Health Reform and the Dartmouth Atlas

One of my problems with the whole health care debate is that, for the most part, it has focused on the redistribution of wealth. One reason the Donkey Clansmen have had such a hard time getting a health care “reform” passed is that they offer a zero sum game. For every winner, there is a loser. There is no “win-win.” There is only “I win-you lose.” That’s tough to ram through Congress.

The health care debate would be far more enlightening if we reframed the debate to discuss root causes: lagging productivity and quality of the health care system. The Obama administration, to its credit, does include productivity- and quality-enhancing measures in its legislative package, but the Obaminators seem far more preoccupied in extending health care to the uninsured than figuring out how to make the system more efficent. If the Elephant Clan wanted to gain more traction with the American people, it would pick up the productivity and quality theme, but it done so only intermittently, much to its misfortune.
The beauty of building reform around productivity and quality is that it allows win-win solutions in which everyone can share. There are two institutional thought leaders — largely ignored, sadly — that have thoroughly explored this theme. One is the Institute for Strategy and Competitiveness, at Harvard University; in particular professors Michael Porter and Elizabeth Olmsted Teisberg (a faculty member of the Darden School). Their analysis focuses on the failure of the structure of the health care delivery system and how incentives need to be changed. I hope to write more about them in the future.

The other thought leader is the Dartmouth Institute, publisher of the Dartmouth Atlas. The Atlas project notes that the cost of providing health care to Medicare patients varies enormously across the United States — from more than $14,000 per Medicare enrollee in Miami, Fla., to $5,300 per Medicare enrollee in Honolulu. States the Dartmouth Atlas website:

Patients in high-cost regions have access to the same technology as those in low-cost regions, and those in low-cost regions are not deprived of needed care. On the contrary, the researchers note that care is often better in low-cost areas. The authors argue that the differences in growth are largely due to discretionary decisions by physicians that are influenced by the local availability of hospital beds, imaging centers and other resources-and a payment system that rewards growth and higher utilization.

Virginians can take some pride in the fact that the Old Dominion is one of the lowest-cost pockets of health care in the eastern U.S. Take a look at the map above: Wisconsin and upstate New York are the only comparable zones of low health care costs east of the Mississippi. (To see how individual Hospital Referral Regions in Virginia perform compared to others in the nation, view the interactive map.) The cost of Medicare per enrollee is less than $7,000 across most of the state. Even in the Arlington region, with its high wage and salary levels, the cost edges up to $7,200 — far lower than the cost up a few miles north in Baltimore.

Clearly, Virginia hospitals and physicians are doing something right. And just as clearly, Virginians should not be made to suffer for the sins of health care delivery in other states.

The Dartmouth Atlas supports the claims of those who contend that much of American health care spending is wasted. How do we reform the system to bring down soaring costs? “An Agenda for Change” proposes the following:

  • Promote the growth of organized systems of care.
  • Require informed patient choice and informed decision making.
  • Promote the training of primary care physicians and fund training programs that teach community-based care in treating chronic illness.
  • Fund a federal science policy that builds the scientific basis for cost-effective care.

The Dartmouth Institute bases its recommendations on hard empirical data, not ideology. I’m not persuaded that the atlas afficianados have the full answer, but they have a very big piece of the answer. I only wish that someone in Washington were listening.


Share this article



ADVERTISEMENT

(comments below)



ADVERTISEMENT

(comments below)


Comments

59 responses to “Health Reform and the Dartmouth Atlas”

  1. Larry G Avatar

    I've seen this chart before and my little brain cannot understand what could possibly cause such large variations in spending but my sense is that the reasons behind it are not specific to the patients themselves but rather how the heath care system functions and I'm suspicious that money is involved.

    I'm also quite shocked that the government itself seems more sanguine than concerned when presented with such tremendous costs for entire regions… not individuals – but entire regional populations of beneficiaries.

    And again – the individuals involved probably have no idea how much their care is costing – taxpayers – only that Medicare "covers" them.

    sort of like these scooter commercials where they happily inform you that if your Doctor approves your need of one – it will be provided with "no out of pocket expenses".

  2. Groveton Avatar

    Off topic but funny ….

    http://www.youtube.com/watch?v=2qZVhnC0XCM

    It seems the Republicans did learn a little from last November's presidential election after all.

  3. Larry G Avatar

    here's the story we don't get that we ought to.

    the Creigh Deeds campaign is being run by individuals and I'm not absolving Deeds of blame – he's signed off on it.. but I'd be interested in knowing more about the folks running the campaign .. what other campaigns they have done – and in the future – what campaigns they are involved in.

    In the end – Deeds is responsible for his campaign folks and it does reflect on him as a potential Gov – and I'm having a very hard time thinking I would want someone who operates their campaign in this manner to run the Governorship the same way.

    I'm not sure that his opponent is a boy scout either.. but better judgement on not using material that is so untruthful as to be easily recognized as such.

  4. Anonymous Avatar
    Anonymous

    There is a United Way poster that says, "When a child succeeds in shcool, when families are financially stable, and in good health, we all win."

    That is the win, win. Especially when 60% of bankruptcies are health care related.

    As for redistribution of wealth, we have reached a point wher you have to go where the money is to get it. Today in America if you earn $110,000, then you earn more than 95% of the population. Yet the 40% above you still earn 95% of the income, and probably retain 97$ of the capital.

    The health insurance system suffers from cherry picking at both ends: the young and healthy who don't buy health care, and the insurors who deny it to anyone who might need it.

    The health CARE system actually works pretty well. It would work a lot better and be more efficient if it didn't have to jump through hoops to get paid. Like our regulations concerning development health care payment rules need to be fair, transparent and predictable. The present system is none of those.

    The Republicans are constantly trying to re-cast this as a health care problem, when it is primarily a health insurance problem.

    I'll agree that incentives to practitioners need to be changed, but again, this is primarily up to the insurors. Consider the Chinese system: you pay your doctor every month; if you get sick you stop paying him.

    Virginians can take some pride in the fact that the Old Dominion is one of the lowest-cost pockets of health care in the eastern U.S.only if their health outcomes are equivalent. Or maybe, virginians are just healthier for other reasons. A look at the map confirms that Lousiana and East Texas, known as cancer alley, has high health costs, as does the heavily polluted Eastern Metropolis, and Retirement Florida.

    To fund a federal science policy that builds the scientific basis for cost-effective care, sounds a lot like my usual cry for systems analysis and cost benefit studies, which the Republicans have renamed as Death committees.

    Informed choice and informed decision making is a good thing, but let's face the fact that health care spending is likely to be highly elastic, when push comes to shove. This is like claiming that HOT lanes represent a free market choice: when you need a bypass, what decision is there to make?

    —————————-

    Larry makes his usual mistaken argument of thinking that taxpayers (meaning himself) are paying for other users of the system, whether it is roads or healthcare. A better way to look at it is that they are pre-paying for their own opportunity to use the system, whenever they like or need to, same as everyone else has before them.

