Beware Hilliary Care!

[Bill Call]

One of the functions of government run health care is to make sure no one leaves the reservation, i.e., don't you dare try to seek treatment without our approval!

See: http://www.timesonline.co.uk/tol/life_a ... 056691.ece

Ultimately, most government run bureaucracies become miniature communist utopias more concerned about obedience to the State than anything else.

In this case the State would rather see people die than risk "unequal" outcomes.

[Brian Pedaci]

Bill, taking an example of a single bizarre policy from the NHS and tying it to Hillary is pretty dishonest. Clinton's plan is not a single-payer, socialized scheme like you're characterizing it. One of the primary tenets is that you can keep your existing coverage if you like. I don't see how this example proves the inevitable conclusion of all government programs is 'obedience to the State'. Food Stamp recipients aren't kicked off the rolls if they decide to purchase some additional food with cash.

I'm not a Clinton supporter, but it rankles me to see such blatant mischaracterization. I don't believe that government can solve all of our problems (or even most of them), but I do think there are some issues that are so large and so complex that only the government has the resources and the ability to come close to making a difference. Health care is one of those conundrums. The free market has not been sufficient to create a sustainable, equitable system.

These are the kinds of cautionary examples which should be used to make sure our system is the best in the world.

[Bill Call]

Bill, taking an example of a single bizarre policy from the NHS and tying it to Hillary is pretty dishonest. ......

I'm not a Clinton supporter, but it rankles me to see such blatant mischaracterization. I don't believe that government can solve all of our problems (or even most of them)

I am not mischaracterizing the health care goals of Senator Clinton and the supporters of national health care. Their goal is the elimination of the private health care industry and its replacement with a government run system. Like most government proposals it is initially sold as a mere incremental change.

The ultimate goal is the elimination of private health care. They envision a state run bureaucracy that issues top down directives regarding treatment and all other aspects of human behavior "to control costs".

Smoke? Eat too much? Eat too little? Eat the wrong things? Don't exercise? Sorry, no health care for you.

The reason national health services are "less" expensive is that they:

Pay doctors less
Pay nurses less
Have no innovation in medicine
Ration health care

You can save a great deal of time and money in the US just by mandating the above policies. Have a heart attack? I am sorry we have already performed our allotted number of surgeries. Have a child with a rare disease? I'm sorry we don't treat that. Need Dialysis? I'm sorry, you are to old. Have cancer? The next surgery is available in 18 months, etc.

Don't get too worked up, Hilliary care is coming sooner or later, at least for the working stiff. As in Canada, France or the UK the upper level bureaucracy is exempt from the rules.

see:

http://www.reason.com/blog/show/120850.html

http://www.reason.com/news/show/120998.html

http://www.reason.com/news/show/29303.html

[Bill Call]

Health care is one of those conundrums. The free market has not been sufficient to create a sustainable, equitable system.

These are the kinds of cautionary examples which should be used to make sure our system is the best in the world.

I agree.

Someone who is 60 years old and retired should be able to buy health insurance for a reasonable amount.

Someone who has MS should be able to buy health insurance for a reasonable amount.

What does reasonable mean? Hellifino.

[Lynn Farris]

Bill,

I beg to differ with you. The reason health care costs are significantly less in other countries is because there are no Health Insurance companies and that is what is wrong with all of the Health Care programs that are introduced with the exception of Dennis Kucinich.

The insurance companies pay big bucks to market their companies. Then they pay big bucks to exclude people or their conditions. In other countries with National Health Care - the cost is much less and the doctor is the one that determines the treatment. One of my employees was telling me her mother's doctor spends more time on the phone with the insurance company arguing for her mother's treatment than he has ever spent with her. That is a waste of both Doctor's time and the insurance.

Combine that with the Bush program (which the dems caved on) about not being able to negotiate with drug companies for lower costs and you have sky rocketing health care costs.

Then you have malpractice insurance. It isn't the victims that are getting rich on recovering from law suits - it is the insurance companies again that are raking in the bucks. This is a big issue. In fact many of our friends who are physicians are leaving Ohio because of mal practice costs.

