Personal incentives and competition can improve quality and decrease costs. However in health care there is the risk that if you ask people to pay higher deductibles that they will forgo needed medical tests and treatments, and as a result illnesses will get worse.
At the same time, I know sites like pharmacychecker have come in handy for me. So has the $4/month prescription drug plan. Researching which pharmacy was cheapest, then buying a medicine in larger doses and breaking it into halves or quarters has worked to save me 70% of what I’d pay if I just arbitrarily picked a pharmacy and bought a medication before in regular doses.
Is there any way to use competition and incentives to drive up quality and drive down cost that does not make people forgo and avoid needed medical care? A person can ‘walk away’ from buying a DVD player or computer, but you can’t really avoid buying medical care. I’m sure people have figured out how to do this, but I don’t know how.
Would letting external agencies (comparative effectiveness boards) do the work of promoting competition rather than letting consumers do it work?
What about giving people a budget for health interventions, and letting them keep the difference? ie, if you need an MRI your insurance company says ‘we will give you $1200 to pay for an MRI. If it costs more than that you pay the difference. If it costs less you can keep the difference’. That would prevent people from avoiding medical care (since you’d get nothing, no MRI and no amount of the difference) if you avoided getting the MRI while still promoting competition and personal incentives.
Well, everything has tradeoffs. If we considered it absolutely vital that everyone owned the safest possible car, then we’d probably have national car care and everyone would own whatever the safest car was, regardless of how much it cost. And realistically, such a plan would probably save lives, but probably wouldn’t be worth the cost.
Likewise with health care. Giving everybody the most expensive treatments and drugs would save lives, but would also bankrupt any country.
So that leaves us with a choice to make: what is the best way to control health care costs? Have a government formula that acts as a triage, determining who gets care when and what kind of care? Or let consumers, to the extent possible, decide for themselves? I say consumer choice is a superior form of rationing, if one must call it that.
I’ve been prescribed expensive meds a few times, and each time I chose not to buy them. In two of the three cases, there was an OTC alternative that ended up working well enough. In the third case, I just decided to wait and get better, since the stomach ailment would go away and all I got prescribed was something to make the time pass a little less painfully.
Now if we were in a single-payer system where I had no co-pay, chances are I’d get all three prescription drugs. But since resources are finite, getting me those drugs I didn’t need would have taken resources away from people who actually did need help.
People aren’t health experts, but I think that people can make better choices about what health care they need to buy and what they don’t need to buy than a government formula. Plus, it would help if consumers would ask doctors more questions. “Do I really need this prescription? What will happen if I don’t take it?” Doctors usually prescribe you something because they assume that’s what you want. If you make it clear that all you wanted was to know what’s wrong with you and if you can get by without medication, they’ll tell you what you want to know.
I don’t think it can work well; and modern American health care is essentially a huge experiment demonstrating this. Ordinary people just do not have the expertise to make good medical choices, nor can they just say “No” and walk away, and trial and error can easily be fatal. Competition is good at producing a few excellent products in a sea of garbage and fraud; the government is good at producing mediocrity. And mediocrity is what is desirable here; “good enough” health care for the maximum number of people. Disappointed customers here don’t just move to a new product until they find a good one; they suffer, or are crippled, or die.
First, you seem to be equating “most expensive” with most effective. Not true, and we need incentives to have doctors prescribe the thing that will work without necessarily costing more money.
My doctor prescribes generics. I’m sure there is an insurance incentive for him to do so. I’m pretty sure any single payer system (which might still have a co-pay) would do the same.
The sales figures for quack alternative medicine seems to falsify your belief that people will make rational health care choices without guidance. I’ve never had the experience of a doctor prescribing something because he thought it was what I wanted. I’d probably survive without some of the stuff I’m taking, but spending a couple of bucks a month on synthroid seems cost effective compared to the chance that I could lose the other half of my thyroid in an expensive operation.
I definitely agree with you about patients asking more questions, and knowing what each drug does and why you are taking it. I don’t think paying more on your own is going to change that. If it were true, there should be evidence that those without insurance are smarter consumers. After all, this is your health, and there are plenty of non-monetary reasons for being a smart consumer.
On the other hand, it is easy to make wrong decisions based on too much self-confidence. I got rejected from donating blood because my pulse was irregular. I had convinced myself it was due to drinking too much Mountain Dew at lunch. I went to my doctor just to get a letter saying I could donate again. I wouldn’t have if it was a choice between paying the doctor and food. Good thing I did - if I didn’t, I could have been dead in weeks. How many unnecessary deaths are you willing to accept from this kind of thing?
The sales figures for quack alternative medicine seems to falsify your belief that people will make rational health care choices without guidance.
The fact that governments decide what to cover primarily based on political considerations shows even greater irrationality. It’s not as if there’s some benevolent organization out there with perfect knowledge and pure motives that can make our health care system work.
