the system is the push to do everything that is medically possible. Now, I'm all for advancement in medicine, but I am also in firmly in the "first do no harm" camp, and I'm sorry, but a super-preemie and a 99 yr old person who's spiraling the drain should not have, in general, hundreds of thousands of dollars invested in their care. As Americans we've been conditioned to expect that we will receive every medical intervention possible--well, it's time to face up to the fact that just because it's POSSIBLE to do something does not = an OBLIGATION to do it.

There are so many factors that have gone into the current situation we're in, but I think the first thing we all need to understand is that we will need to learn to accept what is needed and no more. For example, colds shouldn't be treated with antibiotics thru the ER, and all chest pain does not merit a huge cardiology workup.

I'm a military dermatologist, and I practice far, far differently than my civilian counterparts. I'm in a *GASP* government-run health care system that *HOLYSHIT* functions well. I can order what my patients need, AND I can tell them, nope, I won't do that. If they paid me more and couldn't send me to places where bullets fly, and if they also didn't control my every movement, I'd probably stay.

Having said that, the DOD budget has a very large and increasing proportion devoted to health care, so we're not playing with monopoly money here, either.

I'm interested to see what Russ has to say about this as well since he's in a socialized system. What I think needs to happen, at a minimum, for the system to function reasonably well:

1. Public option on health care. I'd prefer universal coverage, but I'm pragmatic, too.
2. Public health emphasis--HEALTH care rather than disease care as Patricia mentioned above
3. Tort/medical malpractice reform; doctors practice defensive medicine at this point.
4. Decrease unnecessary prescribing and lab/radiology studies
5. Living wills and medical powers of attorney being part of annual physical. This shit has to be clarified before the person in in the ICU on a vent that they didn't want to be on
6. Quit throwing the kitchen sink at everything and use some form of risk/benefit analysis before signing the damned order on the chart
7. More primary care providers need to be trained, and there should be more walk in and urgent care centers, preferably located by ERs so that if the triage nurse deems it non emergent, that patient can be shuttled to receive the cheaper care next door rather than have their cold treated in the ER at a ridiculous level of cost.

I've got more but I need more coffee to think about it.

[OldGuy]

Thanks for that, Tina.

Gleaned from another post, there are companies that are pricing premiums based on behaviors. The more I think about it, if it promotes better behavior (and the company thinks it does) I'm having less of a problem with this pricing plan.

[Charger]

Along with everyone else I believe there are big problems with our current system. I think one option is to treat it more like car insurance. Have companies taken out of the equation and have people purchase plans individually. This will lead to more options as well as lower prices due to increased competition. Help those out who cannot afford healthcare.

[eastcoastsurfer]

Originally Posted by tkinsley

1. Public option on health care. I'd prefer universal coverage, but I'm pragmatic, too.
2. Public health emphasis--HEALTH care rather than disease care as Patricia mentioned above
3. Tort/medical malpractice reform; doctors practice defensive medicine at this point.
4. Decrease unnecessary prescribing and lab/radiology studies
5. Living wills and medical powers of attorney being part of annual physical. This shit has to be clarified before the person in in the ICU on a vent that they didn't want to be on
6. Quit throwing the kitchen sink at everything and use some form of risk/benefit analysis before signing the damned order on the chart
7. More primary care providers need to be trained, and there should be more walk in and urgent care centers, preferably located by ERs so that if the triage nurse deems it non emergent, that patient can be shuttled to receive the cheaper care next door rather than have their cold treated in the ER at a ridiculous level of cost.

I agree with all of these, although 6 is going to be tough. Deciding who lives and dies is not an easy thing and often not one that people want to do.

4 is really a symptom of 3. If the Dr. doesn't do a certain test and misses something the Dr. gets sued. At what point does avoiding a test become malpractice though?

One of the morning guys on local radio is from England. His suggestions were similar to yours with #7 being a huge one. People in the US tend to use the ER as a clinic instead of something for emergencies. His most interesting comment though was how for everyday medical care he would prefer to be in England with their system, but if he had a serious disease he would want to be in the US.