    If the prepayments are not enough to continue to support the system, then we need to figure out why, but it is useless to blame the other guy for his "over use" just because ours hasn't happened, yet.

    He makes a valid point that higher out of pocket expenses would reduce demand. But who would it reduce demand FROM? This argument takes you right around to the other end of the wealth redistribution argument.

    Whether I pay $20 or $40 copay for my thyroid medication, I'm going to get it, or die. The extra $20 isn't going to kill me, but I know some other people that it very well might kill.

    RH

  5. Anonymous Avatar
    Anonymous

    It seems the Republicans did learn a little from last November's presidential election after all.

    Yeah, but it seems Sheila Johnson didn't learn anything from the macaca gaffe.

    RH

  6. Larry G Avatar

    your co-pay relative to your income means everything if in the end it means you are getting "free" money – while the bigger system is going broke.

    If your hip replacement does not cost you a dime – your attitude is much, much different than if it costs you 10% of your annual income AND because of your decision – the health care system you use – Medicare – will go broke in a decade.

    It's not about death squads but it has everything to do with what you can – and should "afford" on your own.

    When we have Medicare recipients whose annual income from their pensions is more than what 99% of teachers make for a full-time living – you should be paying for your hip replacement – not those teachers.

    In essence, the reason we pay twice as much but still cannot provide basic care for everyone is that we are fully reimbursing elective surgery for folks who are using the system for "free" medical care.

    the biggest problem is that none of the politicians will admit to the truth.. and they are trying to find some way to affect changes to what I cite above – essentially without anyone catching on to what they must do – to get the system under control.

    And you only need to look at how they handled Medicare part D to see how we got to this point.

    Medicare PartD was a tacit giveaway to the big pharma.

    Ray talks about his thyroid pills.

    they cost a couple of bucks overseas but here they cost 10 times as much – but Ray does not really care if he is "covered" and that's the problem.

    Europe limits big Pharma to a FAIR rate of return,. In this country – drugs are a wild scam where taxpayers pay enormous profits to the drug companies – not willingly – but because that's how Medicare Part D was designed – by Congress – and signed into law by Bush – with the PayGO rules suspended.

  7. Gooze Views Avatar
    Gooze Views

    Jim,
    One possible explanation for regional cost variations could do with the malpractice climate. Here's a personal example:

    Back in 1991, I was working as an editor in New York City on the international desk of BusinessWeek. We learned that Child No. 2 was on the way.

    I was shocked to learn that the OB doc wanted complete payment up front before he'd even see my wife. This is the way it is done in NYC because of exhorbitant malpractice costs. I'd have to come up with $10K or so and then wait until after the baby was born to file for insurance. Go figure.

    I said to hell with that and made arrangements to have the baby delivered in Little Washington, N.C. at the hospital where my dad had been on the staff. The ob guy would be the same that delivered Daughter No. 1. He is a family friend who said he'd just take whatever insurance paid.

    Everything was just fine. Baby was born healthy. But when we returned to NYC saw that our apartment had burglarized and all of our valuables had been taken.

    Peter Galuszka

  8. James A. Bacon Avatar
    James A. Bacon

    Peter, Interesting story. You're right, the malpractice climate could well be one of the factor accounting for regional variations in medical costs — not the insurance as much as the defensive medicine and bizarre practices like the one you encountered. Sounds totally plausible to me.

    From my quick reading of their stuff, however, the Dartmouth guys don't mention malpractice as a significant factor. I'm surprised.

  9. Larry G Avatar

    this is a data mining problem.

    the answers are in the data.

  10. Anonymous Avatar
    Anonymous

    "Ray talks about his thyroid pills.

    they cost a couple of bucks overseas but here they cost 10 times as much – but Ray does not really care if he is "covered" and that's the problem."

    ————————-

    As usual, you missed the point entirely and changed the subject.

    What I said was that increased out of pocket expenses would not make very much difference to me: I won't die over an increased expense of $20 or $40. I'm still going to get my pills even if I have to fly to Europe and get them cheaper. At that level my price elasticity is pretty high compared to the alternative that Jim Bacon talks about.

    But some people will die becasue of that increased cost. I call THAT a transfer of wealth.

    It is not only a question of whether I'm "covered" it is a question of whether everyone who can be, or needs to be covered, is covered at least cost. We can save a few bucks on thyroid pills or coverage for thyroid pills and bury a few more people. We can save ALL the money on thyroid pills and thyroid insurance and bury a lot of people: I would have been dead long ago, but burying people has costs, too.

    Larry thinks it is impossible to solve that equation, and I don't think it is all that hard. And I don;t think it is a zero sum game. We all win if we solve it correctly.

    RH

  11. Anonymous Avatar
    Anonymous

    "And you only need to look at how they handled Medicare part D to see how we got to this point.

    Medicare PartD was a tacit giveaway to the big pharma."

    For crying out loud.

    You only had to see how my drug bills were paid (not) when I was on disability and medicare and needed some REALLY expensive chemicals.

    Medicaid piad for my doctor, who I saw every six months PROVIDED that I paid for th emedication so I would live long eneough to see him.

    I complained bitterly to my representatives, and THAT is how we got to medicaer part D.

    It's got problems, but it is better than nothing.

    RH

  12. Anonymous Avatar
    Anonymous

    What I read (somewhere) is that malpractice and defensive medicie amount to around 2 or 3% of th eproblem.

  13. Larry G Avatar

    my point:

    We cannot cover everyone if you are getting your drugs for free when you can afford to pay some of that cost – you should pay if you can –

    the bigger problem – when the cost is much too high to start with because Pharma is running amok on profits – and using those profits to corrupt the legislative process that should be striving to provide reasonable basic health care to everyone.

    Because we let big pharma run amok and because we won't charge you a reasonable fee when you can afford to pay – we say that we must ration healthcare to others – and deny them basic care.

    it's a dumb way to do healthcare because in the end – the guy who you deny care – will uses twice or three times as much late stage intervention care to extend his life a few more months – and –

    send you the bill via your insurance premiums..

    this is dumb…wouldn't you agree?

  14. Larry G Avatar

    it's got problems that the European plans don't have because they don't let Big Pharma run amok and we do.

    You're again looking at this in terms of what you get out of it – not whether or not – in the longer run – you'll end up getting less and less and be harmed by it.

  15. James A. Bacon Avatar
    James A. Bacon

    Anonymous 9:46, The cost of malpractice insurance and defensive medicine is commonly put around 10% of health care expenses. I'm sure the trial lawyers will say it's lower, but most observers would agree that it's a lot more than 2-3%.

  16. Larry G Avatar

    I support tort reform but I would tie it to full disclosure of the performance of all health care providers.

    Let's protect them from higher rates – even provide subsidized insurance for OBYNs if we must but when a Doc does something stupid – more than once – we need to know that – and he/she needs to find another line of work instead of being protected by the settlement agreement and then allowed to go harm more people.

