How to control healthcare costs in the United States

[1969912 0]

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Bingo......the people that are well off can afford it, but the people that aren't well off can't. Really it boils down to one of two decisions:

1. we cover everybody and act as a society
2. we cover only ourselves and act individually

I think there would be great pride in having a country that everybody is healthy in and acts as a group rather than only worrying about themselves.

If you want Socialized healthcare, start volunteering to help on the campaign for a candidate who supports that kind of plan.

"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG

[nathaniel 0]

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We would actually spend half or less than half of what we do now if we were to go down the right path and cover everybody.

Increasing coverage will increase costs. It's straight supply and demand. How could it be otherwise? There aren't economies of scale in healthcare. More healthcare costs more than less healthcare.

Enslaving doctors at lower wage isn't a realistic option, and wouldn't work anyway.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[lawrocket 3]

I'm not aying it is feasible, either. All I AM saying is that for "health care" to be "affordable" and "quality" - especially under a socialist system - then access is going to be rationed and "society" will pick its winners and losers.

Societally and economically - from a policy standpoint - the "losers" will be those who do not benefit society but take from society. Having gramps around is a nice thing - for the 2 or 10 or 50 people in the family. But it causes a drain on the other 250 million people here. Thus, the interests of the group (as I have heard stated in this thread) must take precedence over the interests of others. If gramps is just circling the drain, why

I personally find this repugnant. But it's a solution. Anything that takes into account people's will and desire to live - and to remove all stops in that quest - will be expensive. So, health care costs will skyrocket.

It's just that simple. How do we want healthcare?

My wife is hotter than your wife.

[Zipp0 1]

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Enslaving doctors at lower wage isn't a realistic option, and wouldn't work anyway.

If it's OK to limit the amount of money you can sue them for, aren't you limiting the income of lawyers and clients?

Also, other professions sometimes agree to a lower wage in order to save the business. For instance, airlines and auto makers.

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Chuck Norris doesn't do push-ups, he pushes the Earth down.

[lawrocket 3]

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You're missing the importance of balance.......those people that you're talking about cutting off are the people that helped build this country, I think they deserve a little bit more respect than that.

So do I. But do you think government can do that? Do you trust Bush to manage a balanced health care system? What do you think would happen?

My wife is hotter than your wife.

[nathaniel 0]

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We have more disposable income than most countries in the world. We can afford SUV's, storage units, boats and private airplanes. There are whole stores dedicated to selling boxes, containers and shelves to store all our crap in. The statement "we can't afford any more" makes zero sense.

Until you get to the numbers. It's crooked accounting to extrapolate from your circle of friends. their healthcare needs, their SUVs and box stores to the whole US.

Would you pretend that Medicare can continue past 2020 at its current burn rate, or that it could have continued at its burn rate prior to the prescription drug benefit passed a couple years ago?

Medicare vs GDP

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/06/09/the_coming_crisis_for_medicare/

Google for medicare bankrupt 2007 to find a recent article from a media outlet with your favorite bias on the same issue.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[Zipp0 1]

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How do we want healthcare?

What would happen if we outlawed all forms of health insurance? Wouldn't that drive prices down to more realisttic territory?

Just a thought.........

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Chuck Norris doesn't do push-ups, he pushes the Earth down.

[Darius11 12]

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We as a society will not turn away a gravely ill patient because he cannot pay

Prevention costs less then a cure, would we help prevent health issues become major problems or just act or only after.

I'd rather be hated for who I am, than loved for who I am not." - Kurt Cobain

[billvon 2,991]

>Would you pretend that Medicare can continue past 2020 at
>its current burn rate . . .

Nope. We need to overhaul the system - which is why I support a two-tier system that replaces medicare.

[1969912 0]

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I'm not aying it is feasible, either. All I AM saying is that for "health care" to be "affordable" and "quality" - especially under a socialist system - then access is going to be rationed and "society" will pick its winners and losers.

