Health Care

[ASharperImage]

Originally Posted by pjorourke

Exactly -- it is not the cost of the malpractice claims that drive up health care -- that hasn't changed that much. It is the defensive practice of medicine that probably adds 15-20% to the cost.

Never let facts get in the way of a good talking point. I'd love to know where you get some of your statistics. Multiple studies have shown that at MOST wasteful defensive medicine costs about 60 billion dollars, which is about 3% of total spending. Most studies put the number a little lower at 1-2%. There was a largely discredited study done in the 1990s out of Stanford (I believe) which pegged the number at close to 9%, but nobody agreed with the methods and results. In 2004, the CBO looked at this and determined that the costs were about 2% of spending. Tort reform, which could potentially cut wasteful spending by 25% - 50% optimistically would only result in a pitiful 0.5% cost savings.

EgrBvr, you are right. Both sides will pull out statistics to help make their point. But somewhere in there is actual truth. Reality is not a matter of opinion or political viewpoint. My only hope is that decisons get made by people who are willing to change their minds when new evidence and data come out. Believeing the same thing on Wednesday that you did on Monday, no matter what happens on Tuesday isn't anything to be proud of.

I don't know about you guys, but maybe the most appropriate heath care related discussion for this board should be which lady looks the best in a nurse's outfit. Nominations?

[charlestudor2005]

Originally Posted by ASharperImage

maybe the most appropriate heath care related discussion for this board should be which lady looks the best in a nurse's outfit. Nominations?

VNurse has already started.

[discreetgent]

Originally Posted by ASharperImage

I don't know about you guys, but maybe the most appropriate heath care related discussion for this board should be which lady looks the best in a nurse's outfit. Nominations?

And face the wrath of the ones we didn't chose? Not a chance!

[TexTushHog]

Originally Posted by pjorourke

Exactly -- it is not the cost of the malpractice claims that drive up health care -- that hasn't changed that much. It is the defensive practice of medicine that probably adds 15-20% to the cost.

Empirical studies don't bear that out. What many, especially the insurance industry, call defensive medicine is actually good care. They just don't want to pay for it. There are quite a few studies that, including two by the non-partisan CBO, that show that there is little if any defensive medicine that can be quantified and that the number of unnecessary test that can be found are far more often caused by doctor's profit motive.

[pjorourke]

Originally Posted by TexTushHog

that the number of unnecessary test that can be found are far more often caused by doctor's profit motive.

... that in turn are caused by perverse economic incentives inherent in any system driven by government price fiat instead of the market.

As you ASI note, there is substantial difference of opinion on what is necessary care and what is defensive and the cost of same. A patient, with an economic interest in the cost (even a small one), is the best arbiter. I note that we dont have runaway costs in dentistry, eyeglasses, cosmetic surgery and pet care -- all related areas where the patient (or in the case of pets the owner) have an economic stake in decision making.

[WTF]

Originally Posted by pjorourke

... and pet care -- all related areas where the patient (or in the case of pets the owner) have an economic stake in decision making.

Old Spot is ninety in dog years Mr and Mrs Pet owner. Ten thousand dollars to keep him alive another 2 months.........or 50 bucks for a little
euthanasia.

Sounds like death panels work!


Seriously though, this is the elephant in the room. End of life cost have skyrocketed. Nobody wants to talk about it but we have come to a point where cost are a huge concern. Studies show that we spend huge % of one's healthcare cost on the last few months of one's life.

[pjorourke]

It ain't a whole lot easier to put Old Spot down than it is Grandma.

[WTF]

Originally Posted by pjorourke

It ain't a whole lot easier to put Old Spot down than it is Grandma.

Dat be da truth.

I got a buddy who is a vet that makes a killing off , well killing is a bad choice of words, a good living off people not wanting to let go of their pets.

[guest051510-1]

Maybe we should have Dr. Kevorkian draw up the HC Bill.

[WTF]

Originally Posted by Nicolette Bordeauxva

Maybe we should have Dr. Kevorkian draw up the HC Bill.

Well to outlaw people's CHOICE to end their life is pretty stupid.

Life is full of tough choice's. Right now healthcare cost is one of them. Medicade cost is exploding and one of the reasons is end of life care....the very end of life.

Now the choice may caome down to spending money on your kids or your grandparents. You may not like that choice but that is really what we are talking about. Lucky for grandpaw he gets to vote.

[atlcomedy]

Originally Posted by pjorourke

It ain't a whole lot easier to put Old Spot down than it is Grandma.

Now the in-laws may be a different story

[atlcomedy]

Originally Posted by pjorourke

... A patient, with an economic interest in the cost (even a small one), is the best arbiter. .

Until this happens, even it involves (practically it would have to if broad care is an objective) subsidies for low incomes, we will never see significant reductions in the cost of care.

And, this economic interest needs to occur at the point of service; not at the time of paying premiums. And, yes, this would involve changes to the employer paid system.

[WTF]

Originally Posted by atlcomedy

Until this happens, even it involves (practically it would have to if broad care is an objective) subsidies for low incomes, we will never see significant reductions in the cost of care.

And, this economic interest needs to occur at the point of service; not at the time of paying premiums. And, yes, this would involve changes to the employer paid system.

Agreed.

You need skin in the game to have a fair indicator of markets worth. It is the equivalent of moral hazard in the housing bubble.

[pjorourke]

Originally Posted by atlcomedy

Until this happens, even it involves (practically it would have to if broad care is an objective) subsidies for low incomes, we will never see significant reductions in the cost of care.

And, this economic interest needs to occur at the point of service; not at the time of paying premiums. And, yes, this would involve changes to the employer paid system.

Preferably, it would involve scrapping the employer paid market -- this could be done with a law that says as of today (i.e., the date proposed) and $'s spent on healthcare or other employee benefits must be converted to cash salary on a per capita basis (subject to rules proscribed by the Treasury that reflect age/health and other underwriting factors). That locks in the current employer contributions and gets rid of this "free benefit" insanity.

Then you add a per taxpayer (i.e., married filing joint get two) refundable tax credit (payable monthly) which has an aggregate value equal to the money that will be raised from the new taxable income. That would immediately level the playing field and give everyone an equal dollar benefit (not increasing with income). If you have a gold plated health plan, you will pay a little more tax. If you have an average plan, it will be about a wash. If you dont have a plan, you will get the full credit. BTW, you only get the credit if you have insurance -- getting over that constitutional issue of mandated purchase. (of course, this would be a great time to also consider a flat tax.)

Then get rid of the state based limitations on sales and policy requirements and make insurers get rid of their underwriting restriction (or significantly reduce them) so everyone can buy a policy that fits their needs. Policies should have significant cost sharing per service and annual deductibles and out of pocket limits tied to income. You want the gold plated one that covers everything -- its gonna cost you a ton, but its your choice and your problem -- dont expect me to pay for it. I'm sure the carriers will be very creative in developing bare bone policies that fit within the cost of the credit and designing web and employment based mechanisms to sign people up and to arrange for the credit to go directly from the government to them -- eliminating a ton of costs in the process.

[npita]

The bottom line is that if most people were satisfied with the current system of health care, the issue would have never come before the government, the same way that the issue of the affordability and quality of pants has never come before the government. Insurance companies have simply not satisfied enough people to keep the government from being asked to step in by enough unsatisfied people to get the government's attention. You can argue ideology to death, but in the end, the ideology that will be used by congressmen to decide what to do is the least painful path to re-election.