# Reformers' Claims Just Don't Add Up \[health care\] **URL:** \ **Category:** Great Debates\ **Created:** [July 20, 2009, 10:40am UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607 "2009-07-20T10:40:02Z")\ **Posts on this page:** 14\ **Page:** 6
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [July 22, 2009, 4:52pm UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/101 "2009-07-22T16:52:33Z")
> [@Whack-a-Mole](#): > > With something such as mammograms I think private insurance is just as beholden to pressure groups as the government would be. Some things are highly emotional and this is one of them. While on paper it makes sense to delay mammograms to older ages that has little power to sway on a subject such as this. Women are 50+% of the population and if Insurance Company A restricts mammograms to older women while Insurance Company B offers to cover it at lower ages company-A will take a massive PR hit and women will be likely to run to company-B for coverage if they can. The reality of it has little to do with those decisions in a case like this. As such I doubt government would be any better or worse than private insurance at denying mammograms till an older age. I don’t think so. As I mentioned, mammograms (& the like) have been imposed on the insurance carriers by government beyond market pressures. E.g. the [Women’s Health and Wellness Act of 2002](http://www.nytimes.com/2002/06/13/nyregion/deal-in-albany-on-coverage-for-women.html) in NY. > [@](#): > > For less hot button medical issues I think the government would be more able to restrict various procedures that the medical community finds of dubious usefulness. The government would be a one-stop shop whereas insurance companies are constantly jockeying to provide a cafeteria-style of coverage that offers this or that in order to lure customers. They’re also jockying to save money and make more profit for themselves and lower their rates (& thus attract more employers and members). The government tends to be less responsive, as the people who make these types of decisions are less accountable. > [@](#): > > I would also think that this would leave the door open to private supplemental coverage insurance. The government covers X, Y & Z. Want to be covered for procedures A, B & C too? Buy extra insurance that will do that for you if you think it is important. FWIW, preventive care doesn’t lend itself to this type of insurance, since it’s used by people who have no symptoms. IOW, virtually anyone who buys this type of insurance intends to use it, so the cost of the insurance is going to be the cost of the procedures plus expense/profit. No point in it. > [@](#): > > As to the overall “preventative” care being an issue here I think we (or at least I was) conflating “preventative medicine” with “delayed medicine”. Oh, OK. Well I was talking about preventive medicine and not about “delayed medicine”. Also, the poster I quoted in my initial post (#22) was talking about preventive medicine and not delayed medicine, and the person that you quoted in your post (#20) was also talking about preventive medicine and not delayed medicine. I don’t know that I have any quarrel with you about delayed medicine, which is (generally) worse for health and ultimately costs more. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [July 22, 2009, 4:54pm UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/102 "2009-07-22T16:54:09Z")
> [@Fotheringay-Phipps](#): > > I agree that there are some preventive measures that are likely to be cost effective. The issue is preventive measures as a whole. The question then is there any reason to think any proposed systems are likely to improve the cost effectiveness of preventive programs as a whole? I don’t see any reason to think so. If anything, once political considerations intrude, it’s less likely to be based on valid cost/benefit analysis. (IIRC, mammograms for women 40-49 have been subjected to political pressure even under the current system.) Sorry, as a whole doesn’t mean all that much. Private industry hasn’t seemed to do a good job either - my insurance more or less pays for all prevention 100%. If there is a drive to evidence based treatment (which we’ll need to cut costs) that should also tend to push for useful prevention. Sure there will be some political pressure for specific tests, but there is also pressure to cut out even essential tests for cost reasons. > [@](#): > > Your wages are what society pays you - and the resources that you consume - not what you contribute to society. I imagine what you really mean is that you feel you are productive over and above what you consume and that this differential would be reversed if you were incapacitated. Which is valid. Value versus wage would be an interesting discussion - but the major point was that you need to consider lost tax payments when computing the costs and benefits of government