[RobLL]

An illustration why Germany has lower costs. This is 15 years old so could be out of date. When a person has a heart attack and cannot be brought to consciousness on site, in Germany they are taken the the funeral home (or whatever is the equivalent). In the US, despite that fact that such a person will temporarily recover, they almost never leave the hospital alive.

Tina - aren't much of those medical costs offset by money saved on pensions?

[jvernacchio]

Seems like the way things are going small business owners wont be able to afford to cover employees in the near future leaving even more working people not covered and susceptible to the terror that is our modern outrageously expensive health care system. I guess they can just go file for bankruptcy if the bills get too far out of hand right?

Its out of control it needs to be fixed I don't think anyone has the "perfect" answer but right now its just plain FUBAR.

Health care costs choking small businesses


By Rachel Streitfeld
CNN
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WASHINGTON (CNN) -- Maryland auto shop owner Brian England offers health care coverage to his 18 employees, including part-time staff. He calls it "the right thing to do," and besides, he knows taking care of his employees makes good business sense.
Brian England, president of British American Auto Care, catches up on paperwork at the office.

But every year his insurance premium costs rise another 10 or 20 percent, and England worries about the day when the fees will overwhelm him. After payroll and rent, health care is his largest business expense.

"A business down the road could have their labor rate $5 cheaper than us because that's how much it costs for us to provide health care," England said, referring to the hourly rates his business and competitors might offer customers.

Of the 46 million Americans living without health care, an outsized majority -- about 60 percent -- work for small businesses, according to the nonprofit Employee Benefit Research Institute. Owners of those businesses say Congress needs to find a solution to an increasingly costly problem -- but they disagree about how to get it right.

For England, shopping for policies and finding a way to afford to offer the benefits has become a yearly headache.

"I'm in the business to do auto repair," England said. "I'm not in the business of trying to find out how to provide health coverage and how to get the right sort of plan.... And it's not easy."

David Guernsey, who employs 170 people at his office supply business in Virginia, has struggled with the same rising costs to cover his employees -- some years, premiums have gone up 25 percent.

His small company can't hope to compete with the benefits much larger companies can afford to offer their employees.


"Their premiums are dramatically lower than ours are," Guernsey said. "They have leverage over the health care industry to be able to drive their premiums down, and yet we have to be able to compete with those folks. So it increasingly becomes a major competitive issue for us."

Guernsey said that, occasionally, job seekers have complained that they're looking for a plan with more extensive coverage than Guernsey's provides, but he called the plan "pretty good, pretty competitive" and said no one has ever turned down a job offer in hopes of getting better benefits elsewhere.

Both Guernsey and England agree the problem of ballooning costs must be fixed, and they expect the government to take some role in addressing health care costs. Watch business owners discuss the challenges they face Video

Guernsey is skeptical of too much government involvement, and worries a mandate for employers to offer coverage could push up his premiums.

"If the requirement were such that the kind of coverage we offer were dramatically different, dramatically more comprehensive, and the cost accordingly would go up significantly -- then that would be a problem," he said.

Instead, he's hoping small businesses can pool their coverage with larger businesses in order to drive down prices.

England, however, said he would like to see a government health care plan and an emphasis on preventative care. He said a government plan would force insurance companies to offer competitive rates.

"I think once we get to doing that and everybody has insurance and we start to push it with the preventative care and community care, that's going to drive down the prices," England said.
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Taking preventative steps is, after all, something he's learned through his work.

"We've preached preventative care to customers with cars for 31 years," England said. "So if we know it works with cars, we know it works with people, we all know that. It's just a matter of everybody getting onto the plan."

[tkinsley]

Originally Posted by RobLL

An illustration why Germany has lower costs. This is 15 years old so could be out of date. When a person has a heart attack and cannot be brought to consciousness on site, in Germany they are taken the the funeral home (or whatever is the equivalent). In the US, despite that fact that such a person will temporarily recover, they almost never leave the hospital alive.

Tina - aren't much of those medical costs offset by money saved on pensions?

No. The average decrease in life expectancy doesn't offset that much. I smoked for 18 years and supposedly I only decreased mine by 3 years if I did nothing to change that risk. So, even a heavy lifetime smoker may be predicted to lose a decade or so on average.

Germany might be onto something. Banned smilie.