Both. They rather depend on each other anyway; to the extent a non-expert can choose between treatment options usefully, it’s because an honest, competent expert explained to them exactly what the options are and mean. You aren’t likely to make a good choice when your doctor is a shill for a company or a quack who lies well.
I don’t get how increasing competition would have this effect. Presumably the insurance companies would still be making the decisions and just letting you choose the doctor. It seems to me that the situation would be as it is now.
I think you are confusing companies with state-run healthcare.
Okay…let’s try this without the nonsense. If, as proposed, the insurance company gives you a set sum for a procedure and you choose the lowest cost provider to pocket the difference, then the treatment has to be approved by the insurance company…i.e. it is not quackery. It would be easy enough for insurance companies, or the government, to maintain a list of doctors that are accredited and follow proper procedure…i.e. you can’t go to a witch-doctor.
No, I’m not. Government run health care isn’t concerned about profit; they have no motive to deny you care. An insurance company does; they have every motive to take your money, then find excuse after excuse to deny you care in hopes that you’ll die before they have to pay for anything.
competition would work great. first step, getting doctors to specify their rates.
in most socialized healthcare systems, there is a painstakingly nuanced book that outlines how much the government pays for whatever procedure. i remember seeing doctor’s “charge sheets” (here, w/o socialized medicine) that had a finite list of procedures on them (maybe 50) and the doctor would check them off according to what was done (and the clerks would tally up the checks and give you the sum (or give you the copy and it would be submitted to your insurer)
i can’t see any reason (well, I actually can) why doctors should not be made to provide a menu of their services before you go in for your appointment.
second step, outlawing the practice of charging disparate rates for different categories of patients - everyone ought to pay the same for the same procedure, regardless of the source of funds (medicare, private insurance, cash up front, credit)
basically, medical care needs to be better commoditized.
i need to add to this: you need to eliminate the undersupply of doctors before you have price discovery - otherwise you’re just begging for price collusion.
The plan, I believe, is to have a panel of experts make the choices, with their decision implemented automatically unless Congress overrides it. I’m sure they put that in because they never want to give up the possibility of meddling, but I doubt it will be used very often. Sounds reasonable to me. I don’t know of all that much political meddling in health decisions (except the meddling that allowed this crap to be sold without much regulation) but I do know the profit motive controls a lot of decisions now. Is that any better?
The plan, I believe, is to have a panel of experts make the choices
They’ve been trying to have rule by experts for thousands of years, and it never really works out. Your doctor has enough trouble, because for all his expertise, he can’t get inside you. A panel of experts is going to have very little helpful insight.
Now I do think a panel of experts can be sort of like a Fed for the health care sector, and keep costs under control. But I don’t think we can expect such a “Fed” to actually give us better medical care, any more than the Federal Reserve makes us better off financially. The government can only do things on a macro level, and the only part of health care that can be managed on a macro level is the overall cost of the system. Patient health is a micro issue that the government is powerless to affect. Only two people have the power to make a difference at the individual patient level: you and your doctor.
but I do know the profit motive controls a lot of decisions now. Is that any better?
Profit or non-profit, cost control creates the same incentives: expensive treatments will be denied.
A nice, noble sounding speech that suffers from the problem of contradicting reality. Whether it offends your ideological sensibilities or not, government run health care all over the world works better than what we have. People in other advanced nations are healthier and live longer for less money.
Another statement proven wrong. Other countries provide better health care, including expensive procedures, and do it for less money. For-profit health care is simply more expensive AND less effective than government run health care. Like it or not.
A nice, noble sounding speech that suffers from the problem of contradicting reality. Whether it offends your ideological sensibilities or not, government run health care all over the world works better than what we have. People in other advanced nations are healthier and live longer for less money.
Because of health care delivery systems? I don’t think there’s any evidence to support that. Our lower life expectancy is fully explained by our higher accident rate, higher obesity rate, higher cigarette consumption, etc.
However, when actual stats related to health care delivery systems are measured, such as cancer survival rates, the US system is superior.
Another statement proven wrong. Other countries provide better health care, including expensive procedures, and do it for less money.
Most countries do not cover the latest medical technologies or drugs, at least not those with single-payer systems. Mixed systems such as Germany’s or Switzerland’s have a better record in that regard. Wait times are also much longer in single-payer systems for even mid-level technologies like MRIs and hip replacements. The bottom line is that the government saves money just like an insurance company does: by either making you wait, or by not covering you at all.
We put to much money into health care. They have no incentive to make things smaller and cheaper. I saw a program on Japans health system. They pay a lot less than we do. They have invented smaller and far cheaper MRIs . They could not make profits off the American ,expensive ones. There is talk of selling them here. But lowering profits can make you do a better job and find ways to cut costs. There is little incentive for that here.