funded insurance. As for dying early, I could create similar examples. What we’re talking about here affects the entire society. if you focus in only on medical costs, pay what you want, since you are not allowed to consider the impact of a larger deficit either. If a business pays $500 an employee in taxes for healthcare, that’s bad, but if it results in a savings of $1,000 an employee in reduced absenteeism, that’s good. Sure it is hard to figure this stuff out exactly (which is why I mentioned the difficulty of justifying projects based on cost avoidance) but it can’t be ignored. > [@](#): > > I’m not sure what you’re driving at here. Possibly your father & FIL have never been screened for thyroid cancer. I suspect they have been screened, but not to the level that would find a few cancerous cells. I suspect if we did a full survey of our bodies, we’d find all kinds of stuff that would make us nervous. > [@](#): > > Again, what makes you think a UHC type of plan will do better? (Note in particular the [third of my previous links](http://www.nytimes.com/2009/07/17/health/17screening.html?_r=1&em=&pagewanted=all) which discusses a House bill cosigned by 350 reps that is at odds with medical evidence, but feels right to lay people.) We need to distinguish two parts of the problem. The first is the need to reduce health care costs by. among other things, doing only those procedures that make economic sense. This needs to be done UHC or no UHC. Clearly, as the New Yorker article demonstrated, we are doing a terrible job of this now. The House bill doesn’t seem to cover this at all, and I agree that is a serious weakness in it. Neither Joe Shmo or Joe Congresscritter is qualified to make these kind of decisions. However the insurance exec who will be maximizing profitability when deciding what to cover isn’t qualified either. The second part is to make sensible preventative care available to those who can’t afford it now. That’s the UHC part, and that will save money. There is a fairness aspect here also, but we’re talking economics and can skip that part. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [July 22, 2009, 4:59pm UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/103 "2009-07-22T16:59:46Z")
> [@Fotheringay-Phipps](#): > > They’re also jockying to save money and make more profit for themselves and lower their rates (& thus attract more employers and members). The government tends to be less responsive, as the people who make these types of decisions are less accountable. Really? Private industry is accountable to Wall Street. If it increases profits by increasing rates and hurting American competitiveness, which exec is going to suffer again? Perhaps a bit less responsiveness would be a good thing. If there is a useless but faddish test, will the insurance companies stand in the way and risk losing customers? ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [July 22, 2009, 6:33pm UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/104 "2009-07-22T18:33:12Z")
Hey, I’m not arguing in favor of how great a job private insurance is doing now. Far from it. But the only thing that counts is whether there is reason to assume that any proposed alternative scheme will do it better. And in this context, I note that there are factors that favor private insurance and other factors that favor UHC. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [July 22, 2009, 6:57pm UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/105 "2009-07-22T18:57:30Z")
> [@Fotheringay-Phipps](#): > > But the only thing that counts is whether there is reason to assume that any proposed alternative scheme will do it better. Well, we know the current system is a train wreck waiting to happen. The rise in health care costs is absolutely unsustainable. I have seen no one seriously suggest the current system is peachy, working as intended, nothing to see here. Can some changes make things worse? Sure. But all you are really doing in that case is hastening the inevitable as opposed to doing nothing. Train wreck either way. The notion to leave well enough alone makes me think of the current economic debacle and everyone’s unwillingness to change anything as we raced pell-mell to economic disaster. At the time people were making a lot of money. Don’t mess with the goose that lays the golden egg! Of course the goose ultimately poisoned the whole country with those golden eggs (to extend the metaphor). It is like delayed medicine. Bite the bullet today, see the doctor, take your medicine. Not fun but when the alternative is wait and die the decision should be an easy one. Certainly we can bicker over which various fixes make the most sense but fixes of some sort are absolutely indicated. Personally I have little faith in proper measures getting taken because so many congresscritters are in the pocket of the insurance and medical industry (note this extends to both sides of the aisle). Anything that is likely to get done will probably be so full of loop holes and half measures that at best it will be a band-aid on a severed artery. Maybe hastening their own demise is a good thing then. If real change can only occur when disaster strikes then the sooner the better. Limping along for a few more years and deepening the problems serves no one. Given the response to the economic crisis not even sure disaster will get them to move. These are entrenched and powerful interests. I dunno, damned if we do and damned if we don’t I guess. ---