[RobLL]

From TPM today. http://tpmdc.talkingpointsmemo.com/2...-mentioned.php

Poll: Americans Overwhelmingly Favor Universal Health Care -- Until Taxes Are Mentioned
By Eric Kleefeld - May 29, 2009, 4:55PM
A new CNN poll shows just how tricky the debate over health care really is. People are all for expanded coverage and greater government involvement -- right up until they have to face the tradeoffs.

"In general, would you favor or oppose a program that would increase the federal government's influence over the country's health care system in an attempt to lower costs and provide health care coverage to more Americans?" Americans favor government intervention in the health system by 69%-29%.

"In general, would you favor or oppose a program that would increase the federal government's influence over the health care you and your family receive in an attempt to lower costs and provide health care coverage to more Americans?" When it involves their own care and their families, approval is still high, but a bit lower: 63%-36%.

"Do you think the federal government should guarantee health care for all Americans, or don't you think so?" Americans favor guaranteed health care for all, by a margin of 62%-38%.

Now here's where it gets really tricky: "Would you prefer a health care reform plan that raises taxes in order to provide health insurance to all Americans, or a plan that does not provide health insurance to all Americans but keeps taxes at current levels?" It is now a 47%-47% tie, thanks to the threat of tax increases.

I think the German's also include the ability to breath and heart beat on one's own or being conscious to qualify for hospitalisation.

[eastcoastsurfer]

Originally Posted by RobLL

From TPM today. http://tpmdc.talkingpointsmemo.com/2...-mentioned.php

Of course. Everything sounds great when it's someone else's money. People need to understand that no matter how 'free' it looks *everyone* ends up paying for it.

10% VAT here we come. If things keep going the way they look to be going the government is going to tax me into the lower class. LOL

Originally Posted by RobLL

I think the German's also include the ability to breath and heart beat on one's own or being conscious to qualify for hospitalisation.

So you can't be intubated and go to the hospital? I can't imagine that is true. If it is, it's just one more thing I don't think we should be following the Germans on.

[RobLL]

Originally Posted by eastcoastsurfer

So you can't be intubated and go to the hospital? I can't imagine that is true. If it is, it's just one more thing I don't think we should be following the Germans on.

I suppose the real question is how will the various interested parties set up their way of rationing medical care. And even more interesting, how will they describe it so as to avoid the label, 'rationing'. Or will they totally be unwilling to acknowlege this issue? I myself am comfortable that there be some rationing of medical care. And that is what private insurance ought to be for, to have expanded coverage that the government ought not to, and cannot afford to cover. I may or may not choose to pay for it, my decision, my responsibility.

[OldGuy]

A NYT article on rationing (they are using the term "best practices" now to avoid the controversy). I could imagine that a review to identify best practices, especially when broken down into sub-groups (gender, race, ethnicity, etc.) would take a long time before implementation. Would such a review stifle or aid new innovation?

[Axis]

After the trillion dollar price tag came in from the CBO, the Obama administration seems to be distancing itself far away from Ted Kennedy's plan . . .

Apparently responding to the CBO's numbers and the ensuing criticism of the Kennedy bill, Gibbs continued, saying "what is clear is what will happen if we let political posturing stand in the way of reform again: exploding deficits, lob loss, dwindling benefits, and millions more Americans joining the ranks of the uninsured. That's unacceptable, and that's why stakeholders from across the spectrum are joining with President Obama to enact health care reform that finally gets costs under control and expands coverage - without adding to our deficit."

The first came from Linda Douglass, communications director in the White House Office of Health Reform, who said in a statement that "President Obama has been clear that health care reform is critical to our nation’s fiscal future. It is not true reform if it is not deficit neutral There are several bills being written in Congress and committees in the House and Senate are working through many proposals. There is no final bill, and this process has a long way to go. We have not seen the CBO report so cannot comment on it."

Deficit-neutral intrigues me so I decided to check out the administration's plan . . .

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They seem to be making a big PR push for health care reform. Perhaps it would be a good idea to make sure the related part of the website isn't broken.

I'm pleased to see them becoming more deficit-shy. I've posted before that one of the reasons I voted for Obama was because I thought events on the ground would cause him to moderate some of his agenda items that I disagree with.

