Free, Public Healthcare

@ossobuco,

was not. and am not enraged, i have not the energy for that effort.

i kinda speak away from you.

sorry if that bothers you.

truly done, with apologies to the thread author.

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@ossobuco,

You are not the only one who can't see to read?
Look up retinitis pigmentosa and glaucoma. I may make it out of that thicket, in a few weeks, but I have reason for extreme fear.

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@ossobuco,

I've liked the thread in general, and am paying attention.

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@Thomas,

Thomas wrote:

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.

I distinguish between those two as well, but I'm not sure if your last sentence is actually true. I have difficulty seeing, for instance, how failure of one does not translate to failure of the other given the dependence of the providers on the insurance system. For instance, here in Atlanta we have a hospital that treats major emergencies like gunshot wounds. It's the only one with a level 1 trauma center in the metro area. It's been on the brink of bankruptcy for years and would have closed if it weren't for the efforts of local governments to keep it running. This is because, of course, most our local gun shot victims do not carry insurance. It was turned into a non-profit in order to keep it from closing. This hospital faced a choice between making a profit and providing services. It couldn't do both. Is that not market failure?

If all we do is add a government insurer to the already messed up insurance scheme, we aren't cutting any administrative costs at all. We'd still be working with claims and the overhead that comes with them, both on the provider end and on the insurer end.

FreeDuck wrote:

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.

I do. We already have an agency that makes sure we pay our taxes. If we move away from fee for service pricing and toward a salaried model then you have no need to oversee how much doctor's charge for their services. And doctors get to just be doctors and don't have to start the timer the minute they walk in the room, so that they can be sure they turn a profit and cover their costs by seeing as many patients as possible in a day.

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@FreeDuck,

FreeDuck wrote:

We already have an agency that makes sure we pay our taxes.

Yes we do and this "agency" has guns.

If guns are outlawed ... only the government will have guns.

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David Walker on healthcare reform on MSNBC this morning.

http://www.msnbc.msn.com/id/3036789/#31238294

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@H2O MAN,

Quote:

Yes we do and this "agency" has guns.

If guns are outlawed ... only the government will have guns.

I think you meant to post that here

http://able2know.org/topic/132992-1

do you have any thoughts on the thread subject: Public Health Care?

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@JPB,

that was interesting...
what is David Walker's background?

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@panzade,

Ex Comptroller General under Bush II until he resigned in March 2008.

Now President and CEO of PGPF which I talk about here.

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@JPB,

It's amazing that that thread doesn't even have 2 pages!
Thanks for steering me to it

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an interesting take from a doctor in the latest New Yorker which I read last night

"The explosive trend in American medical costs seems to have occurred here(McAllen Texas) in an especially intense form. Our country’s health care is by far the most expensive in the world. In Washington, the aim of health-care reform is not just to extend medical coverage to everybody but also to bring costs under control. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”"

The basic premise is that getting a handle on health care costs can widen the coverage for more Americans

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

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@FreeDuck,

FreeDuck wrote:

This hospital faced a choice between making a profit and providing services. It couldn't do both. Is that not market failure?

It is market failure, but it's mostly a failure in the health insurance market; most of it would go away once that failure was fixed: Universal health care would give all gunshot victims decent health insurance, so by your account the hospital probably could provide its services at a profit.

That said, I do take your point that specialized hospitals can entail market failure. To stay with your example: if a hospital really is the only possible place in town that can treat certain gun shot wounds, that could be a monopoly problem, and may justify the city taking it over.

But examples like this are best handled case by case, and on the lowest level of government that can fix the market failure -- which usually means locally. Nationalizing the healthcare providers would be way overbroad for fixing the kind of problem you describe.

FreeDuck wrote:

If we move away from fee for service pricing and toward a salaried model then you have no need to oversee how much doctor's charge for their services. And doctors get to just be doctors and don't have to start the timer the minute they walk in the room, so that they can be sure they turn a profit and cover their costs by seeing as many patients as possible in a day.

Sounds good so far, but how does this system react when doctors prescribe unnecessary medication, or treatments whose cost are way out of proportion to their benefit to the patient? How does it find a good tradeoff between the time each doctor spends on each patient, the number of patients each doctor treats, and the number of doctors the government needs to employ?

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@panzade,

Quote:

President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”"

PrezBO's BullShit packaged in a slick sales pitch.

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@Thomas,

Thomas wrote:

But examples like this are best handled case by case, and on the lowest level of government that can fix the market failure -- which usually means locally. Nationalizing the healthcare providers would be way overbroad for fixing the kind of problem you describe.

I'm not sure we necessarily have to nationalize it in such a way that the federal government runs the hospitals. Rather, it could be done a bit like education -- national funding and oversight, state-run institutions. There are problems with that, of course. It will be difficult to ensure quality of care without introducing an incentive system, which I'm not opposed to.

Quote:

FreeDuck wrote:
If we move away from fee for service pricing and toward a salaried model then you have no need to oversee how much doctor's charge for their services. And doctors get to just be doctors and don't have to start the timer the minute they walk in the room, so that they can be sure they turn a profit and cover their costs by seeing as many patients as possible in a day.

Sounds good so far, but how does this system react when doctors prescribe unnecessary medication, or treatments whose cost are way out of proportion to their benefit to the patient? How does it find a good tradeoff between the time each doctor spends on each patient, the number of patients each doctor treats, and the number of doctors the government needs to employ?

