Universal Healthcare

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The funny thing about this, though, is that some of our most prestigious clinics have the lowest costs. The Mayo Clinic is one such example; a model not only of cutting edge technology and top-flight care, but also of cost control. As the (very long but well worth reading) article AMaster linked to points out, we actually seem to have an inverse relationship between cost of service and quality of service. Employing every metric currently in use, the Mayo Clinic comes out as one of the top medical institutions in the country. Employing every metric currently used for cost analysis, they also come out as one of the least expensive. Why? They don't order useless tests, for starters.

 

I think it also depends on the prices of the services included in the treatment. I saw some sources that stated that medications tend to be more expensive in the US, which would obviously be partially responsible for the overall price.

Anyway, I don't doubt that the US has some amazing hospitals, but the difference in the price is definitely higher than any difference in quality. I think most Western countries have hospitals at (nearly) the same level, although they may be less numerous than in the States.

 

Several weeks ago we had an online conference call with Howard Dean, who discussed the strategy for Obama's healthcare package and how the oppostition would respond. He commented to us that it would have a "public option" although it would be entirely voluntary, but that nevertheless, "the public option would be there." When I received my message from Obama several days later to begin the campaign, there was no mention of it in his remarks regarding his "healthcare reform bill." I'm still very suspicious that there may not be a public option.

That's what he's been doing, yet without providing us with any details of what's exactly in the plan. There were only some vague, generalizations, with no specifics. How do you begin a campaign without knowing what's in the plan? I'm still waiting to find out.

http://www.msnbc.msn.com/id/30985144/

 

The same way he won the presidency, that's how.

 

I agree in principle with what you are saying (and Drew's point is well noted too), but I can't help but wondering if it doesn't skew the average in the other direction instead. Two points:

1. I'm sure that there are thousands of people the world over who come to American hospitals for procedures for whom cost is no object. In many cases, these people have spent several thousand dollars in travel expenses alone, so the cost of the procedure is not something they are going to quibble about. However, by definition, these people are NOT Americans and wouldn't be calculated into the average. I'm sure there are a lot of wealthy people in the US who also get top notch medical care as well, but very wealthy people tend to have very good health insurance, and so their out of pocket costs are not going to be excessive.

2. On the other hand, there are 47 million Americans with NO health insurance whatsoever. They roll the dice, hope nothing serious goes wrong with their health (and for the vast majority of them nothing serious happens), and the few that do go to the emergency room (and get handed a bill for a few thousand dollars that they cannot afford to pay). For those people, the vast majority of them pay NOTHING towards health care.

I think that health insurance is a lot like auto insurance - it's something that you keep paying for with the hopes that you won't need it. And most people pay way more in premiums that they receive back in benefits. Until the birth of my son, the amount I paid out in insurance costs dwarfed the benefits I received from my insurance, and the same thing goes for my auto insurance (one claim in nearly 20 years of driving).

And I still think that hospitals and doctors charge way too much for the care they provide. I'm not naive - I know it costs a TON of money to run a hospital, and doctors deserve to be well compensated for their services (they need to be seeing as how most doctors have about $250,000 in student loans when they get out of school, and doctors have to spend tens of thousands annually on malpractice insurance). But the costs are completely ridiculous. When my son was born, and I got the bill for his delivery it was over $11,000. My insurance picked up the vast majority, so I only ended up paying a few hundred dollars, but it's crazy what they charge. My wife had a normal delivery - there was no C-section, no emergency procedures, and my son didn't need any special type of care after he was born. She was hooked up to monitors to check her vital signs and the baby's vital signs, she was given an epidural to help with the labor, and we took up a hospital bed for a total of three days. How can that cost $11,000?

 

To me the biggest issue is the difference the insurance companies pay for a procedure versus someone who has no insurance or inadequate insurance. The bill for T3V2 was over $16,000 when all the bills were counted up -- the insurance company paid ~$6,000 (and I paid maybe $100). So the hospitals, doctors, lab, etc. got ~$6,100 total. Had we not been insured we would have been forced to pay the entire $16,000. So the medical community basically sticks it to the people who have the most difficulty paying.

 

That is exactly the problem with the system for those who are lucky enough to have healthcare: We pay more for less. Here are some numbers:

So while it may be true that people come here for more "specialized" treatment, the majority of Americans pay more for less. And it is probably the amount of profit that is made in the system by the "free market" institutions, since it is in their interest (and their shareholders) to offer you less and charge you more. The above numbers are disputed, but the notion that "the healthcare is best here" is laughable.

This is the other half of the problem:

We are the only major industrailzed nation to do this to our people for "philosophical" reasons.

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

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Our cost for Nathan, at around the same time you had T3, is way different:

The total bill was just over $15,000. We paid out of pocket, $1500.00 to the hospital, $1200.00 to the doctor who did the delivery and another $300.00 in state madated lab tests. My company changed insurance carriers that year and the coverage is now much worse - but my rates did not drop. Some "choice."

 

One of the biggest problem with universal healthcare is that no one would get to see a doctor when they needed it.
There are approx. 800-850k doctors in america, however less than 92,000 are General Practitioners.
With the 47 million uninsured suddenly having access to them, good luck.
It's almost impossible to get an appointment in less than 3 weeks now, what happens when each of these doctors has over 500+ NEW patients to tend to?

Oh, as far as malpracticecosts go, lowballed, badly.
Ex. surgeons & ob/gyn range from $17k/year in okla to $227k/year in Fla, while GP's can range from $12k to over $100k/year depending on state.

Also look at what insurance companies actually pay as opposed to what the hospital/doctor bills. If they pay half of what is billed, the doctor is lucky.
Would you expect your mechanic to accept $1500 for a $4000 job or a store to let you buy a $4000 computer but pay only $1500? Than why do we think doctors should do so?