    And again – the pro tort-reform folks – for the most part – are not looking for compromise – they're using tort reform as a hammer to oppose reform period.

    it's just an excuse. If we deal with it..they'll move on to other excuses – like illegals and then to other excuses..

    it's just a diversionary tactic to stall and oppose real reforms funded and encouraged by those that make profits with the current approach and their willing right-wing compatriots who really don't care about the health care issue but are more about denying Obama any achievements.

  17. Larry G Avatar

    " Fish Food vs. Common Sense

    AHIP's ad is a challenge to common sense. They crow that every household sacrifices $1,200 in higher medical bills as “fish food” swallowed up by extra, needless medical costs imposed by trial lawyers. But total income for the median household in the US was $43,318 in 2003, the most recent year on record. Half of all households made more, half made less. So if the ad's claim were true, it would mean that almost 3 percent of the typical American household's income was being lost to "lawsuit abuse" in the medical area alone. Viewers would have to be dumb as an ox not to be suspicious.

    And in fact, the lion's share of the $1,200 figure is attributed to "defensive medicine," the supposed tendency of doctors to order up needless tests or procedures to avoid malpractice lawsuits. Thus, AHIP’s ad recycles a theme that President Bush championed during the 2004 campaign. Not to crow about it, but we've addressed that one before. Actually, there's almost no scientific support for the claim that fear of malpractice awards drives up the cost of American health care to any substantial degree.

    "No Evidence"

    Although the ad cites "HHS data" (referring to the federal Department of Health and Human Services), it really rests mainly on a nine-year-old study by two Stanford University scholars, which is virtually the only such study to find evidence of major costs from "defensive medicine." The 1996 Stanford study concluded that caps on damage awards could reduce overall health care costs by 5% to 9%, but it was based only on a study of heart patients who were hospitalized. AHIP and others cite this as evidence of a 5% to 9% increase across the entire health care system. However, virtually all other studies of defensive medicine have found no such thing.

    Two nonpartisan agencies of Congress have examined the question. In 2004 the Congressional Budget Office found “no evidence that restrictions on tort liability reduce medical spending.” And in 1999 the Governmental Accountability Office evaluated the study and said that the evidence presented was too narrow for estimating the overall costs of defensive medicine.

    CBO concluded that “the evidence available to date does not make a strong case that restricting malpractice liability would have a significant effect , either positive or negative, on economic efficiency.” And the earlier GAO report said of the Stanford study:

    GAO: Because this study was focused on only one condition and on a hospital setting, it cannot be extrapolated to the larger practice of medicine . Given the limited evidence, reliable cost savings estimates cannot be developed.

    Consequently, nearly $1,000 of the insurance industry's $1,200 figure has little basis in fact.

    Would You Believe $234?"

    http://www.factcheck.org/politics/insurance_industry_ad_makes_fishy_claim_about.html

    I call this – "Information Warfare" where the truth is the first casualty

    I'm citing factchecker. I'm sure others can dredge up other data.

    I tend to try to go with organizations that have no obvious axes to grind – and then to pay attention to data that shows opposite conclusions IF it ALSO does not come from a group with an agenda.

    But why let this become THE reason for not enacting reforms?

    Why not put out a COMPROMISE position for tort reform – which we never hear the compromise – only that reform cannot go forward because tort reform is not part of it.

    why do I get suspicious when I do not see the tort reform compromise proposals from those who are citing it as an obstacle?

    I don't think I've heard a single counter-proposal for tort reform other than "it has to be part of the reform".

    well.. hells bells.. is there any more meat on those bones other than that?

  18. Larry G Avatar

    any comments on this:

    " CBO Says Senate Health Bill Would Expand Coverage, Reduce Deficit

    By Lori Montgomery and Shailagh Murray
    A health-care reform bill drafted by the Senate Finance Committee would expand health coverage to nearly 30 million Americans who currently lack insurance and would meet President Obama's goal of reducing the federal budget deficit by 2019, the nonpartisan Congressional Budget Office said Wednesday.

    The bill would cost $829 billion over the next decade, but would more than offset that cost by slicing hundreds of billions from government health programs such as Medicare and by imposing a 40 percent excise tax on high-cost insurance policies starting in 2013.

    All told, the package would slice $81 billion from projected budget deficits over the next 10 years, the CBO said, and continue to reduce deficits well into the future.

    It would also expand coverage to 94 percent of Americans by 2019, the CBO said, up from the current 83 percent."

    http://voices.washingtonpost.com/capitol-briefing/2009/10/cbo_says_senate_health_bill_wo.html?hpid=topnews

  19. Anonymous Avatar
    Anonymous

    "if you are getting your drugs for free when you can afford to pay some of that cost – you should pay if you can – "

    Bu that is the income redistribution acon complains about.

    Anyway, I'm not (wasn't) getting my drugs for free: at that time drugs were not covered under medicaid – zero.

    If I were getting them now then I prepaid medicare taxes for decades before I ever used any of the benefits.

    If we did not plan correctly and the taxes paid are not high enough to cover the benefits provided, what would we do? We could charge all the new enrollees (a lot) more, which is what you propose for real estate taxes.

    Or you can charge everyone a little bit more, except that hurts poor people preferentailly.

    Or you can go for wealth redistribution and tax the rich preferentially. Here is the argument: if the tax plan reduces future deficits as the budget office claims, then rich people will benefit preferentially because otherwise they would be hit with even higher graduated income taxes.

    Sounds like doublespeak to me, but we are rationalizing this whole thing anyway.

    Why would future deficits decline? Savings in Medicare/Medicaid? Healthier people spending more time at work?

    RH

  20. Anonymous Avatar
    Anonymous

    "..the pro tort-reform folks – for the most part – are not looking for compromise – they're using tort reform as a hammer to oppose reform period."

    Amen.

    And the blithering idiots doing PR for these folks don't seem to know or care how obvious this is.

    As long as the Democrats/present administration can't take credit for anything, then they think they win.

    RH

  21. Larry G Avatar

    we already have income distribution out the wazoo.

    reduced or free lunches for kids

    people who get more out of social security and Medicare than they put into it.

    people who have health insurance and end up using more than they pay into it while others use less.

    but you do this with auto and fire insurance also.

    you pay premiums for your auto insurance. You don't get it back if you don't use it because the premise is that you are paying into it so that you can be 'covered' by more than that amount – if you encounter a loss.

    Health insurance and prescription drugs work the same way.

    My view is that with prescriptions and health care – you should pay unless you can't as opposed to a one size fits all – everyone gets free or almost free drugs and care.

    heck if you are a senior an you accept the "senior discount" – who do you think covers it?

    Other folks who don't get that discount do.

    I don't mind the subsidies for those that are in need but I define need to be real need and even then a co-pay is required to keep folks honest.

    I have one of them govt plans that Accurate thinks is so wonderful.