First, doctors no longer have an incentive to prescribe unnecessary medication or treatments as it doesn't make them any extra money to do so. One has to assume that the hypocratic oath still applies to doctors and that they have better things to do with their time than to make extra work for themselves. Further, if they have to see everyone and everyone who walks through their door, I imagine their priorities will fall into place rather quickly. There will necessarily be some rationing.

Any system can be exploited without checks and balances, but that isn't a good reason to dismiss it out of hand. Figuring out how many doctors we need should not be very difficult given that you say we have no market failure in capacity, and given that other countries who provide this kind of health care appear to have been able to figure it out. I don't purport to have a fully defined proposal written up to be adopted by Congress and immediately implemented, I just think it's a good idea worth exploring.

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Quote:

This way, people still have the choice of using private insurance and private doctors of their choice.

Quote:

President Obama has called for health care reform in 2009 that upholds three core principles. It must:

Reduce costs " Rising health care costs are crushing the budgets of governments, businesses, individuals, and families, and they must be brought under control

Guarantee choice " Every American must have the freedom to choose their plan and doctor " including the choice of a public insurance option

Ensure quality care for all " All Americans must have quality and affordable health care

source

Your idea would mean a lot of creating which would cost a lot rather than working with what we already have.

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@FreeDuck,

I agree there's a lot of parallels between the optimal system for healthcare and the optimal system for schooling. As you know I approve of more privatization in the schooling system than you approve of, so it only makes sense that I also approve of less nationalization of the healthcare system than you approve of. But it almost appears we're no longer that far apart. Damn! I was so looking forward to finally trading insults with you.

FreeDuck wrote:

Any system can be exploited without checks and balances, but that isn't a good reason to dismiss it out of hand.

Sure. All I'm saying is that there needs to be a checking-and-balancing agency, and that in practice it would would continue much of the work that health insurance companies are doing now. Therefore it's misleading, whether technically true or not, to say you can eliminate the health insurance companies.

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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.

Why do you think that it needs to be a "market failure" to have room to lower costs? Why isn't the exorbitant cost alone something worth addressing even if it doesn't qualify as a market failure?

Quote:

Therefore, government-operated health care providers (like doctors, hospitals, rehab clinics, etc.) would not be cheaper than privately operated ones.

I think that this is a false premise. Around the world public health care is cheaper than private health care more often than it isn't and the evidence just doesn't support this claim.

What happens in the examples I am familiar with is that a very different class of service is offered where the difference in quality (end result of health, not comfort and nicety) is much smaller than the difference in price.

Quote:

The same is not true of health insurance, because of the problem with adverse selection that I mentioned before. Which is why my solution would be to expand Medicare to everyone who wants it, and leave the rest of the system unchanged except for technical upgrades. (Open, uniform standards for electronic medical records would be an example for such a technical upgrade.)

This doesn't fix that the fundamental costs are exorbitant. There isn't just one problem of lacking health care coverage, the costs alone with the insurance issue put aside are outrageous. I don't want public money going to provide universal health care coverage at these insane costs because I really don't think we can afford it without fundamentally changing the health care system and not just throw money at insuring the uninsured (though I still think that is better than what we have now).

Quote:

It is true that FreeDuck's and McGentrix's proposal would expand coverage -- but so would a subsidy for those people who couldn't afford the Medicare-for-all plan I propose.

I don't care about the coverage so much as the cost. The lack of coverage owes in large part to the cost, but even at 100% coverage the cost of health care is a growing problem that needs to be addressed.

It just doesn't need to cost anywhere near what it costs in the US to provide the basic fundamentals of health care.

Quote:

Government-employed doctors, government-operated hospitals, etc., would not necessarily run more efficiently than privately operated ones.

More efficient is a bit of a red herring. The point, for me, is cheaper, not more efficient and free public health care should not try to provide the same care that private health care does.

All the most modern and hyper-expensive treatment in America is still not beating Costa Rica's life expectancy by much at all.

I don't see the private sector being very well suited to providing that very basic level of care more cheaply than a public system could, and I'd still want a healthy private sector around (I don't support a completely nationalized health care system at all).

Do you really think that it couldn't be cheaper? And if so why is it cheaper in every such example that I am aware of? Or is it that you just think America can actually afford to universal insurance at today's (and more importantly, tomorrow's) costs?

I don't think the evidence supports the former, but I think the latter is much more arguable. I'm not certain that we can't just afford to insure everyone for private care, but the costs are daunting and I do think that basic health care can be provided more cheaply by a public system because I see it right in front of me now where I live.

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@Thomas,

Thomas wrote:

Sure. All I'm saying is that there needs to be a checking-and-balancing agency, and that in practice it would would continue much of the work that health insurance companies are doing now. Therefore it's misleading, whether technically true or not, to say you can eliminate the health insurance companies.

I'm not saying eliminate them. I'm saying eliminate them from the public option. Let insurance and private industry handle everything over and above the agreed upon basic level of care that everyone should be provided.

Still, there is a huge difference between oversight and management of the health care system and what insurance companies do. Oversight is not the primary function of health insurance, and never was.

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@Thomas,

Thomas wrote:

Damn! I was so looking forward to finally trading insults with you.

I, for one, am relieved. The only insult I had prepared was to call you Shultz. I got nothing after that.

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@Robert Gentel,

Robert Gentel wrote:

This doesn't fix that the fundamental costs are exorbitant. There isn't just one problem of lacking health care coverage, the costs alone with the insurance issue put aside are outrageous. I don't want public money going to provide universal health care coverage at these insane costs because I really don't think we can afford it without fundamentally changing the health care system and not just throw money at insuring the uninsured.

Exactly.

1 Reply

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