Even though I am a conservative I see no hope for affordable healthcare in the U.S. short of setting up a complete healthcare system just like the military. Goverment owned schools, hospitals, equipment, and employees.
Many studies are available that clearly show highest pay doesn’t always correlate to highest performance. Good Doctors and nurses could be made available at a reasonable cost. I think the service would have to be just bad enough to make private healthcare still desirable.
I believe a system like this could successfully intermingle with the private sector when long term or catastraphic illnesses were involved.
I have and can afford good heath insurance and I would likely keep it. I know far too many who just cannot afford trips to the Dr. and it does upset me.
Which of these things is not like the other?
I don’t think I properly expressed that thought. I was reffering to slightly longer waiting times for non critical appts, not so plush waiting rooms etc. Nothing that would affect the actual quality of the health care but the experience might not be quite as pleaseant. I obviously wouldn’t have a clue how to administer this but I think it would be more available than what we have now. Cost would be a major factor.
I don’t think I’ve seen a plush waiting room in my life. At any rate, that would be a miniscule part of the cost of health care. And waiting times are plenty long as it is.
The best health care system is probably to just have socialized medicine with optional private insurance for those who can afford it.
Or, possibly have government just take care of all medical procedures above $X cost, and let private insurance and private industry take care of more “routine” procedures.
Correct me if I’m wrong, but I think a better way of saying what you were trying to say would be that you meant a dual system. Government supplies everything in one, at no cost, and private industry supplies the other, for a price. In a system like that, the government system only has to be slightly less desirable for a private system to exist.
In actual fact, that would result in a 2-tier system where the government system was barely adequate for people with not enough money to choose better, and the private system containing a range from [cheap, but only marginally better] to [pricey spare-no-expense] options.
FTR, I could support such a system.
That is much closer to what I was trying to say. For the past 20 years the direction health care has been taking is one that is not sustainable if it is going to be available. In a country such as ours it is unconscionable to not have healthcare available to all. I also think it would help to elimiate or reduce the massive fraud and overcharges which are routinely overlooked.
I know they exist but I’ve never met a person who couldn’t afford to go to the doctor. Surgery or expensive tests, yes.
Every person I’ve ever heard complain about the cost of a doctor’s visit had the financial capacity but not the financial discipline.
I’m more concerned about pre-existing conditions and catastrophic care.
Really? I’ve seen rather a few. (And, yeah, I’ve also seen the other kind: bare-bones, crummy chairs, cold linoleum floors, nothing to read, cold as an ice-box, and under-staffed: you have to wait, just to sign in, so you can wait more!)
What’s sad is that it’s not rocket science to shorten waiting times. Doctor’s have a good idea how much time on average each patient takes. It’s just a function of scheduling accordingly.
Why should we worry about making private healthcare desirable? Let’s put together a system that provides good, affordable healthcare for everyone and let the private sector adapt.
It’s like saying “Let’s make sure the police aren’t too effective, so that most people will still feel like they should hire private security guards.”
So you think the government should deliberately design an inefficient system, because if they actually designed a good system nobody would want private insurance?
It’s time we came to grips with the fact that private industry health care is the modern day equivalent of buggy whip manufacturing.
The government doesn’t have to intentionally make it undesirable. It will automatically be undesirable to a large number of people, and they will use their dollars to pursue some other option, unless the government also makes other options illegal.
It’s the same reason that Walmart doesn’t already have an absolute monopoly on everything.
It’s the same reason private schools thrive.
Private healthcare can be desirable just by being quicker to roll out state-of-the-art treatments, or by skimming off the top of the waiting list willing to pay to skip the line. There’s no reason to put a cap on public healthcare in terms of quality since inherent scarcity will always cap it in terms of speed.
We’ll have a decent health care system in the US eventually … after we’ve tried everything else.
I’ve spent a career in medicine and seen somewhere north of 100,000 patients as an ED physician. Over that course of time I can count on one hand the number of patients who cared what anything costs. The only expense of concern to the patient is the cost to the patient.
When we separate out cost from patient responsibility using a third party payer system (government or private insurance), there isn’t an upper limit to where that cost will rise, anymore than there is an upper limit to how much our government will borrow.
I do not think this is the only problem, but I think it is the primary problem.
I don’t think that is the primary problem. You are making a few erroneous assumptions.
- That given a transparent market, people would shop around.
1b. That people have the ability, time, or inclination to compare prices.
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That opaque pricing is the only, or even the primary information asymmetry.
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That there aren’t already interested parties invested in keeping medical costs down (eg. insurance companies).
The problem is that you will never be able to make consumers confident enough to make medical decisions based primarily on costs. Do you think the average Joe will ever be able to tell you what kind of surgical tools to use, or whether an MRI isn’t needed? Even doctors cannot do that with 100% accuracy. Price feedback only works if you understand the value and utility of what you are paying for. The issue is that most people value their life at infinity, or at least more money than they’d ever have a chance at paying back. If people fully understood and appreciated the product they were paying for wrt to medicine, we would need far fewer doctors.
It’s one thing to pick a low-cost mechanic. It’s entirely different to pick a surgeon based on how cheaply she will work. More importantly, nobody wants a cheap surgeon unless they have to accept it. Now, what transparency, coupled with higher out of pocket costs, would do is prevent poor people from seeing high-priced (read: well regarded) doctors for common ailments. But it would do little to affect the prices of high-cost services like surgery or end of life care. More importantly, to a guy making 50k, is there really a big difference if his heart surgery estimate is 225k vs. 245k? I just don’t think the prices, within the same market, and with comparable services, are all that different.
Lastly, insurance companies are already in the business of lowering medical costs. they just can’t do it well for a variety of reasons. It would be one thing if it were only insurance costs going up. Medical costs are rising as well, and there is little evidence that a price list would help much in the grand scheme of things.
Part of the problem in US healthcare is that most cogs are optimized to generate the greatest possible amount of revenue. The actual providers, doctors and nurses may perhaps be the ones least concerned with that.
Actually changing that to a more effcient model would be a hellish probem. Many health care economists favor changing to something like the Nederlands, German or Swiss setup, as it they are far closer to the US system than to NI or Beveride models.
There are some pilot programs where the insurance company & a hospital come to a agreement that sets a target cost per patient . If the hospital keeps the patient healthy for less, they get a share of the savings. It is in the hospitals best interest to do a better job at preventative care, not order unnecessary tests, not inflate the prices of supplies, etc. It sounds promising.
I can’t remember the right term for it so my searches aren’t coming up with an example.
I don’t see it happening on the national level anytime soon. Politics and economics will get in the way. If you could wave a magic wand and make our health care as efficient as what they have in Europe we would save a trillion dollars a year. but that trillion would mean lower wages for people who work in the health care industry. I don’t see them giving up a trillion dollars w/o a fight.
I could see meaningful reforms on the state level. States like Vermont and MA have passed health reform. Places like CA, MT, IL, etc. might enact statewide reforms too. Vermont’s plan is predicted to make health care 25% less expensive than it would be w/o their new reforms within 10 years of when it is enacted. So instead of spending 10k per person they’ll only spend 7.5k.
I don’t see much hope on this issue. I’m planning to move to another country if I need to when I retire (or if states like VT still have a functioning single payer system, moving there).