AMERICAN CONSERVATISM IN 2008 AND BEYOND

How do I know what will happen when everybody is insured? I can't know any more than anybody else can. But if history is any indication, and so far it has produced the same results every single time, we can be pretty darn sure that if it is the government providing the insurance, the government won't do it more efficiently, effectively, or economically than the private sector can do it.

Much is made of the supposed "unfairness" of our current "system". Implicit in that view are the unstated assumptions that in this area of life there should exist such a "system" that is free of individual cost, responsibility, and consequences for bad choices; or that such "systems" even exist that don't have costs and social consequences comparable (or worse) than the benefits they provide. Moreover, there is substantial distortion (sometimes by omission ) of the relevant facts in these arguments ."Uninsured" doesn't mean no access to medical care - one can pay himself or use public health facilities which are substantial. A large fraction of the uninsured are young, healthy and voluntarily choose to pay more for entertainment, electronic gadgets and other such discretionary expenses than they would for high quality insurance coverage (my company pays 80% of the costs for medical coverage and offers a fairly wide range of choices - still we find that a surprisingly large fraction of the young engineers, chemists and biologists we hire voluntarily elect to forego the insurance coverage just to escape the 20% charge.)

It is merely unfortunate that the political debate on this matter here and on these threads has degenerated mere polemics on competing abstract concepts of social values and design. In such an environment top-down "systems", designed by those who assign themselves the task of telling others how to live, always look better than freedom and individual choice and responsibility. Freedom is usually better.

Finally, I am bemused at the willingness of folks like Cyclo to believe that a government bureaucracy will serve them better, more efficiently and with more individual attention than even a "heartless" insurance company.

Foxfyre wrote:

How do I know what will happen when everybody is insured? I can't know any more than anybody else can. But if history is any indication, and so far it has produced the same results every single time, we can be pretty darn sure that if it is the government providing the insurance, the government won't do it more efficiently, effectively, or economically than the private sector can do it.

I think that you certainly could know more. Just by comparing the various systems and their history - and I'm not just meaning Germany. Or Canada.

This isn't Germany or Canada or the UK, each of which has a small fraction of the population as ours. Even if you add them all together. And whatever happened in those countries does not change US history and what we can learn from it. The US system of government is unique in the world and has provided us with unprecedented freedom, prosperity, and opportunity. Unfortunately it also leaves us more vulnerable to government meddling and the enhancement of personal power, prestige, and fortune among those we elect to lead us.

Health Spending in the United States and the Rest of the Industrialized World

July 12, 2005

Authors: Gerard F. Anderson, Ph.D., Peter S. Hussey, Ph.D., Bianca K. Frogner et al.

While there is no question that the United States spends more than any other country on health care, observers and analysts often disagree about which factors are to blame and which strategies may slow the trend. However, a study published in Health Affairs, supported by The Commonwealth Fund, finds that higher prices for health services such as prescription drugs, hospital stays, and doctor visits, are the main reason for higher U.S. spending. The latest data from the Organization for Economic Cooperation and Development (OECD), which compare trends among 30 industrialized countries, show that the U.S. spent $5,267 per capita on health care in 2002"53 percent more than any other country. In "Health Spending in the United States and the Rest of the Industrialized World" (Health Affairs, July/August 2005), Gerald F. Anderson, Peter S. Hussey, Bianca K. Frogner, and Hugh R. Waters of the Bloomberg School of Public Health at Johns Hopkins University, analyze the OECD data in an effort to determine why U.S. health spending is so much greater than that of other countries. They explore"and reject"two commonly proposed explanations: 1) other countries have restricted the supply of health care resources, which has led to waiting lists and lower spending; 2) the threat of malpractice litigation is much more common in the U.S., resulting in increased malpractice insurance premiums and the practice of "defensive medicine""tests or procedures ordered by physicians to protect against the risk of being sued. Role of Supply Constraints
Many OECD countries have relied on supply constraints to control health care spending, including limiting the number of hospital beds, controlling the spread of medical technology, and restricting the number of physicians. Does the lack of such constraints in the U.S. account for the vast spending differential? No, say the authors. Using U.S. survey data, they calculated the amount spent in the U.S. on the 15 procedures that represent the largest share of the waiting lists in Australia, Canada, and the United Kingdom. Total spending for these procedures was $21.9 billion, or only 3 percent of U.S. health spending in that year. The authors also compared health spending in OECD countries with waiting lists to spending in those without lists. "Health spending in the twelve countries with waiting lists averaged $2,366 per capita," the authors say, "while in the seven countries without waiting lists, it averaged $2,696"both much less than U.S. spending of $5,267 per capita. In a surprising finding, the authors discovered that, despite the lack of waiting lists, Americans do not have access to a greater supply of health care resources than people in most other OECD countries. In fact, the U.S. has fewer per capita hospital beds, physicians, nurses, and CT scanners than the OECD median. One area where the United States exceeded the OECD median was the nurse staffing level in acute care hospitals. In 2002, there were 1.4 nurses per U.S. hospital bed, compared with the OECD median of 1.0 nurses per bed.

Quote:

Not only did expanding and liberalizing insurance coverage push costs upward, greatly escalated as our society became more and more litigious, the government can't simply put in a reasonable benefit and leave it alone.

Are you oblivious to the scientific advances in Medicine since the 1950 Fox?
How many people had pacemakers or open heart surgery in the 1950s?
How many people were on medicines for high blood pressure?
How many women were on contraceptives?
How many premature babies survived?

For that matter, what was the life expectancy in the 1950s compared to today?

I suppose health insurance would be cheaper if we only treated people medically the way they were treated in the 1950s. But don't you think that would be a little ridiculous Fox?

Don't tell me that advancements in medicine and technology is the logical explanation for healthcare being unaffordable.

george, Fox keeps telling us about the cost of litigation increases health care cost, but I can find no such findings.

Jury Verdict Research® Releases Verdict Survey:
-Medical-Malpractice Jury-Award Median Up Slightly
- Overall Median Compensatory Award Down 30%

HORSHAM, Pa. - Jury awards for medical-malpractice claims rose fractionally, while awards for all personal-injury liabilities fell significantly, according to Jury Verdict Research's report, Current Award Trends in Personal Injury - 43rd Edition.

After steadily climbing more than 100% from 1996 to 2000, the compensatory jury-award median for medical-malpractice cases has leveled off the last three years studied. The percentage of $1 million or more medical-malpractice verdicts remained the same from 1999 through 2002 at 52%.

cicerone imposter wrote:

george, Fox keeps telling us about the cost of litigation increases health care cost, but I can find no such findings.

Perhaps it is because you haven't taken the trouble to look. Malpractice liability insurance costs are very high: so much so that they have driven many doctors in some specialties (obstetrics is but one example) out of business and in some venues depriving towns of their only provider. These costs are driven up by tort lawyers who specialize in extracting outrageous judgements, many in class action cases, presented in carefully selected areas where they can find credulous, sympathetic juries, - and who themselves pocket up to half of the money awarded. Our vaunted Senator John Edwards (remember him?) made himself a multi millionaire that way. This has been the subject of intense political debate and widely reported.

That you aren't aware of all this is no shame on you, but that you so complacently criticize others for their awareness of this well-known fact, merely suggests a rather uncurious mind given to premptory prejudgement.

The Malpractice Insurance Crisis: The Impact on Healthcare Cost and Access

Focus: To investigate the impact of rising medical malpractice insurance premiums on healthcare access and costs.

Study Design: Survey of Blue Cross and Blue Shield Plans.

Results:

One hundred percent of Blue Plan Executives in medical malpractice insurance crisis states (as defined by the American Medical Association1) believe that rising medical malpractice premiums are a problem. In non-crisis states, 66 percent view it as an "extremely" or "very" important problem.
A majority of Blue Plans in crisis states report that local doctors are cutting back on some aspect of patient care.
-Fifty-six percent of Plans in crisis states say physicians are refusing some high-risk procedures, versus 32 percent for non-crisis states.

-Fifty-six percent of Plans in crisis states say more physicians are leaving practice or retiring, versus 41 percent of respondents in non-crisis states.

Fifty-four percent of BCBS Plans predict that fees for obstetrician/gynecologists are likely to rise in response to higher medical liability premiums, while 49 percent say that surgical fees will rise.


http://www.bcbs.com/blueresources/cost/cost-access.html

In a companion poll of 500 doctors conducted by Cooper Research on Nov. 3-4, 71 percent of physicians identified medical malpractice insurance and lawsuits as the leading factor driving up the cost of health care followed by the aging population (42 percent) and the cost of prescription drugs (42 percent), and the poor health habits of Americans (37 percent).

Overwhelmingly, 80 percent of the physicians believe medical malpractice reform should be the top health care priority of the Congress, followed by greater access to health care coverage and finding ways for Americans to lead healthier lifestyles (both at 43 percent).
(This was in 2004)
http://www.consumeraffairs.com/news04/health_care_costs.html

An additional insight from the graph, however, is that even after adjustment for differences in G.D.P. per capita, the United States in 2006 spent $1,895 more on health care than would have been predicted after such an adjustment. If G.D.P. per capita were the only factor driving the difference between United States health spending and that of other nations, the United States would be expected to have spent an average of only $4,819 per capita on health care rather than the $6,714 it actually spent.

Health-services researchers call the difference between these numbers, here $1,895, “excess spending.” That term, however, is not meant to convey “excessive spending,” but merely a difference driven by factors other than G.D.P. per capita. Prominent among these other factors are:

1. higher prices for the same health care goods and services than are paid in other countries for the same goods and services;

2. significantly higher administrative overhead costs than are incurred in other countries with simpler health-insurance systems;

3. more widespread use of high-cost, high-tech equipment and procedures than are used in other countries;

4. higher treatment costs triggered by our uniquely American tort laws, which in the context of medicine can lead to “defensive medicine” " that is, the application of tests and procedures mainly as a defense against possible malpractice litigation, rather than as a clinical imperative.
http://economix.blogs.nytimes.com/2008/11/14/why-does-us-health-care-cost-so-much-part-i/?apage=4

"...believe that rising medical malpractice premiums are a problem."