Infrastructure Reforms

[Teahive]

But you miss the main point. The persons who ought to be making health care decisions are the patient and the doctor.

At what point, do you think, should insurance come in?

[Diogenes]

What most people don't understand is that Perversely, it is Insurance which has driven the health care costs to insane levels.

Well, insurance is a cause of high costs, but not the cause. There is a standing army of health care workers all of whom need to be paid whether they're running a multi-million dollar scanning machine or doing brain surgery. The equipment used, the facilities, their maintenance, these all cost huge sums of money. There is no way to make modern health care cheap. The best we can do is make everyone so wealthy they can afford it.

It is a positive feedback loop. Insurance divorces the person receiving the care from the cost, The Medical people find out they can charge more, and expenses expand to meet supply. (Just like government, which is also divorced from the costs.)


Some years ago someone I know needed a cyst removed from her neck. The Doctor would do the procedure for $1,200.00 . He would go as low as $800 and something if paid in cash. His staff said she needed to make arrangements with the local hospital to do the procedure. The Hospital wanted $11,000.00 for the operating room. (A completely unreasonable amount for a 30 minute procedure.) I went to the doctor's head of staff and asked if they could do the procedure in their own facility, and pointed out how much the Hospital wanted just for a room. She consulted with the Doctor and he said okay.

$3,200.00 later, and it was all done, Doctor and anesthesia included.

Money is a drug, and it tempts medical people the same as everyone else. They allow costs and expenses to expand until they fit the available cash supply. (Like Congress, but they don't stop at what's available, they insist on spending way beyond what is available.)

[GIThruster]

I'm not sure I understand your question.

If I had my way, all health care would be free for all. We can't get there from here. IMHO, we need to more than fix the economy first. The only way I know to do this is to have clean, cheap energy for all. After that, we can turn attention to free health care.

[Skipjack]

The Medical people find out they can charge more, and expenses expand to meet supply.

This is why the government insurance defines what a doctor can charge for a certain procedure. If a doctor wants to do the procedure outside of the insurance system, then the patient has to pay out of his own pocket or the difference to the covered procedure.
These things are very rare though. Doctors avoid it, because it is not popular with the patients...

[hanelyp]

At what point, do you think, should insurance come in?

Insurance is properly for catastrophic costs that can't be predicted better than statistically.

[Teahive]

I'm not sure I understand your question.

Is this in response to my question?

The reality is that health care comes at a cost, we're not post scarcity yet. So at some point cost will have to enter the decision making process.

At what point, do you think, should insurance come in?

Insurance is properly for catastrophic costs that can't be predicted better than statistically.

Maybe I'm confused, but there appears to be a word missing. Could you clarify please?

[palladin9479]

But you miss the main point. The persons who ought to be making health care decisions are the patient and the doctor.

At what point, do you think, should insurance come in?

Insurance should be for emergency / unpredictable situations. Universal health care should not be universal health insurance. Somehow they have become one and the same inside the USA, it's more profitable that way for the gatekeepers.

Due to the demand being infinite the government rightly should set the price on the most common procedures / medications. Notice I said most common, meaning 90% not 100%. Cosmetic or elective procedures should not be covered by a governmental system. There should exist a separate set of private insurances for things like cancer. This will create different class's / standards of treatment, people with more money will get better treatment then people with little or no money. That is life, it's unfair and people need to just deal with it. The goal would be that an illness or injury does not result in bankruptcy as your forced to divert all disposable income to the pockets of a health care provider or insurance company.

The purpose of a government health system is to take care of the majority of health issues as a public service. I've seen this best used as a discount system coupled with price limiting system. The patient still has to pay some money, but it's not going to bankrupt them or destroy their lives doing so. My wrist treatment would of been about $20 USD to a Korean on their government system. Funny thing is if you bring out a foreign health insurance card the price immediately doubles. Supply vs Demand being what it is and all.

[TDPerk]

"Due to the demand being infinite the government rightly should set the price on the most common procedures / medications. Notice I said most common, meaning 90% not 100%."

You socialist fool.

Rationing should be by ability to pay, moderated by actual charity.

You'd have the ability to pay (always the actual and never avoided constraint) obscured by government bureaucracy, and less healthcare in fact delivered, nevermind the consequent inevitability that medical decisions will be impacted by political implications.

[Skipjack]

Cosmetic or elective procedures should not be covered by a governmental system.

That is the way it should be. It is that way in Austria. Cosmetic procedures are only covered in sever cases (extremely disfiguring issues).

There should exist a separate set of private insurances for things like cancer

Why that?

This will create different class's / standards of treatment, people with more money will get better treatment then people with little or no money. That is life, it's unfair and people need to just deal with it.

I just hope for your sake that you never get some bad illness and go bankrupt over it because you cant afford the payments and the insurance company denies coverage.
60% of all bankruptcies in the US are because of medical costs. Another result is the IMHO horrible, horrible habbit of just sueing anyone for anything in order to cover the cost of treatments (you know the adds "accident? you might be entitled to money call lawyer X now!").
The damage to the economy because of that is huge.
Plus healthcare gets more expensive for everyone else because of the treatments that are never paid for.

