How to control healthcare costs in the United States

[brierebecca 0]

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how to control the costs of healthcare in the United States.

Based solely on my experiences since I've been in practice, the answer is tort reform. Real tort reform, not the pussy version that exists in most states today. We routinely spend upwards of 50K on cases before we can force the other side to get an expert opinion. That is, we spend 50K before the plaintiff will pony up the dough to get someone qualified to tell them whether their case is purely frivolous. That's bullshit. And it drives up costs tremendously.

Brie

"Ive seen you hump air, hump the floor of the plane, and hump legs. You now have a new nickname: "Black Humper of Death"--yardhippie

[lawrocket 3]

Oh, I agree. Recall I used to defend doctors for a living. My issue is what kind of tort reform. It's difficult to handle things like that to get tort reform without chilling legitimate grievances.

My wife is hotter than your wife.

[nathaniel 0]

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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.

That is not a safe assumption. We could nominally "afford" Medicare by printing money or issuing large quantities of bonds. That doesn't mean we can really afford it. It means we can juggle the books to postpone the collapse at the cost of making the collapse that much worse when it happens.

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Cancel that war and spend that money on medicare.

Medicare is in a position of oligopsony. IOW vast increases in Medicare spending will increase the marginal price of health care. Not lower it, per the popular delusion.

What do you think is the elasticity of supply of healthcare? Is there slack in our hospital system anywhere? Do you think we could schedule a 100% or a 50% increase in operations, consultations, radiology, pharmaceutical services etc next week and continue it indefinitely? Hire a few more doctors down the street from in front of the Home Depot?

This is the far side of the problem of fixing prices. Price fixing is already done to a certain extent today with Medicare pricing and reimbursement rules. The result is increasing numbers of health care providers rejecting Medicare patients, and overcommitment, stretching thin, and decreasing quality of care those resources that remain to accept Medicare patients. Look no further that Zimbabwe for a real-world experiment in price fixing.

Loading the system by increasing demand relative to supply, whether by fixing prices (and reducing supply) or increasing demand will have similar effects, at least in the short to medium term.

In the long term, you're staring down the GDP. Health care spending is increasing faster than the GDP. That can only go on so long before consumers, taxpayers, and / or the government run out of money.

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

[billvon 3,031]

>That doesn't mean we can really afford it.

You can argue that we cannot "afford" the war. However, we are currently paying for it and shouldering that amount of debt - so that money is available. Whether or not such financial policies are good ideas in the long run is a conversation for a different thread.

>What do you think is the elasticity of supply of healthcare?

It's as elastic as anything else in the long term (10 years or so) - not so elastic in the short term.

>Do you think we could schedule a 100% or a 50% increase in operations,
>consultations, radiology, pharmaceutical services etc next week and
>continue it indefinitely?

If we did it tomorrow? No. If we did it over ten years? Yes. (BTW we will continue to use more and more services no matter what we do with medicare, so it's not really a medicare-specific issue.)

In any case, no one is talking about increasing medical care by 100%.

[billvon 3,031]

>The support you are talking about is what we already do - according
>to Billvon in other posts.....

Because we "cover" this by allowing hospitals to pay for it; they (often) end up bankrupt. This is a bad way to handle it, akin to solving a military funding crunch by simply not paying soldiers or suppliers. Sure, it solves the problem, but it's somewhat immoral and there are some significant long term problems associated with that plan.

[sv3n 0]

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

I think we should do both.

Get in a car accident? The care to save your life is covered by the government. The surgery to reconstruct your nose so it's not crooked any more - that's not covered.

Kid has allergies? Emergent care is covered, and he gets some benadryl or claritin. Want an allergy workup done? Not covered. For that you'll need insurance (or you can pay cash as always.)

Liver disease? Basic hospital care is covered. Transplant isn't.

We as a society will not turn away a gravely ill patient because he cannot pay - and that's as it should be IMO. Everyone gets basic care even if they can't afford it. We should do a better job of dealing with paying for such care, such that hospitals/counties/doctors don't go bankrupt trying.

Beyond that, keep it purely capitalistic. Want the latest wonder drug? Need Viagra, or a new nose? Want a new hip joint instead of painkillers? Then get good insurance and/or pay directly.

Can't agree with you........it leads back to the same thing. You're making healthcare only for the people that have money or at least enough of it for insurance. A lot of people don't have an extra $12,000 a year to spend on healthcare and that's where your route wouldn't work.

Example....liver disease....so you'll cover the basic medical care, but not the transplant. so in the long run you would spend more money. The person would end up back in the emergency room again and again until they got the transplant. Or if denied that they would die.

Same trap..........the rich will be fine and the not so rich will suffer.

...and you're in violation of your face!

[sv3n 0]

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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?