Societally and economically - from a policy standpoint - the "losers" will be those who do not benefit society but take from society. Having gramps around is a nice thing - for the 2 or 10 or 50 people in the family. But it causes a drain on the other 250 million people here. Thus, the interests of the group (as I have heard stated in this thread) must take precedence over the interests of others. If gramps is just circling the drain, why

I personally find this repugnant. But it's a solution. Anything that takes into account people's will and desire to live - and to remove all stops in that quest - will be expensive. So, health care costs will skyrocket.

It's just that simple. How do we want healthcare?

I didn't think you though it was feasible.

"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG

[billvon 2,991]

>would we help prevent health issues become major problems or just act or only after.

Would depend on what was cheaper. For example, just plain giving away prenatal vitamins to pregnant women is far, far cheaper than dealing with the potential birth defects that can be avoided by better nutrition. So we'd do that. Addiction treatment programs that have a high recidivism rate - probably not worth it.

[1969912 0]

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What would happen if we outlawed all forms of health insurance? Wouldn't that drive prices down to more realisttic territory?

Just a thought.........Unsure

Are you talking about just the savings because there is no middleman taking a cut? It's probably not a huge %.

"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG

[nathaniel 0]

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I support a two-tier system that replaces medicare.

Any system that is affordable will provide fewer and lesser benefits on average than Medicare.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[Zipp0 1]

No -0 ALL health insurance. Everyone must pay out of pocket for everything health related.

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Chuck Norris doesn't do push-ups, he pushes the Earth down.

[billvon 2,991]

>Any system that is affordable will provide fewer and lesser
>benefits on average than Medicare.

That would be true if Medicare was the most expensive, most efficient possible system. Neither is true, therefore your statement isn't either.

[nathaniel 0]

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What would happen if we outlawed all forms of health insurance? Wouldn't that drive prices down to more realisttic territory?

More/most people who got sick would die, or go bankrupt treating relatively minor conditions.

The idea of insurance is that many (but not all) people prefer and would voluntarily assume a small financial ding with certainty than a large financial ding whose expected cost (probability times cost) is less on average than the small ding. Insurers balance the books to make this happen.

The problem is that many people think of insurance and get ideas of wealth redistribution; the rich paying for the poor to get more healthcare. That's not insurance at all, that amounts to a welfare check.

Insurance does not, and cannot perform wealth redistribution on its own.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[nathaniel 0]

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That would be true if Medicare was the most expensive, most efficient possible system. Neither is true, therefore your statement isn't either.

Subtracting the inefficiencies from Medicare, considering its benefits only would still result in a system that is not affordable.

What proportion of Medicare dollars do you think is spent on actual benefits?

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[billvon 2,991]

>considering its benefits only would still result in a system that is not affordable.

Is it your position, then, that the US would be unable to afford ANY increase in the medicare system? (even assuming we don't overhaul it)

[1969912 0]

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No -0 ALL health insurance. Everyone must pay out of pocket for everything health related.

If the insurance companies have been competing in a free market, then their cut might not be all that big. With the huge cashflow going through them, they shouldn't need a huge % to make good money.

There is another cost increase that was caused by using insurance and direct transfer of benefits from the employer to either the doctor or the ins. co. Read this:

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Two simple observations are key to explaining both the high level of spending on medical care and the dissatisfaction with that spending. The first is that most payments to physicians or hospitals or other caregivers for medical care are made not by the patient but by a third party—an insurance company or employer or governmental body. The second is that nobody spends somebody else’s money as wisely or as frugally as he spends his own. These statements apply equally to other OECD countries. They do not by themselves explain why the United States spends so much more than other countries.

No third party is involved when we shop at a supermarket. We pay the supermarket clerk directly: the same for gasoline for our car, clothes for our back, and so on down the line. Why, by contrast, are most medical payments made by third parties? The answer for the United States begins with the fact that medical care expenditures are exempt from the income tax if, and only if, medical care is provided by the employer. If an employee pays directly for medical care, the expenditure comes out of the employee’s after-tax income. If the employer pays for the employee’s medical care, the expenditure is treated as a tax-deductible expense for the employer and is not included as part of the employee’s income subject to income tax. That strong incentive explains why most consumers get their medical care through their employers or their spouses’ or their parents’ employer. In the next place, the enactment of Medicare and Medicaid in 1965 made the government a third-party payer for persons and medical care covered by those measures.
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"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG

[nathaniel 0]

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Is it your position, then, that the US would be unable to afford ANY increase in the medicare system? (even assuming we don't overhaul it)

When the Comptroller says that the present system is unaffordable, I take it to mean things that cost more than it are also unaffordable.

