Health Care in the USA

Py,
Not really a simple way to put it other than the premise that people always make perfectly rational choices is simply misguided or false.

Studies show a group of people come to better decisions about things like survival, business decisions, etc.

What does that mean? Well, it means that we shouldn't trust the individual to make a rational decision all of the time. It doesn't mean people always make bad decisions.

Therefore, in order to achieve the economic "best of all possibilities" a rationale party, be that government, the insurance company, collective, etc; must make some people's decisions.

Take for example, the speed limit and traffic rules. While it is perfectly rational to stop at intersections and yield to pedestrians, not everyone realizes this. Thus, we have had to make laws to make sure people don't go speeding, fail to yield, and generally make the road a much more dangerous place than it already is.

Point being. We cannot trust ourselves to make perfectly rational decisions all the time. And therefore we need some guidance in the form of rules and laws.

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Originally Posted by ChrisL

I feel I'm ill informed about the current debate in regard to a national government run healthcare plan and it's my own fault. I have to read more on this issue. I say this because my understanding is that should some form of government run program be instituted, the crux of the issue then would be that you WOULDN'T be able to "go find another one". The government would decide what care you could or could not get. Am I wrong on this?

Chris L

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Being that there is absolutely NO bill or plan out there that either side is touting for... In simple terms, yes. But thats only because we have no idea what the bill is going to look like.

Now if the bill comes out and says, "you must go to these doctors here and stick with her for life and she can only prescribe you X treatments".... I would be opposed. Thats too much control. But if it gave you an open list of doctors who have opted in, and provides a list of basic services that are covered, and a list of optional services you can pay extra for... I wouldn't be opposed.

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Originally Posted by ChrisL

...the crux of the issue then would be that you WOULDN'T be able to "go find another one". The government would decide what care you could or could not get. Am I wrong on this?

Chris L

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Yes, you're wrong on that to a degree, but the bill is experiencing some changes as the bureaucrats earn their pay. The deal (I think) was that after five years, you'd have to be insured by either the government plan or a government approved plan, or a grandfathered plan that you held before the bill passed. Employers have to participate or be taxed at varying degrees depending on the size of the company. Citizens have to participate or be taxed.

The government would decide what plans qualify to be offered to the people, and also how the government insurance would cover its customers.

I really think this is a discussion about tools.

Is the federal government the correct tool to use to get better and less expensive health care for the US citizens?

The people pushing this concept seem to think so.

I think that what isn't understood is that for this to work, there needs to be a fundamental change in the way people use health care. Strangely enough, this will not work if there isn't a greater emphasis on personal responsibility. Some of the largest consumers of health care are people that just don't see that they need to be responsible for keeping themselves healthy and safe. Our citizens behave as if no matter what they do to their bodies, the correct medical care should be able to fix it. If they smoke, eat a high fat diet and don't exercise there is always a stent or bypass to patch them up and they can be on their way.

There seems to be a complete unawareness that having the government fund health care doesn't relieve the individual of the need to care for themselves. If they don't, any system will eventually will fall under its own weight.

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Originally Posted by Pyment

Is the federal government the correct tool to use to get better and less expensive health care for the US citizens?

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To me it looks like this is a fairly clear 'yes', just because with the current level of government involvment the results are trailing by many measurments behind the results produced by analogous systems with much heavier government involvment. Just about the only measurement that's ahead is innovation at the cutting edge, i.e. very expensive treatments.

The rising costs must be reigned in and it's pretty clear that providing cheaper care before the condition has deteriorated dramatically is a very important component of this. I really don't know all the numbers, but the policy makers have them.
From the debate so far I think it's unfortnate that arguments are more ideological and less technical. That's great for feeling important and self-righteous, but doesn't really solve the problems.

The insurance providers are willing to provide coverage for preexisting conditions as long as everybody is forced to have health insurance. At the end of the day the only way to lower the cost for higher risk is by increasing it for the lower risk. And I have sufficient number of friends who have condition requiring expensive health care despite being low risk.