    I pay HUNDREDS of dollars a year for prescription drugs even though my plan covers some of the costs.

    and I should be paying… giving me free drugs would mean that someone else could not get the drugs they need. I'd rather pay and have them get their drugs.

    It's both a moral and economic prerogative. it's economic because if they don't get their drugs – they'll spend their last days getting super expensive medical care in a fruitless effort to keep them alive.

    we all pay for this kind of care and we all ought to realize that in the longer run – it's cheaper to pay for their drugs that their end state heroic and expensive end state care.

    That's not going as far as the OECD countries but it's close.

    they basically take taxes from everyone – sufficient to cover the costs but the usage varies by individual.

    In other words, just like with auto insurance -you pay your premiums but you may not use your benefits that often – but others will.

  22. Anonymous Avatar
    Anonymous

    " we already have income distribution out the wazoo."

    That doesn't make it right.

    The only thing that makes it right is if Bacon is wrong and the game has a net positive sum.

    What makes it right is if those whose income is redistributed also get a poportionate amount of the gain.

    That is a high standard on top of a hard sell: those people will ALWAYS see it as stealing unless they see a return on their investment.

    ——————————

    "people who get more out of social security and Medicare than they put into it."

    I'm not sure that qualifies: it is insurance after all.

    We cannot have a system where your tax money support only your exact uses: the transaction costs are too high.

    ——————————-

    "My view is that with prescriptions and health care – you should pay unless you can't…"

    That's the system we have now: you pay until you go bankrupt or die, whichever comes first.

    We can do better than that and still have a win-win system.

    ——————————-

    who do you think covers it?

    Other folks who don't get that discount do.

    Assuming the rules don't change, they are prepaying for the day they will get the discount – at a time when they have less to pay with. What is wrong with a token of respect for elders?

    The argument you make here is logically the same, although the inverse of the argument I make about regulatory takings.

    If you get a discount on your taxes because some farmer pays for services he doesn't get…..

    If your taxes are kept lower and your property value higher because he is not allowed to subdivide…..

    But that is because the rules CHANGED. Oterwise he would have prepaid taxes (for no services) agaisnt the day when he did subdivide.

    ——————————

    "…I define need to be real need …"

    That's big of you.

    I think you have to find some way to let the market define "need".

    What that might be, I have no idea.

    —————————–

    "…giving me free drugs would mean that someone else could not get the drugs they need. "

    Giving you "free" environmental protection means someone else has to do without (something), too.

    Neither one is free. The problem is describing who owns what, and what the price is that makes everyone better off than some other price.

    With the environment we (sometimes) recognize there is a price to be paid for something we all own.

    What we are talking about here is something similar: national peace of mind, not having our personal environment ruined by the pollution of bankruptcy.

    It is easy to confuse that by thinking we are buying our own assortment of pill or services.

    If that was all we needed we could do it with health savings plans like 401k's.

    What happens to the money if you put it in a health savings paln and you don't use it – this year? Why can't we let it roll over and accumulate? Prepay our own health care?

    Well, because one catastrophic event can wipe out more than most people could ever hope to save. And for everyone else without such an event, it would be a waste of saved capital that could be put to ther use.

    That is why we have insurance, to spread the risk. I think it is different from outright wealth redistribution. Insteadof everyone having a savings acoount big enough to cover their own catastrophe, you have one that is big enough to cover your probable cost of a catastrophe that won't likely happen to you specifically.

    RH

  23. Anonymous Avatar
    Anonymous

    "just like with auto insurance -you pay your premiums but you may not use your benefits that often"

    You pay for the opportunity to use the benefits, if needed.

    Same with road usage.

  24. Larry G Avatar

    if you think that paying auto insurance premiums is "stealing" and/or "income redistribution" then yes, you'd probably think that other similar approaches to insurance are "stealing"

    Right now in the health insurance arena – we have the equivalent of an auto insurance scenario where people don't have/can't get auto insurance, then they have a wreck and society has to pay for that wreck through higher premiums on their insurance.

    It's the same deal with social security and Medicare.

    If we did not have a forced savings into these accounts – we'd have folks who would not save and then when they got old and had no money – they would expect everyone else to pitch in and pay for them.

    With health care – it's even worse because we will not even let people pay into the system if we think they might be using more of the system than others.

    Imagine if we did auto insurance or fire insurance that way where they look at you and decide that you're likely to cost more money than average and then refuse to sell you insurance … because they're pretty sure you're going to use more than average EXCEPT than when you do have that wreck – they have to pay anyhow.

  25. Anonymous Avatar
    Anonymous

    "Right now in the health insurance arena – we have the equivalent of an auto insurance scenario where people don't have/can't get auto insurance, then they have a wreck and society has to pay for that wreck through higher premiums on their insurance."

    I think we agree that insurance is not income reistribution. With auto insurance there is an assigned risk pool that anyone can buy into, although it is expensive. That is why you wind up with uninsured motorists.

    In health insurance there is nothing like that, expensive or not.

    But I don't see where you think this is the same deal with social security and medicare: everyone does have them, so there is no equivalent to the ninsured motorist.

    RH

  26. Anonymous Avatar
    Anonymous

    "With health care – it's even worse because we will not even let people pay into the system if we think they might be using more of the system than others."

    Yep, and we let young people drive around without health insurance, which is pretty crazy.

    I thinke we basically agree on this.

    Amazing.

    RH

  27. Larry G Avatar

    everyone has SS and Medicare because they are FORCED to do it.

    you cannot get out of FICA and Medicare taxes.

  28. Anonymous Avatar
    Anonymous

    How about if we make health insurance a prerequisite to a drivers license?

    That would increase the number of people paying in to health insurnce and decrease the number of drivers on the road.

    A win-win!

  29. Anonymous Avatar
    Anonymous

    "everyone has SS and Medicare because they are FORCED to do it."

    And pretty much the same with auto insurance: you pretty much just have to have it. But there will be bloody hell to pay if we make health insurance mandatory.

    RH

  30. Larry G Avatar

    somewhere along the line – the wingnuts got the advantage and basically instituted an Alice-in-Wonderland context to the whole issue.

    up is down and in is out and reality is whatever you want to believe and for gawd sake – deal with facts like you would cock roaches.

    I cannot believe that the American Public is so stupid as to believe the crap being put out by the swiftboaters – but the reality is that yes – they do.

    If you buy TV ads and misrepresent the facts – and you get the right wing radio and TV hairballs to do the same – many apparently do not have time to figure out the truth.

    One of the biggest lies that are being successfully promoted is the myth of wait times.

    http://www.accessmylibrary.com/coms2/summary_0286-87314_ITM

    http://www.commonwealthfund.org/Content/Performance-Snapshots/International-Comparisons/International-Comparison–Access—Timeliness.aspx

    and when you post the facts – the winguts come back with Youtube videos and right wing blog sites using anecdotal accounts.

    you know me.

