From today’s NPR morning edition, they had an interview session with Al Gore. It was rather softball (but this early in the campaign cycle as the closest thing to a serious democratic candidate he has earned it) and decidedly non-confrontational. One segment made me sit up:
My question is: How?
How can we pay less and get more? Obviously this will require massive overhaul of something or other. Gore gives a nice teaser but doesn’t bother lay out (or even outline) what he has in mind.
I readily admit that health care in the US is in trouble. We do have a looming crisis with the un (and under) insured while costs for expenses and coverage continue to rise.
In another interview, Gore espoused a single-payer system. If the US government paid for all health care, they could set lower prices for doctors, hospitals, medicine, etc. So, the saving could come from reducing the payment make to health-care providers.
Of course, there would be a risk that a reduction in payments would lead to a reduction in quality and quantity of care. This article provides a warning about the risks of too much price control.
Of course, if the US controlled the entire health-care market and if individual payments to physicians were prohibited, then the physicians would have no where else to go…
If you want to see what Gore had in mind, I would say look to Canada, in all it’s medically-deficient, long-line-laden, patients-fleeing-the-border-to-be-treated-in-the-US glory. Hey, sign me up!
Or, more productively, you could look at countries that pay less for health care than the US does and, by all conventional measures, enjoy better public health. Who knows, there might be something useful to be learnt, even if it is only what they have to sacrifice to achieve this. Then there could be a rational debate about whether the sacrifice was worthwhile.
This can provide some useful insight, but not as much as you may think. Without accounting for such factors as genetic makeup of the population, geography, population density, and other things, such data isn’t particularly useful. Even talking about the US as a whole is misleading, as the factors I mentioned vary wildly even from state to state.
But we currently have none of those three. Surely, then, there is room for progress on all three counts.
Yes, the “best health care in the world” is debatable, and, to a large extent, purely subjective. But there are several measurable categories (infant mortality and life expectancy spring to mind, but there are others as well) in which the US trails other industrial nations by a large margin.
And eris, I don’t think UDS was implying that some other countries healthcare system (as if they are all the same anyway) could be imposed without modification to the US, but that:
Under our current system, you pay a premium to your insurer, and your insurer pays your health care provider.
That means we have two layers of people who profit from the money you pay for health care. Your insurer takes a profit, and the health care provider takes a profit.
If the government were to step into the insurer’s role, one layer of profit-taking would be eliminated. (The government does not need to build a profit into the “premiums” it would charge.) Thus (in theory, at least) you could pay less and get the same or better health care result.
Could this be done in an efficient way in practice (and without eliminating or drastically reducing profit incentives for medical care providers)? That’s the real question.
Don’t kid yourself, though. The insurance industry is making a killing, and they will fight tooth and nail to prevent the implementation of such a system.
This differs from Gore’s plan. He specifically said private insurance.
Indeed. For me “government efficiency” is all too often an oxymoron.
Would there be legal or constitutional issues with the government taking over a normally private institution? Would you also be for the government taking over in the malpractice insurance business? If I understand correctly, the high cost that medical practitioners have to pay for insurance is a driving factor in the rising cost of health care.
I haven’t seen Gore’s plan, and he didn’t provide details in the snippet you posted. I’ll have to wait to critique it until I see it.
So is “corporate efficiency.”
Particularly when (as I pointed out above), a premium payer is paying not only to finance the insurance bureaucracy, but also some additional amount to make the insurance company profitable.
You mean like air traffic control?
This is just some tricky blame-shifting by the insurance lobby.
(By the way, do you mean to imply that doctors should not be held accountable for acts of negligence?)
Let’s just say I trust juries more than I trust the insurance lobby.
Besides which, truly frivolous lawsuits are dismissed (and the attorneys who file them are potentially liable for damages). Frivolous lawsuits (and there are some) often make big headlines when they are filed. But then when the judge dismisses such lawsuits, it seldom makes the papers. That selective coverage makes it seem like frivolous lawsuits are a bigger problem than they really are.
I’m quite sure he wasn’t. But he did imply that all it took was looking at what they had to sacrifice to get universal health care going.
I don’t have a problem with universal health care anymore, but I find no implementation that satisfies me whatsoever. If my opinion mattered to the rest of the population that might even count for something.
Universal health care still means that the best health care goes to the wealthy. Its just a matter of what everyone else gets, who pays for it, and who will do it for that pay. Simple.
Use some common sense, man. If the insurance lobby is able to convince the people (and their representatives) that the real reason for soaring health care costs is malpractice claims, then the insurance companies may have some chance of getting legislation passed which restricts patients in their ability to make claims against negligent doctors.
Doctor sawed off the wrong foot? Too bad. Your damages will be limited to the cost of a prosthetic. I exaggerate for effect, of course, but that’s what so-called “tort reform” really is in this context – a constriction of patients’ rights.
If the insurance lobby is successful in restricting patients’ rights to sue, then they can increase their profit margins accordingly. (Or do you really think those malpractice premiums will plummet if tort reform is passed? Do you really think there will be more than a token reduction in premiums?)