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Originally Posted by gugi

And I have sufficient number of friends who have condition requiring expensive health care despite being low risk.

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I, and several people I know, have expensive mortgages. Maybe we need a government plan to address that issue too.

Just because the present system is not working for some, doesn't mean more government involvement is needed.

There are large parts of the current system that are working. In fact, some of the most non-working parts of the system are the parts that include the most government involvement.

For instance, a pediatrician I know works in Obama's home state, Illinois. They passed a program intended to improve the health of infants and children. (I believe that is one of the measures of health care effectiveness we are concerned about.) Physician participation is minimal. My friend is one of the physicians who participates (basically because she believes it is the right thing to do). She got her first reimbursement 5 years after she saw the patient. She was reimburse about 7 cents for every dollar billed. Obama was part of the legislature at the time this was passed and voted for it. In fact this was one of the accomplishments trumpeted on his website.

The government's record on reducing costs and creating efficiency in the health care system is not good. Medicare spending was considered out of control in the 80's. As a cost cutting measure, the congress decided to delay reimbursement by paying claims a month later and they shifted a whole months costs into the next budget basically at the expense of anyone who provided care to Medicare pts and had any overhead.

Currently Medicare cost are one of the largest expenses that the government has. Yet costs continue to rise pretty much unchecked.

Are we to expect, based on the record, that government is somehow going to be good at creating economy and efficiency in health care? Do we base our opinion on experience or on hope?

It makes more sense to find what areas work in the current system and model any changes in order to do more of that rather than repeat what has already been ineffective.

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Originally Posted by ChrisL

I feel I'm ill informed about the current debate in regard to a national government run healthcare plan and it's my own fault. I have to read more on this issue. I say this because my understanding is that should some form of government run program be instituted, the crux of the issue then would be that you WOULDN'T be able to "go find another one". The government would decide what care you could or could not get. Am I wrong on this?

Chris L

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You shouldn't feel to bad about not being familiar with whats going on.

No one is.

They haven't written it yet.

They want to have a vote to pass something amazingly huge and incredibly complicated before they write it and give the public a chance to comment on it.

Sound familiar?

What scares me most is that this is becoming this administrations way of doing things. Make up an idea, get the idea passed then write the law, not exactly the way things are supposed to work. In fact it is pretty much exactly the opposite of the way things are supposed to work.



As for health care: It is curious to me that about the only places where health costs are declining are lasic eye surgery and plastic surgery. It causes me to ask why costs are declining in those areas. The two reasons I come up with are: one, no insurance or government plans cover them, and two people shop around for the best price and service.

This leads me to believe that we would be better off paying out of pocket for everything and not allowing any direct payer system to exist. We would also have to force hospitals and care providers to Menu their services then so you could see up front what you had to pay. Or give written estimates of your care same as contractors do.

Yes there would still be things that would cost to much for any individual to pay for so we have insurance. But insurance would only be allowed to pay you. I'll make it easy on the companyss too they should only have to pay you what they have agreed to under your plan for a particular service this could be a percent but I think it would be better if it was actually an amount.

For example if you get a nosebleed ( to pick a ridiculous example). The insurance company would pay X to treat it. You would then have a choice: go to the Walmart hospital and pay x-n for your care pocketing the difference or using it to cover lost wages etc, go to the Sears of hospitals and pay x, go to the Macys of hospitals and pay x+n for great service, or go to the boutique service provider and pay xn for the best expert in the world.

The side that often gets left out of the health care debate is that of the Doctors. They do deserve to get paid for providing a service and they do deserve a premium if they are exceptionally good at their job, how does the government handle that?

I know that in Briton now the majority of doctors are actually foreign nationals, most from India, who are working in Briton for the higher wages as opposed to India and there are vacancies because being a doctor is no longer profitable enough for British teens to consider it a good career choice.

I also have a friend who is a dentist in Germany his salary is mandated by the government. No they don't pay him, but they do set the charges and profit margin for everything he does as well as set a maximum on his annual salary. The way it works is once he hits his salary he has to close up shop, this way all the doctors in Germany have the same opportunity to make the same wage. He finds it extremely frustrating because he considers the other dentist in town a hack, and is frustrated that he gets the same salary for shoddy work. By the way he also only opens part time because if he worked full time he would have to lay his staff off every year in July, when he could hit his salary quota. He'd rather they were able to keep their jobs so he only works half days year round. His receptionist and assistants have no salary protections.

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Originally Posted by Wildtim

You shouldn't feel to bad about not being familiar with whats going on.

No one is.

They haven't written it yet.

They want to have a vote to pass something amazingly huge and incredibly complicated before they write it and give the public a chance to comment on it.

Sound familiar?

What scares me most is that this is becoming this administrations way of doing things. Make up an idea, get the idea passed then write the law, not exactly the way things are supposed to work. In fact it is pretty much exactly the opposite of the way things are supposed to work.



As for health care: It is curious to me that about the only places where health costs are declining are lasic eye surgery and plastic surgery. It causes me to ask why costs are declining in those areas. The two reasons I come up with are: one, no insurance or government plans cover them, and two people shop around for the best price and service.

This leads me to believe that we would be better off paying out of pocket for everything and not allowing any direct payer system to exist. We would also have to force hospitals and care providers to Menu their services then so you could see up front what you had to pay. Or give written estimates of your care same as contractors do.

Yes there would still be things that would cost to much for any individual to pay for so we have insurance. But insurance would only be allowed to pay you. I'll make it easy on the companyss too they should only have to pay you what they have agreed to under your plan for a particular service this could be a percent but I think it would be better if it was actually an amount.

For example if you get a nosebleed ( to pick a ridiculous example). The insurance company would pay X to treat it. You would then have a choice: go to the Walmart hospital and pay x-n for your care pocketing the difference or using it to cover lost wages etc, go to the Sears of hospitals and pay x, go to the Macys of hospitals and pay x+n for great service, or go to the boutique service provider and pay xn for the best expert in the world.

The side that often gets left out of the health care debate is that of the Doctors. They do deserve to get paid for providing a service and they do deserve a premium if they are exceptionally good at their job, how does the government handle that?

I know that in Briton now the majority of doctors are actually foreign nationals, most from India, who are working in Briton for the higher wages as opposed to India and there are vacancies because being a doctor is no longer profitable enough for British teens to consider it a good career choice.

I also have a friend who is a dentist in Germany his salary is mandated by the government. No they don't pay him, but they do set the charges and profit margin for everything he does as well as set a maximum on his annual salary. The way it works is once he hits his salary he has to close up shop, this way all the doctors in Germany have the same opportunity to make the same wage. He finds it extremely frustrating because he considers the other dentist in town a hack, and is frustrated that he gets the same salary for shoddy work. By the way he also only opens part time because if he worked full time he would have to lay his staff off every year in July, when he could hit his salary quota. He'd rather they were able to keep their jobs so he only works half days year round. His receptionist and assistants have no salary protections.

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Lasik and plastic surgery also optional services, so people can choose to have the service or not have the service.

The ideas that you are talking about are already being put into effect with "consumer driven" health plans. They place some responsibility/incentive on the patient to shop around for the most cost effective (sometimes that means quality, not just price) services. They still need work though. One of the problems is that few people would know how to obtain the data that demonstrates this. With technology, it is becoming more available. Many plans and the government to are experimenting with "pay for performance" models as well. I think PfP should be part of future programs.

Jordan

Just wondering, in a national health plan where everyone is required (or forced) to participate, what about those needing more services than others?

Say someone with type I diabetes as opposed to another with no chronic illness. Where is the value in that? One receives much more service yet both are paying the same into the system. Who gets to keep the difference in costs?

In a free market system one can change plans, alter their level of coverage, or opt out all together, if they choose, should they not be happy with their particular plan and/or the way it's run.