A few people would make a lot of money and a lot of people would die. But then again there's only a little time left of that. We'll see what happens in the upcoming election.

...and you're in violation of your face!

[sv3n 0]

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

Interesting thought..........two outcomes that come to mind.

1. healthcare prices drop and we live happily ever after

2. healthcare prices stay and it becomes a commodity for the rich

...and you're in violation of your face!

[billvon 3,031]

>You're making healthcare only for the people that have money or at least
> enough of it for insurance.

No, everyone gets basic healthcare.

>A lot of people don't have an extra $12,000 a year to spend on healthcare
>and that's where your route wouldn't work.

Right now, they are shit out of luck. They either pay up front (which they can't do in your example) or they go to the ER for treatment, don't pay and get attacked by collection agencies. Or they get no care at all.

Under my plan they get basic care - for no cost to them. That's an improvement over what we have now.

>Example....liver disease....so you'll cover the basic medical care, but not
>the transplant. so in the long run you would spend more money.

No. Basic care is covered; you would pay for the transplant. Thus you'd spend less overall.

>The person would end up back in the emergency room again and again
>until they got the transplant. Or if denied that they would die.

Correct. Which is why you might choose to get catastrophic coverage for much less than health care costs now. Or you might decide to gamble and get no insurance at all, and hope you never need a liver transplant. If you gamble and lose - you lose.

>Same trap..........the rich will be fine and the not so rich will suffer.

That will be true under any conceivable plan. (Unless you prohibit doctors from receiving payment from patients, which I think is absurd.) You have some level of care 'free' and you get better care if you can pay.

[sv3n 0]

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You have some level of care 'free' and you get better care if you can pay.

Exactly, if you're rich you get good healthcare where everything is covered, if you're not bugger off if it's more than a sprain we don't like yer kind round these parts.

That's bs. While I agree that at least basic coverage is an improvement....it's not the solution to the problem.

If 18,000 people are dying a year right now because of lack of insurance it would still be same under your system. Since there is no long-term or preventative care they'd still be screwed unless they had money, which makes people special and priviledged enough to see a doctor and get properly treated.

...and you're in violation of your face!

[rushmc 23]

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

I think we should do both.

Get in a car accident? The care to save your life is covered by the government. The surgery to reconstruct your nose so it's not crooked any more - that's not covered.

Kid has allergies? Emergent care is covered, and he gets some benadryl or claritin. Want an allergy workup done? Not covered. For that you'll need insurance (or you can pay cash as always.)

Liver disease? Basic hospital care is covered. Transplant isn't.

We as a society will not turn away a gravely ill patient because he cannot pay - and that's as it should be IMO. Everyone gets basic care even if they can't afford it. We should do a better job of dealing with paying for such care, such that hospitals/counties/doctors don't go bankrupt trying.

Beyond that, keep it purely capitalistic. Want the latest wonder drug? Need Viagra, or a new nose? Want a new hip joint instead of painkillers? Then get good insurance and/or pay directly.

Can't agree with you........it leads back to the same thing. You're making healthcare only for the people that have money or at least enough of it for insurance. A lot of people don't have an extra $12,000 a year to spend on healthcare and that's where your route wouldn't work.

Example....liver disease....so you'll cover the basic medical care, but not the transplant. so in the long run you would spend more money. The person would end up back in the emergency room again and again until they got the transplant. Or if denied that they would die.

Same trap..........the rich will be fine and the not so rich will suffer.

Look, with all due respect, your proposal is nearing socialism. Everyone should be responsible for themselves. (with a safety net for those the CAN"T, not those that will not) We can and do help those that can not help themselves. We have no responsibility for those that will not help themselves.

If you are responsible one can find employment that will provide health insurance. Those that can not or will not we pay for already, one way or another

I am sorry if this seems cold hearted to you, but it is what it is.


May I ask a question? What is your home country?

(It may be US or otherwise but I was just wondering)

"America will never be destroyed from the outside,
if we falter and lose our freedoms,
it will be because we destroyed ourselves."
Abraham Lincoln

[lawrocket 3]

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so in the long run you would spend more money.

Do you have any idea what the long-term costs of a lifetime of anti-rejection medication are? Besides just the medications, the ER trips and folks needing intensive care for sinus infection?

I don't buy that argument one bit.

My wife is hotter than your wife.

[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?

A few people would make a lot of money and a lot of people would die. But then again there's only a little time left of that. We'll see what happens in the upcoming election.

So you don't trust the government to run health care? Hmmm.

And you are arguing in FAVOR of it? Is that not somewhat despicable to argue for a system where the POTUS could determine that loads of people would die?

Incidentally, it's one of the very reasons why I'm arguing AGAINST it. I'm not putting my healthcare in the hands of anybody but ME. Not you. Not anybody but ME.

My wife is hotter than your wife.