**Author:** ![Squink](https://avatars.discourse-cdn.com/v4/letter/s/b5e925/32.png) [@Squink](https://boards.straightdope.com/u/Squink)\ **Post date:** [July 22, 2009, 7:32pm UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/106 "2009-07-22T19:32:38Z")
> [@Whack-a-Mole](#): > > Certainly we can bicker over which various fixes make the most sense but fixes of some sort are absolutely indicated. Personally I have little faith in proper measures getting taken because so many congresscritters are in the pocket of the insurance and medical industry (note this extends to both sides of the aisle). Don’t forget the interest some have in seeing president Obama fail: > [@](#): > > In an interview on CNBC, Sen. George Voinovich (R-OH) admits that at least half the opposition to health care reform is about scoring political points against President Obama rather than substantive policy disagreements. > > Said Voinovich: “I think it’s probably 50/50.” [http://politicalwire.com/archives/2009/07/22/politics\_driving\_opposition\_to\_health\_care\_reform.html](http://politicalwire.com/archives/2009/07/22/politics_driving_opposition_to_health_care_reform.html) That’s a great big pile of partisan crap right there. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [July 22, 2009, 8:07pm UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/107 "2009-07-22T20:07:50Z")
> [@athelas](#): > > Nice try with the _ad homeniem_, but the chart is based on CBO data. Try arguing that that’s biased. So much for the [CBO data](http://cboblog.cbo.gov/?p=332): > [@](#): > > The figures released yesterday do not represent a complete cost estimate for the legislation. In particular, the estimated impact of the provisions related to health insurance coverage is based on specifications provided by the committee staff, rather than on a detailed analysis of the legislative language. ---
**Author:** ![intention](https://avatars.discourse-cdn.com/v4/letter/i/e95f7d/32.png) [@intention](https://boards.straightdope.com/u/intention)\ **Post date:** [July 23, 2009, 4:42am UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/108 "2009-07-23T04:42:29Z")
> [@Sitnam](#): > > In emergency situations hospitals are required by law to provide care, insured or not, so those with insurance pay for those without already. > > Imagine the savings for everyone involved if we could avoid those emergency situations in the first place. I fear that this kind of careless thinking characterizes both sides in the health debate. Avoid emergency situations? My wife is a Nurse Practitioner, who worked for years in ERs. What did she see the most of? Well … accidents and incidents. Kids who fell out of trees. Survivors of automobile accidents. Stabbings and shootings, the “knife and gun club”. Brain donors from wrecks on what the ER staff called “donorcycles”. Hypothermic homeless people. Attempted suicides. Alcoholics with DTs. Domestic violence victims. People with strokes. Teenagers suffering from skateboard attacks. You get the picture. If you have a way to “avoid those emergency situations”, bring it on. If not … well, perhaps a bit of thought about what you are calling for might be in order. Yes, people with colds and sniffles do come in to the ER, but the big ticket items are inter alia the ones listed above. Many parts of the health system in the US are broken, no doubt … but fixing it will be a difficult task, which will require deep though, extensive discussion, and careful planning, and which will not be susceptible to “sound bite” fixes. ---
**Author:** ![Whack-a-Mole](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/whack-a-mole/32/141_2.png) [@Whack-a-Mole](https://boards.straightdope.com/u/Whack-a-Mole)\ **Post date:** [July 23, 2009, 4:56am UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/109 "2009-07-23T04:56:49Z")
> [@intention](#): > > I fear that this kind of careless thinking characterizes both sides in the health debate. > > Avoid emergency situations? My wife is a Nurse Practitioner, who worked for years in ERs. What did she see the most of? Well … accidents and incidents. Kids who fell out of trees. Survivors of automobile accidents. Stabbings and shootings, the “knife and gun club”. Brain donors from wrecks on what the ER staff called “donorcycles”. Hypothermic homeless people. Attempted suicides. