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@Thomas,

Medicare coverage as it exists today is much more comprehensive than emergency care. I don't have numbers but I doubt the costs compare even when non-emergency visits to the ER are counted.

I endorse universal health coverage but I'm concerned about piggy-backing hundreds of millions of currently uninsured individuals onto a system that already can't support itself. I'd much rather scrap the system as we know it and follow a process that results in real health care reform that allows all of us a basic standard of care that we can all afford.

1 Reply

@JPB,

Yes, Medicare coverage is more comprehensive than emergency care. But some of that extended coverage prevents you from going to the emergency room in the first place, often at a fraction of the emergency room cost. Diabetes, for example, is very expensive once you're falling into comas and need dialysis, but cheap to manage with a steady stream of medication. And I'm using this example for no particular reason except that I'm personally afflicted by it. There are many others just like it.

JPB wrote:

I endorse universal health coverage but I'm concerned about piggy-backing hundreds of millions of currently uninsured individuals onto a system that already can't support itself.

There aren't hundreds of millions of currently uninsured individuals in the United States. "Only" tens of millions. You don't get to hundreds of millions unless you count those who are currently covered through someone's employer, and who would pay into the Medicare-for-all system by switching from premiums (premia?) to taxes.

Sure, tens of millions is still a lot of people. But it makes the problem an order of magnitude smaller than you just said it is.

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@Thomas,

Thomas wrote:

I think this premise is false. To my knowledge, no economist who has looked at health care is claiming that there is significant market failure in providing healthcare, as opposed to providing health insurance. Therefore, government-operated health care providers (like doctors, hospitals, rehab clinics, etc.) would not be cheaper than privately operated ones.

How do you get from no market failure in providing healthcare to government-operated health care providers would not be cheaper? Just because there are plenty of hospitals (and that can be debated) doesn't mean that the government can't run them more efficiently. And lack of insurance, for most people, translates to a lack of health care, regardless of whether there is a hospital nearby that could treat them if they could afford it.

Quote:

Just as government-operated farms wouldn't produce cheaper food than privately operated ones. (That's the reason I made that comparison.)

I think the point you're missing is the one about the middle man and the administrative costs. Insurance, private or public, is an unnecessary third party to what should be able to take place between a patient and a doctor. Imagine if the billing department of a hospital or a doctor's office completely disappeared.

To MM's point, I think something along those lines is needed. I had envisioned them as local health clinics, but aid stations are not so far fetched.

1 Reply

@FreeDuck,

FreeDuck wrote:

How do you get from no market failure in providing healthcare to government-operated health care providers would not be cheaper?

Because that's the definition of market failure -- shortfalls compared to perfect efficiency. But maybe I was using incorrect vocabulary, in which case I'm sorry. I distinguish between those "providers" who do the actual work -- doctors, hospitals, rehab clinics etc. -- and the health insurance companies that finance them. My point is that there is market failure in the latter, but not in the former.

FreeDuck wrote:

I think the point you're missing is the one about the middle man and the administrative costs. Insurance, private or public, is an unnecessary third party to what should be able to take place between a patient and a doctor. Imagine if the billing department of a hospital or a doctor's office completely disappeared.

There will always be a middle man. All countries with universal health care systems -- Britain, France, Canada, you name it -- have government agencies making sure that you pay your health care taxes, that doctors don't charge too much for their services, and that they don't prescribe unnecessary medication, tests, or hospital stays. These agencies may or may not be called insurance companies. Either way though, they are still middlemen, and I don't see how you could realistically abolish them.

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I'm mostly staying off of this one, cuz it's a bit too close to home.

how much less would drugs cost if there were no advertising allowed, like liquor...

(every time I go to gram's and turn on the tv, i get bombarded for cialis, viagra, the little purple pill... ... ...)

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@Rockhead,

Does any health insurance plan pay for Viagra and Cialis? I don't think it would make much of a difference to the medications that are actually covered. Especially for those that are older than 18 years and have generic competitors.

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@Thomas,

advertising budgets come off the top...

and profits are the name of the game, just like with the insurance companies.

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@Thomas,

I believe they do, Thomas. There was a national uproar a few years back when Viagra was covered but birth control pills weren't. The answer was to cover bcps.

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@Rockhead,

Chugga chugga advertising..
that brings up the problem for me with health dispensary from US pharmacies - most of them are now chains (chains, chains), few independents. It is hard for me to see pharmacies as any solution in the US, however they may work in Costa Rica.

But I'd like to hear more about how they work in Costa Rica.

I didn't post that mm's idea intersests me, so I'll add it here.

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@Thomas,

Thomas wrote:

JPB wrote:
I endorse universal health coverage but I'm concerned about piggy-backing hundreds of millions of currently uninsured individuals onto a system that already can't support itself.

There aren't hundreds of millions of currently uninsured individuals in the United States. "Only" tens of millions. You don't get to hundreds of millions unless you count those who are currently covered through someone's employer, and who would pay into the Medicare-for-all system by switching from premiums (premia?) to taxes.

Sure, tens of millions is still a lot of people. But it makes the problem an order of magnitude smaller than you just said it is.

HA! I had it at tens and changed it to 100s based on memory of a sound bite. Correction noted.

1 Reply

@Thomas,

Thomas wrote:

Yes, Medicare coverage is more comprehensive than emergency care. But some of that extended coverage prevents you from going to the emergency room in the first place, often at a fraction of the emergency room cost. Diabetes, for example, is very expensive once you're falling into comas and need dialysis, but cheap to manage with a steady stream of medication. And I'm using this example for no particular reason except that I'm personally afflicted by it. There are many others just like it.

I agree, and in this case you're preaching to the choir. I embrace preventative coverage as part of universal health care. Preventative care is much cheaper in the long run than emergency care but that still doesn't bring us close to the cost of granting Medicare coverage to the uninsured or under insured.

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@JPB,

To add, I didn't just say no to McGentrix's idea.

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lovely idea comrade

americans are good at making guns that could staunch the flow

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@Rockhead,

For an upper limit on the effect of advertizing on the price of medicine, I looked at the income statements of some major pharmaceutical corporations (Glaxo Smith Kline, Novartis, Pfizer, Sanofi-Aventis, and Merck).

They all spend between a third and a quarter of their total revenue on "Selling General and Administrative". So if they could evaporate their "Selling General and Administrative" budget, and if they used all the money to cut prices of their "Total Revenue", your medications would be 25-33% cheaper. Nothing to be sniffed at, but nothing Earth-shaking either.

1 Reply

@Thomas,

on my budget, 25-33% could mean the difference between having medicine and not.

then there is HMO and Blue Cross advertising...

mebbe we should just cancel TV.

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@Rockhead,

For them, it also means the difference between having and not having money to spend on researching and developing the next drug, and for someone in 20 years to have that drug or not. I don't think there are easy tradeoffs here.

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@Thomas,

I'm torn - I have a decades' old friend who's tenured in pharmacology, and roiling resentment as a person with low money since I was ten.

Easy tradeoffs? Some of us strive to buy any groceries, to pay any clinic visit fees, and you worry about future pharmaceutical research?

I was there around the time medicine changed, when NIH was still the primo funder, but then petered out, and then research was swamped by pharm money. NIH pretty much funded anything I was ever involved in, sometimes rather primary research, with good results.
Profit as a spark for research has some allure, but I see it as problematic.

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@Rockhead,

Thanks for mentioning advertising. That reminded me of hospital discounts.

Back in '07, I spend three weeks in a hospital. Grand total for hospital only was $15,000. My co-pay, plus insurance payment to hospital totaled up to something on the order of $8,500. The balance was discounted by the hospital per agreement with the insurance company. Same approximate % discount on the ambulance ride. I'm guessing the hospital could do that because of absolute certainty of payment. Does it follow that if everyone were covered by the same insurance, the total hospitalization might have been in the area of $7,000 to $8,000? In other words, if all medical bills were certain to be paid, could all medical bills be lowered by roughly 40%? Some kind of universal coverage may make sense.

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@Thomas,

No, there aren't any easy trade offs which is why the hard decisions have never been made. We need to provide a reasonable level of care to all of our citizens and we're strangled by a system that makes the costs of bringing a new drug to market prohibitive to the manufacturer without long term exclusive rights to market the drug.

1 Reply

@JPB,

JPB wrote:

Preventative care is much cheaper in the long run than emergency care but that still doesn't bring us close to the cost of granting Medicare coverage to the uninsured or under insured.

Maybe this is true if you look at prevention alone. But I don't believe it's true at all if you look at all the efficiencies you can get from a universal health care system. To show you why I don't believe this, here's a back-of-the-envelope calculation in round numbers:

As a nation, Americans spend 15% of their income on health care. Germans on the other hand, who have universal health care, spend 10% of their income on health care. This is the second largest percentage among the major Western economies, and it overstates German expenditures because it's based on a smaller GDP than America's. As an aside, this cost reduction comes at no price in public health: Our life expectancy, child mortality rate, and other metrics of public health, are better than America's.

Hence, if America can generate comparable efficiencies by adopting the German-style system now proposed by the Democrats, the new system would insure 300 million Americans instead of 250 millions, at a cost of 2/3 the old dollar amount per person. Altogether, then, you would still spend less money than you do today.

Granted, this is just a back-of-the-envelope calculation. But there's nothing unrealistic in it. It's entirely plausible that you can insure all the uninsured, and finance it with nothing but the efficiency gains from the reform. Universal health care is one of those rare cases where Milton Friedman is wrong and there is such a thing as a free lunch, after all.

2 Replies

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