[mike777]

"It appears to me you are comparing reasonable access to health care with unreasonable expenses of limited value."


1) I thought the above was your main point. That government makes the political and economic decisions of what is unreasonable expenses of limited value and what is reasonable health care.

See Helene's post about IC beds.


To reword your point hopefully fairly, should the guiding ethical medical question be what is of the greatest value to the most people or what is best for this patient.

"Peter Littlejohns, NICE's clinical and public health director, noted that "there is a limited pot of money," that the drugs were of "marginal benefit at quite often an extreme cost," and the money might be better spent elsewhere."

http://online.wsj.co...3435303415.html

In 2007, the board restricted access to two drugs for macular degeneration, a cause of blindness. The drug Macugen was blocked outright. The other, Lucentis, was limited to a particular category of individuals with the disease, restricting it to about one in five sufferers. Even then, the drug was only approved for use in one eye, meaning those lucky enough to get it would still go blind in the other. As Andrew Dillon, the chief executive of NICE, explained at the time: "when treatments are very expensive, we have to use them where they give the most benefit to patients."


2) I have no idea what you mean about the voting thing or how you could disagree.

Clearly the Democrats won big and clearly the Democrats are for some public option. I am not saying they are for socialized medicine that you appear to be for but they may be.


3) I have no idea how you disagree with my comments about limited supply and unlimited demand or how they do not equate for you.

I agree health care costs are much higher than 1954 but who wants 1954 health care at 1954 prices.


4) as for your comment about supply in a few hands, I dont understand what you mean. There are over a 1000 health care insurance companies. I grant they are not allowed to compete over state lines and that limits competition, I would be for allowing competition across state lines.

I do believe a public option will crowd out for profit companies but many think that is a good thing.

As for Passed OUT comments I am not sure how private insurance companies or private health care providers are allowed in a single payer context. That does not sound like a single payer system but then I really am unsure how they work.

[helene_t]

nigel_k, on Aug 28 2009, 01:34 AM, said:

surely sovietizing the supermarkets should take priority over sovietizing the health system?

That strikes me as a purely ideology-based remark.

If you have the theory that a strong role for the government in the supply of health care is inefficient then you should reconsider that theory, because the fact is that it works. The shortage of IC beds in the UK notwithstanding, the fact is that most if not all developed countries achieve better health care results than the US, at far lower costs.

[OleBerg]

nigel_k, on Aug 28 2009, 02:34 AM, said:

If we accept the premise that the profit motive is incompatible with the proper provision of essential goods and services, the surely sovietizing the supermarkets should take priority over sovietizing the health system?

Definately not.

I don't mind a doctor dictating me what medication I should take for an infection, but I would mind the very same doctor dictating me what brand of cereal I should eat.

[hrothgar]

mike777, on Aug 28 2009, 04:39 AM, said:

You clearly prefer the government to make these political and economic decisions and not free capital markets via the pricing mechanism.

Please point meet at any country where these decisions are made by free capital markets using a pricing decision.
(The US most certainly does not fall into this camp)

[mike777]

USA and almost all countries. Price is used as a rationing mechanism and an information discovery mechanism.

There are very few Socialist Health care systems, most certainly not in the USA are the economic and political power in the same pair of hands.

As I pointed out in my previous post there are state limitations on the free flow of capital, which should be changed. But for the most part there is a free flow of capital with increasing government regulations.

Here is a basic example, interest rates are the price or cost of money. Interest rates affect the flow of capital. Price affects capital investment decisions.

Side note I need to go now and take my wife to the hospital for an operation. Hopefully our healthcare systems works in real life and I need to quit this thread.

[hrothgar]

mike777, on Aug 28 2009, 03:55 PM, said:

USA and almost all countries. Price is used as a rationing mechanism and an information discovery mechanism.

There are very few Socialist Health care systems, most certainly not in the USA are the economic and political power in the same pair of hands.

As I pointed out in my previous post there are state limitations on the free flow of capital, which should be changed. But for the most part there is a free flow of capital with increasing government regulations.

Here is a basic example, interest rates are the price or cost of money. Interest rates affect the flow of capital. Price affects capital investment decisions.

Side note I need to go now and take my wife to the hospital for an operation. Hopefully our healthcare systems works in real life and I need to quit this thread.

As usual, the facts strongly contradict your claims

I strongly recommend looking at the following:
http://hcfan.3cdn.ne...c_20m6i6nzc.pdf

There is a nice chart on page 4 that shows the combined market share for the two largest Health Care providers in each state.

Don't suppose that you'd care to provide the good working definition for a "competitive market". (You know, the kind of thing that I expected my Econ 101 students to be able to provide)

[blackshoe]

helene_t, on Aug 28 2009, 02:46 AM, said:

The shortage of IC beds in the UK notwithstanding, the fact is that most if not all developed countries achieve better health care results than the US, at far lower costs.

I have not seen these data. Have you a link, or an offline source?

[kenberg]

blackshoe, on Aug 28 2009, 10:10 AM, said:

helene_t, on Aug 28 2009, 02:46 AM, said:

The shortage of IC beds in the UK notwithstanding, the fact is that most if not all developed countries achieve better health care results than the US, at far lower costs.

I have not seen these data. Have you a link, or an offline source?

Cost can, perhaps, be calculated. Quality issues of course get tougher. We rank badly in infant mortality, 33rd according to
http://en.wikipedia.org/wiki/List_of_count..._mortality_rate


While that suggests bad health care, it would be worthwhile to see where the deaths come from. Sixteen year old mothers are more likely to have their children die than would be the case, on average, with a twenty-four year old mother. Iceland has the best record, 2.9 deaths per 1,000 compared with the US 6.3 per 1,000.

But you can look further. The same reference puts the UK 22nd with a rate of 4.8. The Minnesota rate, available by following the links at
http://www.health.st...nfantmortality/
is 4.9. Not all that much to choose between the UK and Minnesota.

The Minnesota report gives an ethnic breakdown of the numbers. 9.2 for African Americans, 10.3 for American Indians. 4.4 for whites.

So Iceland outdoes us all, but Minnesota is fairly equivalent to the UK, and the real disparity is between races.

What this suggests to me is that analyzing any data can get pretty tricky pretty fast. Sample question: Is European health care more successful in reducing the gap between races in infant mortality?


The following is from the Guardian:
http://www.guardian.co.uk/lifeandstyle/bes...nfant-mortality

"Nearly 1 in 100 babies die in their first year of life in some parts of England, official figures show. A new study has found that babies are most at risk if they're born in deprived areas, areas where there is a higher proportion of mothers under 18, and areas with larger ethnic minority populations."



It is not unreasonable to speculate that class and race are more important here than the health care system.

[PassedOut]

blackshoe, on Aug 28 2009, 10:10 AM, said:

helene_t, on Aug 28 2009, 02:46 AM, said:

The shortage of IC beds in the UK notwithstanding, the fact is that most if not all developed countries achieve better health care results than the US, at far lower costs.

I have not seen these data. Have you a link, or an offline source?

I did not realize that this was in question. There are many sources of information about this. Here are some links.

United Health Foundation: America's Health Rankings: Comparison to Other Nations (2008)

Quote

The Commonwealth Fund rates the U.S. last in health care system performance when compared to a group of six countries that include Australia, Canada, Germany, New Zealand and the United Kingdom.  The U.S. spends twice as much as these six countries on a per-capita basis, yet it is last on dimensions of access, patient safety, efficiency and equity. (see note 3)  So, while the U.S. is spending more on total health care when compared to other countries, the country is getting less access, patient safety, efficiency and equity.

The results of these studies are a wake-up call to everyone in the United States to strive to improve all aspects of our health system however possible, including education, prevention and clinical care.  Other countries have improved their overall health by improving their health care system, indicating that we too can do the same.

Reuters: Healthcare costs in U.S. vs. rest of world (2006)

Quote

UNITED STATES: 15.9 pct of GDP, $6,657 per capita

FRANCE: 11.1 pct of GDP, $3,807 per capita

GERMANY: 10.7 pct of GDP, $3,628 per capita

SWEDEN: 8.9 pct of GDP, $3,598 per capita

CANADA: 9.7 pct of GDP, $3,430 per capita

UNITED KINGDOM: 8.2 pct of GDP, $3,064 per capita 

JAPAN: 8.2 pct of GDP, $2,936 per capita

Medical News Today: USA Spends More Per Capita on Health Care Than Other Nations, Study Finds

Quote

The United States spends more on health care per capita than other industrialized nations but does not receive more services, according to a study published on Tuesday in the July/August issue of Health Affairs.

- The United States has 2.9 hospital beds per 1,000 residents, compared with a median of 3.7 beds per 1,000 residents among the other nations examined;

- The United States had 2.4 physicians per 1,000 residents in 2001, compared with a median of 3.1 physicians per 1,000 residents among the other nations examined in 2002;

- The United States had 7.9 nurses per 1,000 residents in the United States in 2001, compared with a median of 8.9 nurses per 1,000 residents among the other nations examined in 2002;

- The United States has 12.8 CT scanners per one million U.S. residents, compared with a median of 13.3 scanners per one million residents among the other nations examined;

- The United States appears to have more magnetic resonance imaging machines per capita than many of the other nations examined, but the machines are used only 10 hours daily in the United States, compared with a median of 18 hours daily in other nations; and;

- The average medical malpractice payment, which included both settlements and judgments, was $265,103 in the United States in 2001, compared with $309,417 in Canada and $411,171 in Britain.

[awm]

It seems like this actually explains a lot of the problem in the US.

Compared to other countries with comparable wealth, the US has a shortage of medical resources (doctors, especially general practitioners, nurses, MRI machines, etc).

In a free market system, a low supply naturally leads to a higher price. But what's supposed to happen, is that as the price rises the demand goes down (people decide they don't really need this thing if it's so expensive) and the supply goes up (there is more money to be made producing the commodity in question).

However, the US health care system seems to break this free market process. The issue is that when the price of health care goes up, it does not directly effect people's use of health care, because they are covered by insurance through their employer, expenses are paid, etc. So increasing the cost of medical care does not change the actions of individual people. The increased price (price has to increase to prevent shortages) is hidden from consumers and is passed on to their employers. Basically the only way people's health care behavior changes substantially is if they don't have insurance, so the employer eventually cuts health care (too expensive) or cuts payroll (employees too expensive because of health care cost) leaving more people uninsured. So the price increases are much larger than they would otherwise need to be to change behavior, and the upshot is a lot of people without insurance.

Meanwhile, higher price is also supposed to increase supply. If general practitioners (and nurses etc) were making lots of money, then presumably more people would go into these professions and supply would increase etc. But in fact the pay rates for these professions are held down because of fixed pay-per-appointment rates from medicare and from large-scale bargaining by the insurance companies (many of which have local monopolies). So the extra money from the increased price mostly goes into the coffers of the insurance companies and not into the pockets of doctors and nurses. So supply does not increase as fast as it needs to, and the process continues.

Basically the issue is that insurance companies are acting as intermediaries, hiding the costs from consumers (so they don't cut down on unnecessary procedures) and also hiding the profits from doctors (so the supply of doctors doesn't increase). The obvious solution would seem to be getting rid of insurance companies and letting the government take over their role as intermediary. This works relatively well in a lot of countries. In most cases the free market would be more efficient than the government, but health insurance is a funny "market" where the free market paradigm seems to be broken.

[hrothgar]

awm, on Aug 29 2009, 12:24 AM, said:

It seems like this actually explains a lot of the problem in the US.

Compared to other countries with comparable wealth, the US has a shortage of medical resources (doctors, especially general practitioners, nurses, MRI machines, etc).

In a free market system, a low supply naturally leads to a higher price. But what's supposed to happen, is that as the price rises the demand goes down (people decide they don't really need this thing if it's so expensive) and the supply goes up (there is more money to be made producing the commodity in question).

However, the US health care system seems to break this free market process. The issue is that when the price of health care goes up, it does not directly effect people's use of health care, because they are covered by insurance through their employer, expenses are paid, etc. So increasing the cost of medical care does not change the actions of individual people. The increased price (price has to increase to prevent shortages) is hidden from consumers and is passed on to their employers. Basically the only way people's health care behavior changes substantially is if they don't have insurance, so the employer eventually cuts health care (too expensive) or cuts payroll (employees too expensive because of health care cost) leaving more people uninsured. So the price increases are much larger than they would otherwise need to be to change behavior, and the upshot is a lot of people without insurance.

Meanwhile, higher price is also supposed to increase supply. If general practitioners (and nurses etc) were making lots of money, then presumably more people would go into these professions and supply would increase etc. But in fact the pay rates for these professions are held down because of fixed pay-per-appointment rates from medicare and from large-scale bargaining by the insurance companies (many of which have local monopolies). So the extra money from the increased price mostly goes into the coffers of the insurance companies and not into the pockets of doctors and nurses. So supply does not increase as fast as it needs to, and the process continues.

Basically the issue is that insurance companies are acting as intermediaries, hiding the costs from consumers (so they don't cut down on unnecessary procedures) and also hiding the profits from doctors (so the supply of doctors doesn't increase). The obvious solution would seem to be getting rid of insurance companies and letting the government take over their role as intermediary. This works relatively well in a lot of countries. In most cases the free market would be more efficient than the government, but health insurance is a funny "market" where the free market paradigm seems to be broken.

Doctor's make a pretty good living even after the insurance companies take their cut.

I suspect that various barriers to entry have a MUCH more significant impact on the supply of doctors than low wages.

For example: college, med school, and the like are all enormously expensive. Residents don't get paid much at all and have miserable working conditions. Anyone wanting to become a Dr needs to be willing to trade off a pretty miserable "now" against what is potentially a very lucrative future. Relatively few people are willing to do this.

The AMA does everything it can to restrain entry into the market.

[mike777]

"As I pointed out in my previous post there are state limitations on the free flow of capital, which should be changed"

Back the operation went well.


As for my post I just wish the posters would actually read what it says before they claim I say stuff which I do not. The facts posted support what I said, they do not contradict it.


Just to repeat the main point and not these side points. Winston was advocating a system where the economic and political power are in the same hands. A system where health care costs are paid for regardless. I think he made his point clearly.
----------------------------------------

"Basically the issue is that insurance companies are acting as intermediaries, hiding the costs from consumers (so they don't cut down on unnecessary procedures) and also hiding the profits from doctors (so the supply of doctors doesn't increase). The obvious solution would seem to be getting rid of insurance companies and letting the government take over their role as intermediary. This works relatively well in a lot of countries. In most cases the free market would be more efficient than the government, but health insurance is a funny "market" where the free market paradigm seems to be broken."



Yes I agree with your entire post, excellent points. The fact we are paying 100% more for what seems to be the same quality of health care is wierd. Even if one thinks we have the best/better health and pay for innovation that other countries do not pay for.
-----------------------------------------------------


Excellent point made by Richard.

"Doctor's make a pretty good living even after the insurance companies take their cut.

I suspect that various barriers to entry have a MUCH more significant impact on the supply of doctors than low wages.

For example: college, med school, and the like are all enormously expensive. Residents don't get paid much at all and have miserable working conditions. Anyone wanting to become a Dr needs to be willing to trade off a pretty miserable "now" against what is potentially a very lucrative future. Relatively few people are willing to do this.

The AMA does everything it can to restrain entry into the market"

[mike777]

To echo Adam's excellent post. The one regulation I guess I always most strongly support is transparency, more transparency. Clearly all of us, including me, have no idea how much stuff costs, like my wife's operation today. I certainly never understand my company's health insurance plans and our HR dept. knows less.
-------------------------------------------------------------------------------------------------

To echo Richard's excellent post.

"Among other concepts, Friedman advocates ending the mandatory licensing of doctors and introducing a system of vouchers for school education."

http://en.wikipedia....ism_and_Freedom

------------------------------------------------------------------------------------------
Winston's posts make for an interesting and thoughtful thread. Well worth it.

"am of the opinion that no needed procedure, treatment, or drug should be denied because it is unprofitable. In my opinion, health care should be acknowledged as a cost to society. We spend more than the rest of the world combined on our defense budget - to do so and not have universal health care should be considered a moral crime in the universe."


"The idea of a publicly-held corporation determining my need for a procedure or treatment goes against all I believe in as a part of the health care providers in this country, because I know the interest of that company is not in my well being but in appeasing the shareholders by earning higher profits.

I really don't want an Enron or WorldCom executive making decisions that affect my ability to receive health care."


Here is the basic counterpoint. I expect many to disagree.

"The Relation between Economic Freedom and Political Freedom
In this chapter, Friedman promotes economic freedom as both a necessary freedom in itself and also as a vital means for political freedom. He argues that, with the means for production under the auspices of the government, it is nearly impossible for real dissent and exchange of ideas to exist. Additionally, economic freedom is important, since any "bi-laterally voluntary and informed" transaction must benefit both parties to the transaction."

http://en.wikipedia....ism_and_Freedom

[awm]

hrothgar, on Aug 28 2009, 04:30 PM, said:

Doctor's make a pretty good living even after the insurance companies take their cut.

I suspect that various barriers to entry have a MUCH more significant impact on the supply of doctors than low wages. 

For example:  college, med school, and the like are all enormously expensive.  Residents don't get paid much at all and have miserable working conditions.  Anyone wanting to become a Dr needs to be willing to trade off a pretty miserable "now" against what is potentially a very lucrative future.  Relatively few people are willing to do this.

The AMA does everything it can to restrain entry into the market.

Certainly it's true that doctors make a lot of money relative to most other professions. But becoming a doctor entails a huge amount of time (medical school, residency) and money (medical school is expensive). A typical doctor has about 120K of educational debt.

Here's a chart of doctor's salaries after three years. Primary care doctors are making 147K-160K. This is pretty good, but many specialists are making much more. For example, cardiologists are averaging 317K. After ringing up such a huge debt (and spending so many years in school when their peers are out in the work force), is it any surprise that many doctors opt for the more lucrative specialties?

[mike777]

I was surprised when I started getting so many medical doctors as clients who basically had retired at a very early age because they hated the practice.

1) They changed professions
2) They became stay at home Moms or DAds
3) They became teachers, researchers.

It reminds me when I dated a doctor in Calif. who also had an mba and law degree and was trying to figure out what degree she should get next. Anything to not practice medicine with patients.

[Winstonm]

blackshoe, on Aug 28 2009, 10:10 AM, said:

helene_t, on Aug 28 2009, 02:46 AM, said:

The shortage of IC beds in the UK notwithstanding, the fact is that most if not all developed countries achieve better health care results than the US, at far lower costs.

I have not seen these data. Have you a link, or an offline source?

I don't mean this comment as coy, smug, or sarcastic:

If you have not seen this information is can only be because you have not tried at all to find it. It is not hard to locate.

[Winstonm]

Quote

"There was no mention of sovietizing - what are you trying to do, promote fear by trying to compare socialized medicine to the U.S.S.R.?
They are not the same. Your argument is invalid - no one but you said that the profit motive was incompatible with the proper provision of essential goods and services."




Since you make this claim at the very least back it up, just do not dismiss it by saying it is not the same, please.

I am opposing the terminology - Soviet-style communism DOES NOT equate to socialism or socialized medicine. I am not opposed to some form of socialized medicine.

[Winstonm]

mike777, on Aug 28 2009, 04:48 PM, said:

To echo Adam's excellent post.  The one regulation I guess I always most strongly support is transparency, more transparency.  Clearly all of us, including me, have no idea how much stuff costs, like my wife's operation today. I certainly never understand my company's health insurance plans and our HR dept. knows less.
-------------------------------------------------------------------------------------------------

To echo Richard's excellent post.

"Among other concepts, Friedman advocates ending the mandatory licensing of doctors and introducing a system of vouchers for school education."

http://en.wikipedia....ism_and_Freedom

------------------------------------------------------------------------------------------
Winston's posts make for an interesting and thoughtful thread. Well worth it.

"am of the opinion that no needed procedure, treatment, or drug should be denied because it is unprofitable. In my opinion, health care should be acknowledged as a cost to society. We spend more than the rest of the world combined on our defense budget - to do so and not have universal health care should be considered a moral crime in the universe."


"The idea of a publicly-held corporation determining my need for a procedure or treatment goes against all I believe in as a part of the health care providers in this country, because I know the interest of that company is not in my well being but in appeasing the shareholders by earning higher profits.

I really don't want an Enron or WorldCom executive making decisions that affect my ability to receive health care."


Here is the basic counterpoint. I expect many to disagree.

"The Relation between Economic Freedom and Political Freedom
In this chapter, Friedman promotes economic freedom as both a necessary freedom in itself and also as a vital means for political freedom. He argues that, with the means for production under the auspices of the government, it is nearly impossible for real dissent and exchange of ideas to exist. Additionally, economic freedom is important, since any "bi-laterally voluntary and informed" transaction must benefit both parties to the transaction."

http://en.wikipedia....ism_and_Freedom

Mike,

I don't necessarily disagree with conservatives and free marketers on many subjects - but I totally disagree with the conclusion that free market principles and capitalism is ALWAYS the only right answer.

I think health care may be one of those issues where socialism may well be the better path.

Regarding your statement about Democrats solidly favoring a public option, you are dead wrong - only the liberals of the party want public option and the Obama administration is working on marginalizing those liberals.

This is why I recommend the Greenwald article. http://www.salon.com...nion/greenwald/

[kenberg]

I tried reading the greenwald article. Perhaps he is an acquired taste that I haven acquired yet. I found the article largely incomprehensible.

[Winstonm]

kenberg, on Aug 28 2009, 07:57 PM, said:

I tried reading the greenwald article. Perhaps he is an acquired taste that I haven acquired yet. I found the article largely incomprehensible.

I understand - it is not his finest writing but it does tell the story. He points out how Obama and his administration are putting pressure on the liberals in the party to abandon the public option..... because of the influence of the corporations.

The Dems don't want all that money going into Republican coffers for the next election cycle.

Basically, he is demonstrating that there is no effective differences between the two parties - all are only interested in appeasing the moneyed interests.

Here is the money line from the article:

Quote

More important than all of that is the fact that there is one principal reason that Blue Dogs and "centrists" exert such dominance within the Party:  because the Party leadership, led by the Obama White House, wants it that way and works hard to ensure it continues.

Rahm Emanuel does not want a public option - and now Obama is claiming that a "public option" was never a "necessity".

Greenwald shows why and how this has happened - but it is not well written, I agree.