How Will Health Care Reform Control Costs and Reduce the Deficit?

Drug companies and health insurers clearly have very significant lobby groups in the U.S. It always amazes me what they can get away with there.

Every system does that. It's presumptuous to claim the US doesn't. The US does a lot more rationing than other countries.

We ration based on what the insurance covers. We ration based on ability to pay. We ration based on the ability to buy insurance.

I think you are very confused. When you write "The US does a lot more rationing than other countries" just what exactly do you mean? Are you referring to the US government? Or perhaps you are refferring to other actors here as well.

The US government operates health care plans for Civil Service Employees, Congressmen and Federal Judges, Military servicemembers and vetrans. All do indeed involve some form of rationing or limitations on services available. These limits are very generous for Legislators and Federal Judges; more variable for civil servbice employees; and generally a good deal more limited for the military and vetrans, though for service related injuries for active duty servicemembers there are few limits at all. In addition there is (together with the States) Medicaid for the poor and Medicare for those over 65. Both of these are highly rationed, and in the case of Medicare the current Administration is proposing to significantly reduce the payment rates for services and has already seriously limited the number of service providers willing to even accept Medicare patients in some areas of the country. This is because federal law limits the supplemental charges providers can levy on these patiuents.

Private citizens can buy medical care in any amounts they wish subject only to what they are willing to pay for. Most employers provide various forms of health care insurance, usually involving multiple options with different cost sharing formulas with their employees. Most of these insurance plans come with various limitations on coverage, however there is no rationing in the sense that service is not denied or limited by anyone - rather the individual is responsible for paying the difference. If he or she chooses to forego the service because of cost that is no different from any other like economic choices consumers make every day. It is not what is usually meant by the word "rationing".

one more thought, just cuz my blood pressure is not high enough yet..

I wonder how many of the folks ranting against national health care have flood insurance. purchased from the federal government...

http://en.wikipedia.org/wiki/National_Flood_Insurance_Program

it's socialism I tells ya...

"Private citizens can buy medical care in any amounts they wish subject only to what they are willing to pay for. Most employers provide various forms of health care insurance, usually involving multiple options with different cost sharing formulas with their employees. Most of these insurance plans come with various limitations on coverage, however there is no rationing in the sense that service is not denied or limited by anyone - rather the individual is responsible for paying the difference. If he or she chooses to forego the service because of cost that is no different from any other like economic choices consumers make every day. It is not what is usually meant by the word "rationing". "

It is rationed.

no one with a pre-existing condition is accepted...

and are therefore unemployable.

But they have stopped paying for furniture and appliances every time there is a flood. I knew some people who never moved their furniture so they could get new after every flood. Now only one replacement.

seriously...

auto insurance is privatized because there is a profit to be made.

(and in Kansas you are REQUIRED to have insurance, as long as you have a drivers license, even if you have no car.)

hmmmm.

but flood insurance is a government game, because there is no money to be made.

why should other (wealthy) folks prosper from our necessary health services?

If only that were true.
Insurance companies do lots of things to ration care. Most people with insurance don't know what is covered until they need it. When an insurance company says they won't pay for "experimental" procedures it doesn't define that and they have been known to decide that 40 year old procedures are experimental. If someone comes down with a chronic disease, an insurance company will just raise the rates until the person can't afford it any more.

For you to argue that insurance companies don't ration care shows complete ignorance on your part.

George didn't say you could purchase insurance coverage, he said you could purchase medical care (directly from a provider) limited only by what you're willing to pay. It still isn't true because many providers will not accept an uninsured patient, particularly if that patient has a history of needing medical care.

Instead of "willing to pay for" he needs to subject "willing and able to pay for."

Nationalized health care will still pay for a lot of procedures that are beyond the means of an individual.

Have you done an exhaustive survey to prove this strange assertion?

Just offer to pay in cash as soon as the service is performed and see how they respond. I suspect if you do that and ask for a 10% discount most will agree without hesitation. That has been my experience.

How many times have you done this after having arrived at the Emergency Room?

I'm sure you'll understand that this isn't an adequate solution for those who don't have thousands of dollars of liquid cash on hand, just waiting to be tapped for emergency services.

... which can really add up. Auto accidents in particular can lead to many and multiple grievous, simultaneous injuries. I have had a few friends whose health plan was similar to what you propose (i.e., they had no plan and simply wanted to pay cash whenever possible) who ended up in a lot of trouble after bad accidents.

Cycloptichorn

I agree with that. Unexpected large cash demands are a problem if one is unprepared for them. We deal with things like that generally through insurance and loans. For example we buy automobile liability insurance because most states require it and because the risk of an adverse legal judgement and the attendant high costs is very real. We also often pay more to buy collision insurance to protect ourselves from the unexpected large cost attendant to replacing or repairing a vehicle. High deductable health insurance policies that don't cover routine costs of medical exams and ordinary care, but do offer protection for high cost treatments are available and at much more reasonable prices than the HMP and PPO policies that most folks depend on.

Yes I have had the experience of paying cash for medical/dental treatments and also asked for and got a 10% discount on the normal rates. However, to answer Parados, it wasn't in an emergency room.

Most people spend much more on transportation, food, entertainment and rent or home ownership than they do for medical care. Why should medical care be in a category all by itself? Food and lodging are just as essential for life and health. We have active marketplaces for those services & goods, and they serve us very well in terms of quality, quantity and the price of goods available (certainly far better than have any of the socialist experiments the world has seen over the past century).

I'll readily agree that even the best commercial medical coverage plans involve a degree of chicken **** and extra administrative cost. Like any insurance policy they also involve limits on cost and coverage - otherwise they couldn't continue to exist financially. We only have the illusion that government programs can't fail in the same way. However as the Greeks are learning, and as many state employees and pensioners here are learning that even the government's purse can end up empty (The city of Stockton filed for bankrupcy yeaterday).

I don't know how many people plan for needing an organ.

publications.milliman.com/research/health.../2011-us-organ-tissue.pdf

I also don't know how many people have a million dollars lying around if they need an organ or how many people can even get a loan for that amount. Not exactly a good loan risk if they have the average assets of a US median home owner of $170,00.



Even the simple cost of having a defibrillator installed, $50,000,or a hip replaced, $45,000 is beyond the average US citizen's ability to pay.

The costs for food and shelter are not subject to jumps of 90,000% due to unforeseen circumstances.

Really, why do you even bring up this red herring that's been dispatched time and time again?

What is the cap on your automobile liability insurance policy? Mine is $1 million and I'm thinking of iuncreasing it (the cost isn't much).

Everything you addressed above could readily be covered by a high deductable medical policy.

Well let's see. Assuming that a single person spends (say) $350/month on food and (say) $1,250/month for rent, that's $19,200/year. A "90,000% jump" wold raise the price to $17,299,200 per year. That's a lot.

On the other hand, assuming the average healthy person spends $1,000/ year on routine preventive medical costs the same "jump" would yield a cost of $0.9 Billion , and I don't know of any medical procedures that cost that much.

Perhaps you are just pulling numbers out of your ass.

I have yet to observe you "dispatch" anything, not even a red herring.

Hmmm... are you capable of performing mathematical operations? Are you familiar with the concept of percentages?

Perhaps you should revisit your calculations.

Additionally, try performing your calculations on a monthly basis. I won't dispute your $1000/year figure. To make it easy, let's make it $1,200/year.

$100/month. (since you seem somewhat mathematically challenged)

Can you calculate a 90,000% increase?

Haha, that's a Bay Area estimate for sure!

Cycloptichorn