Also I take it at face value when he says that the rate of increase is the killer, and that we need either massive tax hikes (unaffordable in their own right) or drastic benefit reductions to make it affordable.

The whole proportionality argument in analogy to other developed nations is a fallacy because despite our first world bravado we have a third world nation amongst us. First world bravado doesn't pay the bills.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[1969912 0]

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What would happen if we outlawed all forms of health insurance? Wouldn't that drive prices down to more realisttic territory?

More/most people who got sick would die, or go bankrupt treating relatively minor conditions.

The idea of insurance is that many (but not all) people prefer and would voluntarily assume a small financial ding with certainty than a large financial ding whose expected cost (probability times cost) is less on average than the small ding. Insurers balance the books to make this happen.

The problem is that many people think of insurance and get ideas of wealth redistribution; the rich paying for the poor to get more healthcare. That's not insurance at all, that amounts to a welfare check.

Insurance does not, and cannot perform wealth redistribution on its own.

You're right, but Friedman suggests using something like a medical savings account for basic, low cost expenses, and have a shared pool for catastrophic events. I have not read that part closely yet.

"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG

[billvon 2,991]

>When the Comptroller says that the present system is unaffordable, I take
>it to mean things that cost more than it are also unaffordable.

Ah, I see your point now.

It is certainly true that revenues and spending are quite mismatched (on the order of about 100 billion) and that needs to be fixed. That, however, does not mean that more healthcare is not affordable, any more than the Countrywide bank impending bankruptcy means that homes are no longer affordable. Don't confuse what's wrong with medicare with what we can or can't afford.

Take the Iraq war; costs for that so far are around half a trillion. Since we are affording it, it's safe to argue that we can afford it. Cancel that war and spend that money on medicare. That will close the deficit we're seeing now and allow us to actually increase spending - all without any new income.

>and that we need either massive tax hikes (unaffordable in their
>own right) or drastic benefit reductions to make it affordable.

I'd propose:
-repurposing the Iraq war money to medicare
-restructuring medicare to be part of that two-tier system I was talking about earlier

>The whole proportionality argument in analogy to other developed
>nations is a fallacy because despite our first world bravado we have a third
>world nation amongst us. First world bravado doesn't pay the bills.

I'm not claiming that.

[rehmwa 2]

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>Take the Iraq war; costs for that so far are around half a trillion. Since we are affording it, it's safe to argue that we can afford it. Cancel that war and spend that money on medicare.

well, that's half right. How about not spending the money at all

cancel the war
cancel other stuff
lower taxes going forward so people can buy insurance based on their individual needs

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Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[billvon 2,991]

>How about not spending the money at all

Cause then there is no public assistance at all. Girl hit by a car? Check her purse. No insurance card? No wad o'cash with notarized letter authorizing payment from said wad? Let her bleed to death.

We don't do that (fortunately) because we have a policy that we help everyone in emergent situations, which is how it should be. That means we offer care even when there is no evidence that people can pay for it - and indeed often do not. That's de facto 'social coverage.'

Things that will not work:

-letting people die (too much compassion)
-making everyone pay no matter what (too much compassion, not enough debtor prisons)

So you are going to have a level of care where everyone is seen. How does that get paid for? You can do what you do now, which isn't working too well. You can come up with a better plan that covers such expenses, which is what I support. That way you get that minimal level of coverage, and people can decide what they want beyond that.

[rehmwa 2]

I didn't say cancel existing public health assistance. I said don't move one bad investment into another bad investment.

The support you are talking about is what we already do - according to Billvon in other posts..... Why advocate moving funds into an area already covered?

edit - "cancel other stuff"....

"other stuff" = wasteful and useless programs - to be interpreted by each reader to mean whatever programs they personally don't like

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Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants