Comments on: Single-payer health bill has healthier prospects than ever

By: Colin Lee

Colin Lee — Mon, 26 Jan 2009 21:02:49 +0000

The health care system, like any system, has three outputs — how many, of what kind, at what cost. That is all any system can produce. In the health care system, that translates to trade-offs among cost, quality, access. How many will have access to what quality of health care at what cost? No system can maximize all three.

Craig, you’ve bared your religious leanings as far as economics, but how much does your dogma bear out in actuality?

Why does Japan have the longest life expectancy (in spite of high tobacco and suicide deaths), the lowest infant mortality, and one of the lowest costs of care on Earth? We pay 16% of our GDP for our medical system compared to their 7%, yet ours has inferior quality of care and theirs covers everyone. Even when you consider technology as quality of care, Japan also uses several times more MRIs than we do. If today’s medical system considers one man’s liposuction to have more value than another’s lifesaving preventative physical, then what kind of ethical breakdown are you proposing?

I’m not arguing that any system is perfect, but certain systems are undeniably more inefficient than others regarding all three “outputs” you mentioned. Our system is undeniably inefficient by its very nature as a profit engine for middlemen to deny care.

By: Craig Westover

Craig Westover — Mon, 26 Jan 2009 18:35:58 +0000

Wow — a lot of misconceptions here.

First — in the current system we do not have health insurance, we have managed care system with prepaid medical care. Insurance is asset protection. In a free market system, patients choose their level of risk and convert unpredictable and unaffordable expenses to predictable, affordable expenses (premiums) and cover predictable and affordable expenses out of pocket.

If the concern is the uninsured, a better solution than screwing up the system for everyone is providing low-income families health care vouchers (think food stamps) and letting low-income people participate in a free market health care system with some dignity. Instead of herding the poor into government programs, provide them funding and let them make their own health care decisions with some dignity.

Managed care is managed care whether done by private insurance companies (that are private in name only given the excessive government regulation of the industry) or managed by government. Changing the managers doesn’t eliminate the fundamental problems with a managed care system. Someone else make your health care decisions for you and decisions are made without a pricing mechanism to determine their efficacy and value.

The universal system doesn’t reduce cost, it only shifts it. As long as one is healthy, not paying for insurance is great. But when you need care, you pay for it in terms of queuing up for treatment and the inability to get certain treatments deemed uneconomical by the government. Cost are passed on to the patient in terms of lower quality of life, pain, and uncertainty. In a universal system, “value” is always measured by the provider (government) irrespective of the standards of the patient.

The health care system, like any system, has three outputs — how many, of what kind, at what cost. That is all any system can produce. In the health care system, that translates to trade-offs among cost, quality, access. How many will have access to what quality of health care at what cost? No system can maximize all three.

In a free-market system where patients control the money, doctors determine what services they will provide at what price and insurance companies offer policies with varying degrees of risk and various price levels from which patients select, the patient in consultation with doctors and insurance agents decides what those trades will be. When government runs the system, someone else makes the decision for the patient, the doctor, and there are no insurance agents — the patient has no choice.

(Until The Canadian Supreme Court ruled differently, it was illegal in some parts of Canada for doctors to treat patients outside the system..No choice was allowed. Much like social security, it will be unallowable for people to opt out of a universal system. Choice is not an option for patients or doctors.

So here’s the trade-off, and let’s be honest about it. We can have a system based on individual freedom where patients ultimately control their own medical decisions, but in which they must accept responsibility for making those decisions or we can have a system based on equality where patients give up the right to make their own health care decisions in return for free service, the level of which is determine by someone else.

In the free market system, we have to face the issue of health care for low-income families. A part of the safety net can come from voluntary charitable sources, but we must be willing to consider vouchers paid for with tax dollars that enable low-income individuals to participate in the health care market.

In the universal system, we must acknowledge that the individual is but the means to an end and the end is an efficient health care system irrespective of the health car outcome of any one individual person. We find it acceptable to force people into a program without their consent and deny them choices that, while of value to them, might disrupt the system. We are willing to trade our independence and judgment for free stuff.

That such a program as universal health care would even be considered is a sad commentary on our ethics and knowledge of economic principles.

By: Gary Lee

Gary Lee — Mon, 26 Jan 2009 17:44:20 +0000

The easiest way to understand how health insurance companies in the US (known in the healthcare business as “payers”) look at patients actually receiving healthcare services is to know that every payment for a healthcare service is referred to as a “loss”. Insurance companies are not in the business of providing healthcare, they are in the business of loss prevention. In that respect, the insurance companies have a mission to prevent access to healthcare whenever they can. This sounds heretical and absurd, but it is the way payers actually operate. There are many people in the healthcare financing industry, as the payers are called, dedicated to loss prevention. They aren’t there to assure that we get what we think we are paying for, which is access to healthcare. Their job is to assure that their employers suffer as few lossses as possible. The insurance industry will tell you that the problem with healthcare is fraud and waste by doctors and others in the clinical care system trying to drive up revenues. The “fraud” the insurers talk about is often the attempt by a doctor or clinic staff to file the insurance paperwork in such a way that the care the doctor believes is medically necessary will be covered by the insurer. Much of this expensive extra paperwork is to carefully thread through the minefield of obscure rules and bizarre exceptions which the insurers build to justify refusing payment for care your doctor thinks you need. So who do you trust? Would you go to an insurance executive for care, or would you be more inclined to trust your doctor? A majority of doctors in Minnesota now support a single payer plan. They know how the system actually works, and they think the current system is broken. Let’s rely on their advice.

By: Eric

Eric — Sat, 24 Jan 2009 17:40:04 +0000

There’s a cancer in the American health care system: the for-profit element in insurance and medical care provision.

Princeton health care economist Uwe Reinhardt has said that when he attends international health care policy conferences it’s universally understood that to refer to some proposal as similar to what the Americans do is to characterize it as unworkable.

In case you haven’t seen it, I’d highly, highly recommend the PBS Frontline documentary Sick Around the World, which first aired earlier last year:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

The contrast between what we do and what’s going on in the rest of the world is substantial. One gets the overwhelming impression that America is comparatively unserious, almost studiously stupid, in thrall to a dogmatic belief that markets will solve all of our problems in light of overwhelming evidence to the contrary.

By: Keith Kuckler

Keith Kuckler — Sat, 24 Jan 2009 13:50:04 +0000

This is really great news. Remember when 20 years ago, we were all told that the way to keep health care affordable, was managed care. Durenburger, among others kept up the mantra for HMO’s, we have all seen the rise of that model, and, guess what? our health care costs have gone through the roof. How can you have affordable health care, when thirty seven per cent of the premiums are going to management and administration? The answer, as every advanced industrial society has proven, is that you can not. The answer is single payer, national health care for everyone, paid by everyone.

By: EddieP

EddieP — Sat, 24 Jan 2009 12:09:17 +0000

The insurance companies are the biggest roadblock to America’s healthcare effeciency. They diagnose, prescribe and decide who and how patients are treated. They are experts at practicing the three Ds(delay, deny and defend). Worse yet they steal thirty-one percent of of every healthcare dollar we spend. Elimination of the insurance companies from our healthcare system will provide coverage for all in a more affordable and efficient way and will actually help our economy.