[billvon 3,031]

>if you're rich you get good healthcare where everything is covered, if you're
>not bugger off if it's more than a sprain we don't like yer kind round these
>parts.

Imagine a poor patient with a broken leg. Two cases:

Today - no money? Bugger off.

My plan - no money? Let's get you an X-ray, make sure the break is set. We'll get a cast on that. Here's a prescription for painkillers because that's going to hurt. Stay off it for eight weeks; come back then and we'll get the cast off and check you out. What? You want surgery so you can jump on it sooner? Sorry, that's extra.

Which plan works out better for the poor?

>If 18,000 people are dying a year right now because of lack of
>insurance it would still be same under your system.

So you think providing basic care will not affect outcomes at all? If that's true, why are we even bothering with basic medical care? It's clearly not needed!

[nathaniel 0]

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You can argue that we cannot "afford" the war. However, we are currently paying for it and shouldering that amount of debt - so that money is available.

We can afford the war because it's presumed finite. Heretofore no one in this thread has proposed mugging our grandchildren for the exclusive benefit of the present crop of citizens, although that's what Congress is doing by increasing benefits instead of taking them away.

The money has to come from somewhere. Future wealth is a finite resource, and we share it with our grandchildren.

Your remarks imply that either
* the cost of health care will go down as spending on it goes up, which is self contradictory, or
* the extra benefits will be for a finite set of people at the expense of future generations, which is shortsighted, or
* the benefit will be diminished, which you won't endorse

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In any case, no one is talking about increasing medical care by 100%.

Let's do some math.

How much do you think we would increase gov't medical care by if we extended health care to everybody?

We've got 16% of people without insurance now. Versus approx 27% getting gov't health care now (source: wikipedia), that represents an increase of nearly 60%. Tack on another 5% for the underinsured to make it a 77% increase.

I'd like to see some good figures on the population that is presently without insurance, compared to the population that is on gov't assistance already.

Nobody was giving numbers in this thread, but we are definitely in the ballpark of a massive increase in gov't health care. Quite possibly on the scale of a 50% to 100% increase.

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

[georgerussia 0]

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I'm not going over all this........I'm not ready to write a thesis on healthcare.

I see. That is what I call populist - when you just throw in an idea which "sounds cool" without any thinking whether it could actually work, and how it affects everything.

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False.....if you for instance we're to take the amount from france of $2,736 and times it per population of 300,000,000 which would be $820.8 billion.

Right now we spend $1.9 trillion dollars on healthcare each year..........we just saved $1.276 trillion dollars.

Nope. If you take amount from France, you have to add the price of plane tickets to France as well, and it will cost much more. Otherwise how really are you going to make it work "like in France"?

Actually I wonder why didn't you take amounts from some poor African country - probably you would end up with less than $100 a year. This what a good populist would do, like in the good Soviet Union jokes, where the Party called the astronauts and tell them:
- Guys, you know, Americans have landed on the Moon. We must show them we're the best - in two months your shuttle should land on the Sun.
- Oops... heh.. but sir, the Sun is hot, how're we gonna land there?
- You guys think the Party is full of idiots? You think we do not know the Sun is hot? Everything has been settled, when your shuttle is landing on the Sun, it will be night time.

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And then we have the excess from the cut military budget......we're now rich and can afford to put that money into other programs like public schools.

Why? We don't have to. We already spend more on public schools than several African countries together. According to you it should be enough for us - as this is enough for them, right? - so no more spendind needed.

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This is affordable and would be a positive thing for this country.....everybody has the right to be healthy, it shouldn't be a priviledge.

And everybody has the right to be rich, is this correct? So I would start from this one, and I'm the first in line.

* Don't pray for me if you wanna help - just send me a check. *

[1969912 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.

Is that because it is a two-tier system?

"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

[georgerussia 0]

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Because everyone should be able to pay for cancer treatment, not only the rich.

Well, the quote above says that there are MORE people dying from cancer in Britain than in U.S. And I believe it, as it is the same in Russia. The "everyone should be able to pay for cancer treatment", where the government spendings are fixed (budget) means one of the following:

1. Cancer treatment is cheap. There will be enough money to treat anyone, but this results that the doctors earn very little, and therefore are not really committed to their job, which results in bad quality of service, and no drugs available. This means that you will be treated, but you'll die anyway unless you're really lucky, and got a good doctor. This happens in Russia.

2. Cancer treatment is expensive. The doctors are paid a lot, the quality of service is very good, and the doctors are striving to improve it as a result of competition. However because there is limited money, not everyone could get that quality service in time. This happens in Britain, and - I suspect - in Canada.

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I hope as a society we value life more then a profit.

Not really. I don't think there is a lot of people who give ALL their profit to save lives on Africans who suffer from some illness - and that means that a lot of people valued their profit more than the life of another human being.