    I am not in favor of giveaways to anyone unless it is a basic need and they will essentially be on the streets without it.

    we've got a virulent anti-govt crowd out there right now and their idea of govt – is to sabotage it – i.e. to make FEMA be a BAD agency to PROVE that govt should not be doing it.

    You gut the finance regulations then you blame govt for the ensuing meltdown.

    Our healthcare system is "better" than 16 other countries though virtually none of the metrics will support that idea…

    nevermind the facts.. just kill govt..

    I knew we had Neanderthals hiding in the woodwork but never realized their ability to win over the folks in the middle.

    as a society – sometimes, I think we are dumb as stumps.

  31. Anonymous Avatar
    Anonymous

    I liked Groveton's example; If you wanted to find a really good aircraft pilot where would you look?

    The US Air Force.

    No doubt government can be improved, but that does not mean that what we have is totally useless.

    Maybe we should runa a little experiment: totally shut down government for a day. A tax free day for criminals, if you will. No traffic lights, no nothing. Make it the last day of the month so no checks go out. No taxes collected, No immigration control, military on stand down.

    Then see how much support the no government crowd has.

    RH

  32. E M Risse Avatar
    E M Risse

    Jim Bacon:

    Good post on health care!

    One thing that seems to be missing is the importance of Regional solutions.

    The map indicates there are Regional dysfunctions as there are with most other Services.

    National particpation in citizen health care should be focused on making Regional systems efficient and effective including standards for Aplha Community labs.

    EMR learned recently that private labs have different standards / criteria for tests. Your A1C may be different depending on which lab does the test.

    Only Regional systems can address the questions such as a surplus of medical offices noted in an earlier post, and other health related Regional imBalances.

    Also would be interested in your take on the Martin Feldstein reform formula in today's WaPo.

    EMR

  33. Larry G Avatar

    re: A1C strategies

    have it done by two different labs on the same day

    and .. if you use a blood glucose meter and are game for some not reassuring info – test the same drop of blood 3 different times on the same meter at the same time.

    and if you REALLY want to be impressed – try that same thing with different brand meters.

    Type II Diabetes is an excellent example of what happens to people who do not have insurance and/or a regular doctor who is paying attention to your lab results.

    I go to an endocrinologist and when I called the other day to make an appointment for my annual exam (which includes A1C tests), I was told that the EARLIEST appointment was Dec 24.

    and remember – I have insurance.

    A person with elevated A1C levels is 3 times more likely to die early – and die from cardiovascular and organ disease.

    Our health care system is focused on giving you treatment for your cardiovascular disease ONLY AFTER it has fully involved itself and not a minute before.

    The average person has absolutely no idea of what a good glucose or A1C level are – despite the fact that it detects Type II – which is one of the biggest health care problems in this country – and leads directly to very bad outcomes downstream.

    this is the perfect example of what is wrong with our health care system – and it affects not only those without insurance but even those with insurance.

    and if anyone thinks the pvt healthcare companies are going to fix this – you're dreaming.

    the pvt healthcare industry is most profitable when you are most in need of expensive healthcare.

    EMR – making healthcare regional won't fix this.

    it's industry-wide, nation-wide and simply stated – there is no profit in giving you an simple but accurate A1C test.

    they want to see you when you need a bypass.

  34. E M Risse Avatar
    E M Risse

    Larry said:

    “The average person has absolutely no idea of what a good glucose or A1C level are – despite the fact that it detects Type II – which is one of the biggest health care problems in this country – and leads directly to very bad outcomes downstream.

    “This is the perfect example of what is wrong with our health care system – and it affects not only those without insurance but even those with insurance and if anyone thinks the pvt healthcare companies are going to fix this – you're dreaming.”

    Very well stated.

    You are right… and it will remain that way until the deck is re-stacked so health care practitioners make LESS money under this type of condition than if the system is working well.

    As Jim Bacon likes to point out, citizens of the US of A pay more and have worse results in healthcare, education, Mobility and Access, Affordable and Accessible Housing…

    “The pvt healthcare industry is most profitable when you are most in need of expensive healthcare.”

    Right again!

    “EMR – making healthcare regional won't fix this.”

    Two out of three is not bad, Larry.

    In fact a Regional system – OK, a comprehensive system with a Regional focus – is the best path to general health. It would involve Cluster health networking, Neighborhood health education, Village health clinics, Community hospitals and Community labs, SubRegional and Regional Specialty Hospitals run by a Regional health care Agency (elected or appointed by an elected Regional governance structure) with national standards and allocation of MultiRegional / MegaRegional resources.

    In fact it is the ONLY way to create a functional healthcare system. The system must reflect the organic structure of society.

    “It's industry-wide, nation-wide and simply stated – there is no profit in giving you an simple but accurate A1C test.

    “they want to see you when you need a bypass.”

    OK! Larry is back on the right track!

    Why have citizens allowed a system to evolve so the wrong actions are rewarded?

    Settlement pattern – Mobility and Access, Affordable and Accessible Housing – energy conservation, water quality, and resource allocation, the economic system, education, healthcare, the same causes and the same results over and over. A few benefit greatly and the rest pay the bills.

    Seems to suggest the need for Fundamental Transformation of governance structure, right?

    Elephants and Donkeys are not going to fix this. They thrive on donations from those at the top of the Ziggurat in every one of these systems.

    EMR

  35. Larry G Avatar

    geeze – I don't know what to say.

    I'm speechless..

    in a single day – both Ray and EMR …agree with me.

    ehhh.. speechless?

    that's a big of a stretch in my case – right?

  36. Larry G Avatar

    re: " Elephants and Donkeys are not going to fix this. They thrive on donations from those at the top of the Ziggurat in every one of these systems."

    really? I thought this was "free speech"?

    but you're right.

    the money stinks – and the worse part is it comes from us embedded as part of the price of what we pay for goods and services – and then. the best part – they get to write it off as a business expense.

    so in a way.. they're adding fees onto their products/services so they can give free-speech 'donations' to their favorite politicos…

    oh.. and the very, very best part…

    so those politicos use that money to convince us to vote for either the Donkeys or the Elephants so they can get back into office and get more "free speech" money.

    pardon my sarcasm .. folks.

    actually, I'm amazed that ANY legislation that benefits the lowly taxpayer ever gets passed.

  37. Anonymous Avatar
    Anonymous

    "and .. if you use a blood glucose meter and are game for some not reassuring info – test the same drop of blood 3 different times on the same meter at the same time.

    and if you REALLY want to be impressed – try that same thing with different brand meters."

    Hah!

    You want to have some fun, try some real chemistry sometime.

    You think your blood sugar is whacky? try analyzing 30 year old environmental samples to figure out which way a plume of conaminents went, and how much is left.

    We make our environmental diagnoss on data that is a lot more erratic than your blood sugar.

    RH

  38. Anonymous Avatar
    Anonymous

    EMR,

    Good regional treatment makes sense, but when I needed serious help I found the best help avaialable – regardless of location.

    RH

  39. E M Risse Avatar
    E M Risse

    EMR forgot one thought above vs Larry’s comment on Regional systems not helping:

    If there were Regional health care systems (as noted above) and Citizen Media then, Larry, EMR and five others could put a spotlight on the problems that Larry points out and get some action / change / transformation.

    With the current structure of MainStream Media (Enterprise owned and controlled by ad revenue) and Business-As-Usual two party duopoly (governance practitioners owned and controlled by political donations) there is not chance of change until the system collapses. Then it is replaced by a clone of the one that collapsed.

    Citizens do not need ‘less government,’ citizens need BETTER government with a structure that reflects economic, social and physical reality and makes decisions at the level of impact.

    EMR

  40. Anonymous Avatar
    Anonymous

    And if the Regional health care system works as Dr. Risse envisions it, it would be the BEST health care available.

    Location matters.

  41. Larry G Avatar

    perhaps but in a world with almost 7 billion people – wouldn't you think that there would be some existing models that are worth replicating?

    I was telling EMR -I think local is better for direct accountability and transparency but local is terrible for establishing standards and uniformity that provides more cost-effective and, in theory, higher quality care.

    One of the bigger MYTHs in the healthcare debate is that the other industrialized countries have longer wait times and the truth is this.

    they have longer wait times for elective procedures but they have shorter wait times for primary care where in this country – getting a doctor appointment when you are sick and possibly at risk for complications is dang near impossible in a few days and in Europe and Japan – a sick patient can usually see a doctor in a day or so.

    and because our system discourages regular doctor visits – we don't catch disease in the early stages and that's part of the reason we pay more per capita.

    all the European countries have more primary care doctors per thousand people than we do – and it's no accident – that's the way their govt-sponsored health care works – on purpose.

    Over here, we wonder why our pvt healthcare system doesn't work that way – and get this – we're told it's the govt's fault that we don't have enough primary care physicians.

    …but then again.. we don't want the govt involved in healthcare….

    It's an Alice-in-wonderland environment where we pretend we have the best healthcare system in the world – and when the data shows otherwise – it's the govt fault.

    go figure.

  42. E M Risse Avatar
    E M Risse

    Larry said:

    “I was telling EMR -I think local is better for direct accountability and transparency but local is terrible for establishing standards and uniformity that provides more cost-effective and, in theory, higher quality care.”

    Sorry Larry, that is NOT what you said.

    And besides what is unclear about:

    “… a(A) comprehensive system with a Regional focus – is the best bath to general health. It would involve Cluster health networking, Neighborhood health education, Village health clinics, Community hospitals and Community labs, SubRegional and Regional Specialty Hospitals run by a Regional health care Agency (elected or appointed by an elected Regional governance structure) WITH NATIONAL STANDARDS AND ALLOCATION OF MULTIREGIONAL / MEGAREGIONAL RESOURCES.” (Emphasis added.)

    EMR

  43. James A. Bacon Avatar
    James A. Bacon

    Larry, if you've got a problem with insufficient numbers of primary care physicians, fix that problem — don't turn the entire health care system upside down with a 1,000-page bill written by a handful of people that no one will have a chance to read until two days before the vote.

    If you've got a problem with Big Pharma profits, fix that — don't turn the entire health care system upside downwith a 1,000-page bill written by a handful of people that no one will have a chance to read until two days before the vote.

    And so on down the line. You dwell on a lot of problems (real and perceived — I'm on Accurate's side regarding the methodology used to compare the performance of the American system vs. European systems) that all have relatively narrow-bore solutions, and which the proposed legislation won't fix. The Obaminators have CUT A DEAL with Big Pharma, or didn't you notice? The Obaminators will be CUTTING Medicare spending, thus encouraging more physicians to drop Medicare patients, or didn't you notice?

    You also have to come to grips with the fact that the health care reform doesn't address *productivity* in any meaningful way, and *quality* only in passing.

    If health care reform gets passed in anything resembling its current form, it will be a fiasco. If I were you, I'd be terrified that your team will end up being held accountable for one of the biggest legislative hack jobs in U.S. history.

  44. Larry G Avatar

    Jim – I'll deal with these point by point

    primary care physicians –

    do _we_ agree this is a problem that needs to be fixed and that it may have much to do with the relatively worse outcomes in our country?

    if we don't agree on that nor the fact associated with it – then we're not even close to agreeing that it should be addressed.

    but the bigger question is why – with a free market private healthcare system – that it does not get addressed by the pvt healthcare system to start with – and then it gets blamed on the govt?

    if we AGREE that this is a problem – do we also AGREE that the pvt health care system has not addressed and is not likely to?

    are you saying that it is the govt job to subsidize/incentivize primary care physicians ?

    Jim – will you acknowledge who opposed Medicare originally and for what reasons?

    I don't have a problem with Big Pharma profits – I have a problem with how we handle big pharma verses Europe and our own VA – and how the folks on the right passed Medicare Part D off budget.

    The Dems got some of that stink on them too – but where are the Republicans fix to this if they opposed using our own VA approach?

    Methodology – I've provided authenticated sources from objective non-partisan organizations verses the you-tube videos and right-wing blogs that accurate provided.

    Even when he provided authentic sources – he cherry-picked – and he even acknowledged that he cherry-picked.

    my problem with this is why in the world would you not believe organizations that are keeping these statistics in the first place?

    I think it's because we really don't want to face the truth that our system – by most world measures – from a wide variety of non-partisan sources simply does not measure up – and those facts don't jive with what we've been led to believe.

    saying that comparisons are not valid because we are "different" – on a wide variety of different metrics – is a neat way to say that none of the metrics are valid so they don't count.

    not buying it guy.

    the BEST you could do is to provide corrected statistics from a likewise non-partisan source and to stay away from anecdotal "evidence" portrayed on you-tube, right wing blogs and industry-purchased TV ads.

    at the very LEAST – you should WANT to know the metrics – and be familiar with them.

    do you believe the one about the primary care physicians?

    why would you believe that but not other metrics if both came from the same source?

    geeze the 4096 limit got me – so you get two in a row.

  45. Larry G Avatar

    continued:

    'fixing" the system

    I think we have the same problem with this as we had with the tarp/stimulus.

    I simply believe in both cases that we cannot – NOT ACT.

    We will EFFECTIVELY lose productivity if health care continues to eat up any productivity gains and gobbles up the money so that – as in the last several years – there was a net loss in people's incomes because the gains all went to health care costs.

    we are headed for an economy where health care costs become 16% of the GDP and if we leave it predominately in the hands of the pvt sector – there is nothing that will change the outcome.

    so.. does the govt intervene?

    If you think it must – then what happens next – may not suit you and it may not suit be – but we know that the govt must be part of the solution – as it is in 16 other countries and as it is in our own country with Medicare, Tricare, VA and the Govt Health Benefits program.