[palladin9479]

Cosmetic or elective procedures should not be covered by a governmental system.

That is the way it should be. It is that way in Austria. Cosmetic procedures are only covered in sever cases (extremely disfiguring issues).

There should exist a separate set of private insurances for things like cancer

Why that?

This will create different class's / standards of treatment, people with more money will get better treatment then people with little or no money. That is life, it's unfair and people need to just deal with it.

I just hope for your sake that you never get some bad illness and go bankrupt over it because you cant afford the payments and the insurance company denies coverage.
60% of all bankruptcies in the US are because of medical costs. Another result is the IMHO horrible, horrible habbit of just sueing anyone for anything in order to cover the cost of treatments (you know the adds "accident? you might be entitled to money call lawyer X now!").
The damage to the economy because of that is huge.
Plus healthcare gets more expensive for everyone else because of the treatments that are never paid for.

Go reread my post.

Having full 100% government healthcare isn't going to work well. Having a free market solution isn't going to work either. Compromising between the two gets you a workable solution based on practical application not political philosophy.

Healthcare is NOT expensive because of the "unpaid people", that is a BS lie spread around. It's expensive because the laws of free market say providers can charge that much and still have a market. The value of a commodity is based on what someone else is willing to pay for it. Thus the value of healthcare is now how much your willing to pay. Not too many things in life more important then your life / good health. That puts healthcare as the top priority for disposable consumer income. I know exactly, line by line, the costs of a hospital bill. They overcharge on everything, if you were given two doses of a medication they will charge you for the entire pack / bottle. Each IV is charged as a case. Everything is itemized to maximize profit, yet the hospital still will be running in the red. When looking at their expense sheet you see tons of unnecessarily expenses that were put there by too much regulation. And I'm not talking sanitary type regulations but the actual inner workings of what constitutes a "hospital". Full ER, OR, radiology, labs, along with special treatment centers. It's insanely expensive to run and for 80~90% of health needs it's unnecessary. That is why small clinics have become more and more popular, yet due to many state laws there is a big limit to who can work there and what they can diagnose / treat. It's a big mess created by competing interests (AMA being a big one).


No one has yet been able to say how to keep the consumer price of healthcare down in a free market. Note I said price not cost, they are not the same thing. Cost is how much the service provider has to pay to provide you with the service, it includes materials, labor and any form of incidentals (insurance / ect..). Price is what you the consumer pay to the service provider for the service, it's typically expressed as cost + risk + profit, though sometimes risk is calculated into cost instead. Reducing the costs to doctors / hospitals / biopharms will only increase their profits as the price to you the consumer is set by supply vs demand laws.

I'm being very rational and practice here. I care about outcomes not political philosophies nor religious dogma, though they've become one and the same now. The answer back is nothing but froth and vomit.

[choff]

One of the trends I see listening to complaints from country to country is that the Healthcare system is being deliberately run into the ground, and it doesn't matter if the country in question has a public or private system. The idea seems to be population reduction.

[Skipjack]

I'm being very rational and practice here. I care about outcomes not political philosophies nor religious dogma, though they've become one and the same now.

Sam here! I have experienced both systems now and my opinion is based on that and the price that I have paid in either system as well as the care that I have received in return plus the consumer friendliness of the system. In all of these the system in Austria wins in my opinion.

[rj40]

I'm being very rational and practice here. I care about outcomes not political philosophies nor religious dogma, though they've become one and the same now.

Sam here! I have experienced both systems now and my opinion is based on that and the price that I have paid in either system as well as the care that I have received in return plus the consumer friendliness of the system. In all of these the system in Austria wins in my opinion.

I would be very interested in reading something on the Austrian system. How does it differ from others? Where is the money saved? How happy are most users? How are people with low chabnces of survival treated? What about people who might be seen to have "brought it on themselves?".
Do you have a link to a website wi such an overview?

[Skipjack]

There is a yearly comparison of European healthcare systems. Austria is usually among the top performers. The comparison considers all these factors and more.
I think I posted it on this board before.
Austrias is among the most expensive of the (mostly) public healthcare systems. It is still significantly cheaper though than the US option (measured in percent of the GDP). Noone ever goes bankrupt here because of their medical bills. Availability is great, wait times are short, copays are less than in the US (if there are any at all). People here have the option for an additional private insurance that covers certain cosmetic procedures (like porcellain dentail crowns instead of the standard fillings), alternative medicine treatment and it gives you things like a single bed room in hospitals (normally the bed rooms are for 6 people) or the choice if lying in a private sanatorium instead of a hospital (the doctor of your choice will perform the surgery there then, instead of the general hospital). There is worries about whether the doctor, clinic, or pharmacy accepts your insurance. You can go anywhere and have full coverage.
So basically they save money on things that are merely for personal comfort, but not on things that affect outcome.

[seedload]

Does there need to be a huge private healthcare system somewhere in the world to fund innovation and investment in order for public healthcare systems to leverage off of?

Will people from other countries, professing the greatness of their public healthcare, one day regret the time when they encouraged the US to follow suit?

Like our military, does our apparent overspending allow other countries not to spend - and to gloat about it?

Couldn't be.