 

That isn't just a problem with universal healthcare, but our current system as well. Our current dearth of general practitioners comes down to the way our incentive system is structured, since most hospitals, doctors, and insurance companies work under a pay per service structure. Despite being far more important, preventative care simply doesn't pay what specialized care does. Fix the incentive system and our dearth of GP's will work itself out.

We have models for just this type of thing with the Mayo Clinic(s) and other hospitals that have chosen to switch their doctors from a pay-per-service structure to a salary based system.

 

Yeah, however, the Mayo clinic is a non-profit organization, not sure if that would work at a for profit organization.

 

Which suggests that a for-profit model is not ideal.

47 million uninsured means 250 million insured. Which means you're talking about each doctor going from 2500 patients to 3000 patients. Suddenly the increase doesn't seem so outlandish.

 

I never have a problem seeing my doctor. I got a flare up of gout in my foot last week, I called him in the morning and had an appointment in the afternoon. When my son gets sick, the pediatrician (who is pretty much a GP for kids) sees him within 24 hours of making the phone call. Most people go to their GP when they get sick. If you had to wait three weeks for an appointment, you either would be recovered from your illness, in the hospital, or dead.

Every other industrialized nation on earth provides universal health care to its citizens, so we know that the concept is possible, not just in theory but in practice. The major obstacle preventing the US from doing this is trifold in my opinion. First, and most obvious, is that the other industrialized nations of the world did not have to deal with a multi-billion dollar private, for profit, medical insurance industry. And it's the for profit more than the private part that I think leads to a lot of the problems we have today.

The second point is more nuanced. Many people in the US (and I include myself among them) pay quite a bit for their insurance but they are also fairly happy with their insurance. Switching over to something else that is unknown is not something they are inclined to do. That's why all proposals allow you to keep your current plan if you are happy with it, with the option to opt into the new plan at a later time if you want to.

The third and final point is I do not think health care works on the free market the same way most other products do. People do not purchase health care the same way they buy a TV. Your life does not depend on you owning a plasma HD flat-screen TV, and buying a regular 27" TV will do just fine. There is no adverse impact (other than not liking your TV as much) for not buying a top of the line model. Same thing with purchasing a vehicle. I bought a minivan this spring, and while I would have loved to have got the pimped-out version with leather interior, heated seats, and a DVD player, I went with the mid-grade package to save several thousand dollars in vehicle costs. There is no adverse impact (other than not liking my vehicle as much) for not buying the top of the line model.

But that's not how people buy health care. Nobody wants to be frugal when it comes to protecting their health, or their spouse's health, or their children's health. That's why I think that classic free market system doesn't really apply to health care where competition among for profit companies can keep prices low. For just about any other product, I can chose to not purchase the top of the line product (even in cases where I can afford it), but can instead purchase something with fewer features at a reduced cost. When it comes to health care, people want the best their money can buy. If you work for a company that offers different medical plans (like mine does) the only way you wouldn't purchase the one with the most comprehensive coverage is if you couldn't afford it.

 

Aldeth, I think the main problem most Americans have with universal healthcare are the horror stories we have heard from some other nations. Yes, universal healthcare can be implimented well, and it can work well, but it can also be implimented poorly and work terribly, and once it's there, you're pretty much stuck with what you've got. At least with our current system if you don't like it you can go for a competitor, but with a universal system, generally, everyone pays for it, even if they use an alternative plan.

 

I agree, but there are so many other nations that have universal health care we should have adequate templates to use to pick one that works well. Look at the examples we have - big nations, little nations, wealthy nations, poor nations, nations with good medical infrastructure, and those without. It's not like this hasn't been done before by just about every 1st wrold (and many 2nd world) countries in the world.

The argument that we should not do something becuase it may be implemented poorly can be used to argue against any action a government could ever take.

 

For one thing, I think you'll find the US is a very different case from other nations, even those that are "wealthy" and "large". The US exists in states of wealth and size that really puts us in a rather unique category, not to mention the unique implications of our size and wealth combined with our history. While other templates may be useful, and we can certainly learn from the mistakes of others, that's still not too much of a guarantee that we'll get it right.

On top of that, I wasn't actually arguing that this is a reason we shouldn't do it, just that it's a reason it hasn't happened. I think we should be VERY careful in setting up such a system, but that, properly implimented, it would be well worth the cost. Fear, however, is a very strong deterant in most people's minds.

 

Pretty much what he said, but with one caveat. There's no reason to believe that a hospital couldn't still turn a profit if it switched its incentive system from pay-per-service to salary. The doctors might not like it as much and profits will most assuredly go down a little, but if we, say, required all hospitals to tweak their incentive systems, I doubt they'd close their doors tomorrow.

And here is the 2.217 trillion dollar answer.

It should also be pointed out that 47 million uninsured doesn't mean 47 million who don't regularly see a doctor. While a substantial number almost certainly don't, plenty more are just paying for every visit or already visit a free clinic regularly -- and then are flat out screwed if/when they encounter a serious medical problem that requires hospitalization, other specialized care, or expensive medication. GP's would get substantially less than an influx of 500 new patients apiece, since visiting a GP is fairly cheap even without insurance.

 

Yes, even if they aren't true.

 

Chandos, you know SOME of them are true, and you also know that, like lies traveling faster than the truth, bad news makes good news look like continental drift.

 

Chandos, you mean like this.patient stacking

And

And
universal healthcare problems

http://nhsexposed.com/

The US system is by no way exempt from horror stories either, however as has been stated by others, at least here you have other options.

 

Yes, I've experieced those horror stories first-hand HERE, with my own family. So, you are really pretty much wasting your breath by trying to convince me that our system is so much better. It's not. And have really have been waiting for this one: Which "options" are you referring to?