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I also think most would agree that valuing a profit more then humane life is immoral. At least I hope most agree.

Yes, if you ask them. It's free to agree.

* Don't pray for me if you wanna help - just send me a check. *

[georgerussia 0]

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The system of UHC that you advocate sounds like something the old USSR would come up with, not something we would consider in the USA.

Nope. What was in ex-USSR is exactly the opposite - free healthcare for everyone with no cost. You had to pay for drugs, but it was not expensive, as all the drugs were made locally. Obviously the quality and the affordability suffered - it was easy to get an appointment when you have a sore throat, but if you need cancer treatment or bypass - your changes were not so great if you live outside Moscow.

* Don't pray for me if you wanna help - just send me a check. *

[georgerussia 0]

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Regulate the prices, bring healthcare down to a reasonable level, and make sure that everyone is covered.

I have already asked you - when you are trying to regulate "prices", you are regulating salaries. Do you want YOUR salary to be regulated as well if someone (like a homeless or a McDonalds employee) thinks you earn too much?

* Don't pray for me if you wanna help - just send me a check. *

[sv3n 0]

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>if you're rich you get good healthcare where everything is covered, if you're
>not bugger off if it's more than a sprain we don't like yer kind round these
>parts.

Imagine a poor patient with a broken leg. Two cases:

Today - no money? Bugger off.

My plan - no money? Let's get you an X-ray, make sure the break is set. We'll get a cast on that. Here's a prescription for painkillers because that's going to hurt. Stay off it for eight weeks; come back then and we'll get the cast off and check you out. What? You want surgery so you can jump on it sooner? Sorry, that's extra.

Which plan works out better for the poor?

>If 18,000 people are dying a year right now because of lack of
>insurance it would still be same under your system.

So you think providing basic care will not affect outcomes at all? If that's true, why are we even bothering with basic medical care? It's clearly not needed!

Take your same example in the quoted post and apply to someone with cancer.

Who has the most chance of surviving it, the rich guy who can spend all the money in the world or the poor guy who can't afford insurance?

I'm not saying basic healthcare wont help, but people get that right now anyways...........right hospitals are forbidden to turn people away. So with that standard in place..........there's still 18,000 people a year dying.

...and you're in violation of your face!

[sv3n 0]

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so in the long run you would spend more money.

Do you have any idea what the long-term costs of a lifetime of anti-rejection medication are? Besides just the medications, the ER trips and folks needing intensive care for sinus infection?

I don't buy that argument one bit.

Bingo.

...and you're in violation of your face!

[sv3n 0]

Wow......that's irrational thinking at it's best. Sounds like you're back peddling.

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I see. That is what I call populist - when you just throw in an idea which "sounds cool" without any thinking whether it could actually work, and how it affects everything.

Obviously, France is able to have healthcare and they're ranked number 1........also their healthcare rates are those provided.

So........it's not a wild fantasy, it's working right now.

Do you think people in france pay to fly to france everytime that they go to a doctor? Talk about wild right tangent....are you still enjoying the crack pipe?

If you're going to model your healthcare after someone else's it seems france seems like a good candidate..........they're ranked number one and their healthcare costs are half per person of ours.

...and you're in violation of your face!

[sv3n 0]

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Regulate the prices, bring healthcare down to a reasonable level, and make sure that everyone is covered.

I have already asked you - when you are trying to regulate "prices", you are regulating salaries. Do you want YOUR salary to be regulated as well if someone (like a homeless or a McDonalds employee) thinks you earn too much?

I don't disagree with you there......that's a hard road to follow. But if the reason our healthcare prices are so high is as plain as the prices are overinflated..........then how do you suggest we bring them down to a reasonable level?

...and you're in violation of your face!

[Royd 0]

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Regulate the prices, bring healthcare down to a reasonable level, and make sure that everyone is covered.

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I have already asked you - when you are trying to regulate "prices", you are regulating salaries. Do you want YOUR salary to be regulated as well if someone (like a homeless or a McDonalds employee) thinks you earn too much?

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I don't disagree with you there......that's a hard road to follow. But if the reason our healthcare prices are so high is as plain as the prices are overinflated..........then how do you suggest we bring them down to a reasonable level?

So, you think that the medical field should do it just because they are feeling altruistic? I dare say that there are very few people in the medical field who are truly 'called' to the profession.
How many doctors would we have if they knew that they had to invest the time and money required, out of their own pocket, and then be told by the govt. that they were only allowed to make $70,000 a year.
Maybe we could get the govt. to insist that those teaching in the universities only get to make $30,000 a year. After all, we have to cut costs.
How about the industries that build all of the different equipment? Should they only make a 1% profit?
Do you see where this is going? The next thing you know, we've got unqualified illegal aliens installing oxygen systems in the hospitals. But, hey, we are keeping down the price of health care.