It will be interesting to see how they plan to fund this thing in a deficit-neutral way without increasing taxes on 95% of us.

[RobLL]

Originally Posted by OldGuy

A NYT article on rationing (they are using the term "best practices" now to avoid the controversy). I could imagine that a review to identify best practices, especially when broken down into sub-groups (gender, race, ethnicity, etc.) would take a long time before implementation. Would such a review stifle or aid new innovation?

That did not seem to be posted last night at 10PM PDT. Really a timely article. I have wondered if best practices/rationing could be introduced in a similar way my prescriptions are: - OTC - buy myself; generic $25 3 month supply; approved $70 for a 3 month supply; not approved expensive co-pays.

There is always an advantage of not telling people "No". As a parent I went out of my way to avoid saying it. (and of course this has the advantage of greater credibility when you do say it). I could see co-pays rising really fast as treatment or drugs are more expensive while providing no or little extra benefit. Most people are far more careful as they have to pitch in their own dime. And a standard hand-out providing a 'rationale' for the 'rationing'. Interesting, those two words. And supplemental insurance ought not to be banned, as in Canada (?), if someone wants insurance for all sorts of marginal or optional treatments I see no social benefit in telling them no.

In terms of innovation with so much of this done on an international basis new procedures could be done somewhere, but not everywhere at the same time.

[RobLL]

A thought on drugs: This is based upon the reality that governments of the developed world end up paying most of the costs for drugs anyway.

What if the various governments, based upon their "review board" made BIG lump sum payments to drug companies based upon how much the drug was worth in health benefits. (and should a new benefit be discovered later they could get a further bonus). Then the drug would subseqently sell as any generic - based upon the cost of manufacturing. Poor nations would benefit by having inexpensive access to all drugs, as they became more prosperous they would start having to make those same lump payments.

I can see no real disadvantage in this system. Drug companies would scream about no or low lump sums for "me too" drugs which were only marginally better than existing drugs, but tough luck on that one. Real innovation should be richly rewarded. Drug companies would know about how much money was available across the world every year for new drugs, and would compete accordingly. Should really super things come across, say a cure for Altzheimers, which would save untold trillions(?) governments would come up with extra money - happily!

[OldGuy]

Kids will make healthier choices. I know from personal experience that if I replace junk food snacks with fruits, veggies, yogurt they get eaten just like the cookies and cakes would.

[eastcoastsurfer]

Originally Posted by RobLL

And supplemental insurance ought not to be banned, as in Canada (?), if someone wants insurance for all sorts of marginal or optional treatments I see no social benefit in telling them no.

If the government plan is going to be so great why does there need to be supplemental insurance? By having supplemental at all it shows that the government plan is lacking. My guess is that the supplemental plans also will not have a tax break. So, at the end of the day companies will quit offering insurance and defer to the government plan. Individual supplemental insurance will most likely cost more than what I pay now. When all is said and done I'll end up paying more money for the same or less benefits. Brilliant healthcare reform!

Originally Posted by RobLL

I can see no real disadvantage in this system. Drug companies would scream about no or low lump sums for "me too" drugs which were only marginally better than existing drugs, but tough luck on that one. Real innovation should be richly rewarded.

Except drugs will not get developed. It's fun to think that drug companies come up with revolutionary new drugs out of thin air, but that is not how it works. Drugs (and science in general) come from small evolutionary steps. Those 'me too' drugs help pay the bills while they work on other science. They can also help invent new methods by solving solved problems in different ways. Those methods can then be applied on new problems.

Worst of all is you then put the government in charge of what drugs get developed. Look at what Bush did to stem cell research, do you really want the government in charge of telling the companies which drugs they can and can't develop?

[tkinsley]

I agree with you on the drug development issue and stifling of new drug discovery... but there has to be something to do to control costs of this stuff. As it is, it seems the US is footing the entire bill for R&D; how else is it that other countries pay pennies on the dollar for the same medications we pay hundreds or thousands for here?

Seems to me that the fundamental structure of big pharma needs to be scrutinized, and not necessarily by the government. THere should be a shared cost in drug development, period. Raping only or primarily the US health care consumer is not an acceptable method to finance this--IMO.