Bill, look at the other Westernized countries. Their health care is better than ours. Heck, look at Costa Rica, a developing country - they have better health care too. And they all offer it to all of their citizens for what they pay in taxes and their taxes plus medical insurance is usually lower than what we pay.

But I do agree with you that we need to go either Kucinich's way of Single Payer National Health Care for all or Ron Paul's way of breaking up the AMA letting more people become doctors so that their is more supply which will force prices down and allow us to negotiate with drug companies for better prices-or buy them from Canada or whatever. Really let the market take charge.

Go one way or the other. There is no middle ground. JMHO

[ryan costa]

A free market paradigm of health insurance isn't
compatible with the expense of modern healthcare technology, equipment,
and administrative costs. At least not without a much more stoic
cultural acceptance of abortion, euthanasia, and mortality in general. but that might drive the religious right back to being religious left.

Innovation generally costs more than standardization, at least so far as technology is concerned.

A broken finger or bad case of the flu can easily cost more than a years
worth of health insurance premiums. free market health insurance companies assume the same drawbacks used by critics of government services.

technology and advances in knowledge and the cost of training people in that knowledge has far outpaced the old days of affordable healthcare. blame the lawyers, blame the AMA, blame the school of knowledge behind medicine: it doesn't really matter.

some basic level of health insurance or healthcare could be run like a utility. at least, primary care and mundane specialties like ob/gyn, broken bones, etc. these providers can be allowed to discontinue seeing patients that give them problems: so the providers won't be tempted to price themselves out of the cesspool, like upper middle class people often insulate themselves in expensive "communities". Patients will then be more interested in being good patients and practicing healthy lifestyles. insurance for specialists can continue to exist in the hypothetical free market. in addition to insurance for more exclusive primary care.

Or there is SimpleCare: http://simplecare.com/

[Brian Pedaci]

The ultimate goal is the elimination of private health care. They envision a state run bureaucracy that issues top down directives regarding treatment and all other aspects of human behavior "to control costs".

Smoke? Eat too much? Eat too little? Eat the wrong things? Don't exercise? Sorry, no health care for you.

This is different from private health insurers how?

I like Ronald Bailey's articles in Reason as well. This one is, I think, a better critique of Hillary's current plan and a pretty good blueprint for how government-mandated health insurance doesn't have to equal government-run health insurance.

[dl meckes]

Bill, taking an example of a single bizarre policy from the NHS and tying it to Hillary is pretty dishonest. ......
The reason national health services are "less" expensive is that they:

Pay doctors less
Pay nurses less
Have no innovation in medicine
Ration health care

You can save a great deal of time and money in the US just by mandating the above policies.

Isn't that sort of the same idea you propose for controlling education spending?

[Will Brown]

It seems strange that everyone has a simple answer for a problem of such complexity. I have not yet heard a politician give any indication that they have considered all aspects of this problem; they just try to formulate a plan that will attract the most votes. I'm also a bit leery of accepting the widely broadcast figure of how many people don't have insurance; that doesn't mean they cannot get medical care. The people who calculate that figure also seem to assume that everyone who works at a company that doesn't provide insurance doesn't have insurance. However, if you are a student whose employer doesn't provide insurance, you very well may have insurance as a dependent of your parents; if you are on Medicare and work for a company that doesn't provide insurance, you still do have insurance under Medicare. Also, I personally know people who are near-destitute and have no insurance, but they still get medical care, as many physicians seem to feel their duty is to provide the care, whether or not the patient can pay.

Some of my feelings are that our costs are so high now because of two factors: first, medical science, at great expense, has made great advances in recent years, so that someone with a medical event that would have killed them 30 years ago, can now be saved. So we are receiving more and better treatment, and we are receiving it over longer lifespans, and I think its fair to say that, in general, the elderly need more medical care than the young. Second, costs have soared since the government got involved with Medicare and Medicaid. With these programs, care is unlimited, and often the caregivers provide treatment that the patient would not want, if they had to pay themselves. My mother, at advanced years, developed cancer throughout her bones; she just wanted to be made comfortable in the short time she had left. The medical establishment, with Medicare's support, provided her all sorts of treatments that she didn't even want, without even asking her. They molded a fiberglass brace that resembled a turtle shell; I'm sure it cost thousands, and she refused to wear it after leaving the hospital, as she just wanted to stay in bed.

On the other hand, the government programs and many insurance programs, while imposing a lot of administrative costs, do hold prices down. A typical instance would be a visit to a doctor, who bills $130; that is what you pay if you don't have coverage. The insurance programs will typically pay perhaps $45, leaving you a copayment of $10, and require that the doctor bill nothing above the $55 they have established as the fair cost of that visit.

Right now, having insurance is largely voluntary. Some employers provide insurance at no cost to the worker, but the trend is that the worker has to pay part of the cost of the insurance. It is not uncommon that younger workers, having lower incomes, a real need for some stylish shoes, and a belief that they will live forever and never need medical care, decline to pay their fraction of the insurance premiums, and forgo coverage. So what happens when that uninsured person becomes ill and needs expensive treatment? Is it fair that other people, who have paid for their own insurance, should have to pay the full tab for this person who didn't participate? Reguired universal coverage would appear to be an answer, but at the same time there may be some very advanced treatments that cannot be done for what the insurers and government think is a fair price; the rich may be able to afford them, but many of us who could afford to pay the difference between the approved amount and the charged amount, cannot get that treatment, as the doctor doesn't want to go to jail for accepting more than the approved amount.

Many of the countries that provide apparent no-cost care have tax rates that would shock most Americans. If they have a tax rate of 50 or 60 percent, but give you free medical care, you have to be pretty gullible not to realize that you are paying for the medical care, just not directly.

Some countries that provide subsidized or free care to pay their medical people very little. I think everyone has heard the stories about Soviet physicians moonlighting as taxi drivers. To me, highly educated medical professionals deserve more than a living wage; why spend all that time in school, amassing all that educational debt, if you cannot receive some benefit?

Governments that are involved in health care do have to pay for it. Here, our congresscritters just appropriate more money, add it to the national debt, then slink into retirement before our kids have to start paying off that debt. In other countries, they just ration care. Canada is reported to do this regularly. The provinces appropriate the money at the start of the fiscal year, then in the second half of the fiscal year, they realize they didn't appropriate enough, so they have to decide whether to plow the roads or provide medical care. Their solution often is to ration medical care, deferring all but the most critical cases into, at least, the next year. This leads to the strange situation where Canadians bus to the US for treatment, while Americans bus to Canada for prescription drugs. Good deal for the bus companies.

Another problem is prescription drugs. It takes a huge amount of time and money to develop a new drug, and if the drug companies don't make enough money to continue this development, the pipeline will run dry. Right now it seems to me that Americans are paying these research and development costs through high prices, while the rest of the world gets a free ride. Assume that the research and development costs involved in discovering, proving, and marketing a new drug are $25 per pill, but the manufacturing cost is only $1 per pill. So the manufacturer sells the drug here for $30 a pill (recovering their costs, and reaping a profit that is probably split between paying for more research and development, and paying some dividend ((without some dividend, investors will not buy into the company, and it will be out of business)). Since the manufacturer can recover their research costs by domestic sales, the will gladly sell the drug overseas for perhaps $2 a pill, which nets them $1, as the manufacturing cost is only $1. There is no way that is fair! I don't know what the best solution is, but all users of the drug should have to bear some of the research and development costs. Perhaps allowing Medicare to negotiate the cost of their drugs is the solution. Another might be imposing some tax on overseas sales that are less than a certain level, and using the proceeds of that tax to recoup some of the costs the government incurs in medical research and oversight of manufacturing. Perhaps a substantial tax on lay advertising of drugs would help; if I never see another ad to Viagra or its ilk, I'll be happy. The idea that a lay person can self-diagnose, then get a physician to provide a medication selected by the patient, seems foolish, but I guess we have created a culture where we want a pill for every occasion.

As I said first, this is a very complex situation. Even choosing among the competing insurances offered is more than most of us can handle, and while I think competitive marketplaces have been generally good, I'm not comfortable with the possibility that I will pick one plan that I think will save me $10 a month, only to discover that something I overlooked will cost me $400 a year.