    This problem is going to be fixed by cutting benefits – in Medicare and other plans.

    that's what has to happen and it will happen in the pvt sector also.

    but we need to understand what "cutting benefits" means in the context of having everyone insured with basic insurance.

    cutting benefits mean that the guy who is hauling down 100K a year in retirement benefits and wants the gold-plated version of some procedure is no longer going to get it free.

    the guy that wants Viagra is not going to get it unless he pays for it – just as my plan works right now.

    the guy that wants the scooter from the scooter store will no longer get it free. He'll have to come up with 20 or 50% of the cost unless he is in poverty circumstances.

    these are the things that are killing both Medicare AND pvt sector care.

    but the difference is how they're going to get there.

    the pvt sector care is just going to double their premiums, and dump more folks off and double the percentage of GDP costs but still provide "free" healthcare to whoever can manage to keep up with the premiums.

    If we do not address this – then you and I and virtually everyone else will have family members and neighbors and fellow church goers who are going to get nothing – until they are close to death and then they'll get very expensive, late stage care – that will be 'covered" by the hospitals who will then add it to YOUR hospital bill – and then YOUR insurance company will either increase your premiums or dump you if they can.

    simply stated – you cannot "fix" this by tweaking parts.

    no more than we could keep from going into a depression without the tarp/stimulus

    …in my view….

    I don't see any of this as the scourge of the Obamanators as Clinton told us the same thing – and for 8 years the folks who could have done the "tweaks" that you recommend – they did not.

    they kicked the can down the road with Medicare Part D tied to it and now are taking the same position that their side took with Medicare was voted in.

    and we all know what would have happened to the elderly and seniors if they had to get health ins from the pvt sector.

    so.. how can you – on one hand talk about how terrible Medicare is

    and out the other side of your mouth say that we cannot get rid of it?

    I think you need to take _a_ position on this.

    If you are opposed to concept of single payer public option health care – then you should be adamantly opposed to Medicare – just as Dick Armey is.

    In other words, if Medicare is the problem – then it needs to go away. don't go all wobbly on your principals here.

    I make no apologies on the tarp/stimulus or this.

    In my view – we must do it.

    It's a moral and economic imperative.

  46. Anonymous Avatar

    "And if the Regional health care system works as Dr. Risse envisions it, it would be the BEST health care available. "

    Nonsense, some regions would still be better than others, depending on what you need. You should have the ability and the right to find it and go get it.

    Transportation matters as much as location does.

    RH

  47. Anonymous Avatar

    "fix that problem — don't turn the entire health care system upside down with a 1,000-page bill written by a handful of people that no one will have a chance to read until two days before the vote.

    If you've got a problem with Big Pharma profits, fix that — don't turn the entire health care system upside downwith a 1,000-page bill written by a handful of people that no one will have a chance to read until two days before the vote."

    Jim, there are easly a thousand such problems. If we could fix them with one page per problem, we would be ding well to get away with a thousand page bill.

    The problem eith this thing isnt that it is too big, it's that it is nowhere big enough.

    The problems we have are that numerous, that important, and that expensive.

    If we DON't do this, we will be spending 35 cents out of every dollar on health care and even MORE people STILL won't have insurance.

    What will be the Republican/Conservative/Free Market argument after that happens? Where is there definition of market failure?

    RH

  48. the "market" does not "fail" – by definition.

    but the "market" does have a goal of equality and equity of those whom the market derives it's commerce.

    it's not up to the market to make sure that everyone can afford what the market offers.

    I don't know why we pretend otherwise.

    when we say that there is a "problem" with the "market" and that we should "fix it" – who would we get advice from on how to "fix it"?

    the market? the folks who believe the market is always right and govt incapable of doing better than the market –

    this is the problem.

    we have folks who fundamentally do not believe in govt to start with – "advising" on how the govt should "fix" a problem in the "market".

    this is why much of what is being said is simply not rational.

    Let me give an example.

    We say that Medicare will go bankrupt in 10 years or less because the govt cannot control the costs…therefore this proves that the govt is incompetent.

    Now -let's look at the pvt sector healthcare.

    what will happen to pvt sector healthcare in 10 years – IF THEY ALSO DO NOTHING?

    well..the suckers will go bankrupt just like Medicare will – but the pvt sector – by definition can not be "incompetent".

    so we use TWO different standards for the same problem -that problem being that BOTH Medicare AND pvt industry are – unable to control costs.

    The pvt sector is allowed to increase premiums and deny people as their way of doing "something" to keep from going broke.

    The pvt sector is not called "incompetent" for raising rates, reducing benefits and even denying care – but if the govt responds in this way – it "proves" that they are incompetent.

    this is what I'm talking about.

    perfectly apparently rational people are arguing the above argument

    and when you start to break it down and look at it – you start to realize just how convoluted the reasoning is…

    The entire health care industry – private and govt – whether it is Medicare, Tricare, the VA and all 16 systems in Europe have exactly the same fundamental problem – and that is that the demand for medical care exceeds the resources being provided.

    The "market" deals quite effectively with this. If you cannot afford the service, then you don't get it.

    If we were willing to turn over ALL of the ERs over to private companies and let them deny care to those who could not afford it – it would "solve" this problem.

    and when you step back – that's essentially what this whole debate is about – who will run the ERs and how will they function for those who cannot afford the service.

    We tell Dominion Power that they must provide electricity and we decide their profit margin.

    No one that I know would advocate letting Dominion decide how much profit they would make if they could.

    Now someone will point out that Dominion is a Monopoly.

    Nope. Not any more than the healthcare companies are.

    There are multiple providers of electricity throughout Va – and they COULD in theory compete to provide power and pay each other for using each other's distribution system but what happened?

    We found out that in a "deregulated" environment that electricity rates would soar – out of the reach of many.

    so what did we do?

    how did we "fix" this".

    Well.. the govt decided to regulate by limiting profit.

    A state agency figures out how much profit Dominion and others should get – and that's it.

    Why not do health care insurance the same way?

  49. Canada life insurance Avatar
    Canada life insurance

    I suppose it all comes down to raw political power, pride in everybody's political philosophy, individualism or socialism, and whether one should depend on government or free markets, not who is right and who is wrong.
    Many theories have been made, so there won't be definite solution. Evrytime there are people who are always unsatisfied and always have the "rightest" solution, which is in most cases unfeasible.

  50. Anonymous Avatar

    "it's not up to the market to make sure that everyone can afford what the market offers."

    True, but when the market offers only what no one can afford, it is no longer a market.

    In a market, if you don't like one offering, you can turn someplace else. When you cannot do that, then the market has failed.

    That's the problem with calling HOT lanes a market solution: they are nothing of the kind. Instead, they are evidence that the "market" for HOV has failed.

    RH

  51. Anonymous Avatar

    Excellent.

    The right unfeasible solution will solve everything.

    RH

  52. a "market" for HOV?

    who created HOV Guy?

    did the "market" produce HOV?

  53. Anonymous Avatar

    who created HOV Guy?

    Environmental agitators and activists pushed gov't to create HOV, because they believed it would produce a social benefit.

    In fact, the cost of operating a car pool in order to be able to use the new HOV facilities was higher than the costs saved, and therefore HOV was underutilised.

    Now you have a market failure, resulting in expensive facilities being underutilized, and this counts as a reduction in the proposed and expected social benefit.

    You could, as is now being planned, pay people additional sums to operate car pools, and increase the asset utilization, That way you get the expected social benefit, but at a higher cost than anticipated, thus reducing the net social benefit.

    Or you can have HOT lanes in which non car pool drivers pay additional raod taxes for the privilege of using the HOV lanes. This gets you more utilization of the expensive asset, and more revenue, but it still gets you less of the planned social benefit (less congestion and less pollution and speedier travel times) than expected.

    Any way you slice it you do not get the originally planned social benefit. However if you count the new revenue, this may be used to contribute towards some OTHER "social benefit".

    Which begs the question: If the other social benefit can't pay it's way either, is it still really a net social benefit (both projects combined), considering that the original social benefit (HOV) failed, and the newly supported one is in the hole too?

    In this case the "market" is the use of a public asset as compared to its costs, combined with the exteranl benefits (fewer vehicles and pollution).

    It is still the same equation: TC = PC + EC + GC.

    RH

  54. Eventually, this is all moot. We are inevitably headed for single payer because the current system is unsustainable. The Green Party has always been in favor of single payer. Personally, I offer this quid pro quo: universal single payer in exchange for flat tax. Let's put the paper pushers out of work and make the economy more efficient.

  55. Anonymous Avatar

    Single payer – Let's import a system that is failing in the UK.

    TMT

    From today's London Times

    The Times October 15, 2009

    Half of hospitals do not fully meet core care standards, says regulator
    Sam Lister, Health Editor
    Almost half of hospitals fail to meet fully the core standards of care despite a decade of Government investment in the NHS, according to the health regulator’s annual report.

    The Care Quality Commission (CQC) warns today that more than 40 health trusts are at risk of being refused new licences to operate, which will be issued next April.

    The report, an annual assessment of quality of care and financial management of NHS organisations, concludes that while there have been significant improvements in waiting times, tackling superbugs and controlling budgets, many trusts are still failing the basic requirements of good care.

    These include the number of patients having operations cancelled, heart disease care, record keeping, infection control and child protection.

    The rest is at http://www.timesonline.co.uk/tol/life_and_style/health/article6875344.ece

  56. here is what this boils down to in my view.

    We are using a double standard when evaluating the two primary alternatives.

    single-payer "fails", Medicare "fails" because govt is not competent enough to control costs so single-payer is "going bankrupt".

    Now, let's look at the pvt side.

    Pvt healthcare costs have doubled in 10 years and are projected to double again in 10 years but we don't say that pvt healthcare is "incompetent" and "unable" to control costs

    we don't say that

    why?

    if BOTH single-payer systems AND Pvt healthcare costs are going up at the same rate then why is the govt side said to be "incompetent" and this "proves" that govt should not be doing health care.

    It's a crazy argument on it's face ESPECIALLY when you take into account that if the govt response to this is to do what pvt health care does

    pvt healthcare will raise premiums

    pvt healthcare will cut benefits

    pvt healthcare will dump people (which govt is not allowed to do).

    so.. we're having this totally bogus conversation where we won't even agree to deal with the facts and the realities.

    We've heard this.

    reform the pvt healthcare by requiring them to accept anyone with pre-existing conditions.

    okay.

    let's do that.

    what will happen ?

    well.. the pvt companies costs will increase – right?

    but see.. we don't call them "incompetent" when this requirement would make it harder for them to control costs.

    but if we put the same requirement on govt – then govt is "incompetent" for not controlling costs.

    this is a totally disingenuous approach to portrayal of the issues – and the really bad part about this is that as long as we continue to not deal honestly with the issues – we won't get to a better solution.

    it is maddening..

    we are DITHERING for no good reason other than we feel the need to scratch our butts instead of get serious about the issue.

    grump!

    you and I should no more want to see the kid next door die from a pre-existing condition while his parents go bankrupt than we'd want to see that same family denied from sending their kid to a public school.

    so we have universal education as an "enlightened" industrialized nation

    but we'll watch the kid next door twist and turn while we put dollar bills in the 7-11 jar to "help".

    we are a nation of very selfish people sometimes.

  57. just FYI – none of what I said was directed at TMT or anyone else.. just a rant.

  58. it occurs to me that part of our dilemma is this.

    Many do not trust the Govt to be able to effectively deal with the issue in a cost-effective way

    but at the same time – they know and acknowledge – they admit – that the private sector is not going to deal with the issue without the involvement of the govt.

    and they seem resigned to the fact that the private sector approach will result in higher costs, denied coverage and millions of people they will not even offer coverage.

    my problem is – how can any of us, in good conscience support such a path?

    taking a "I don't know what the answer is so leave it alone" approach is non-responsive to the problem.

    the "leave it alone" approach is not an option unless we want to admit a fatalistic viewpoint that will eventually lead to a doubling or even a tripling of people who do not have insurance and will have to essentially pray that they get to age 65 before they die.

    but then.. there is a fear that doing something will actually make it worse but in a different way.. that the govt won't being able to keep the costs under control and that path is doomed also.

    Jim B favors an incremental approach to fixing specific problems – which perhaps others do also but I don't see a strong enough connection between the suggested "tweaks" and solutions to the fundamental problems.

    This NYT article is where I think we are headed and should be both with Medicare and health care for folks too young for Medicare:

    Choosing a Policy to Cover What Medicare Doesn’t

    http://www.nytimes.com/2009/10/15/your-money/15HEALTH.html?em

    everyone will get basic care just as we now get basic social security.

    it will be up to you to add on to that policy what you can afford and how you choose to allocate your income.

    you will have to decide, for instance, how much you want to pay for your mortgage, your car AND your health care.

    and just as with your mortgage and your car – you have choices from minimal apt/townhouse to McMansion and econobox to Cadillac with OnStar.

    Your choice. Some folks will (as they do now) spend more on their teeth than they do on their cardiovascular system.

    but we cannot preside over an American Society where we let people die for want of simple basic health care.

    None of us should allow this to happen. It's wrong. It's immoral.

    We should not be giving away free hip replacements or liposuction or Viagara.

    those things should be paid for by the folks that want them.

    You can do that out of your pocket or you can bye a GAP policy on top of your basic health care (that everyone will have).

    but none of us should support a path where the end result is people dying for a lack of basic health care.

    as always, my 2 cents

  59. Anonymous Avatar

    Larry, you are right. Based on experience I don't trust the federal government to do the right thing on health care. And when the feds have control of something that big, there is no place to go for relief. Keep in mind that these are the same clowns that, if they pass a carbon cap and trade bill, will include ways for Wall Street to manipulate the process.

    At least where insurance companies are involved, one can complain to the federal government, which might do something.

    TMT

Leave a Reply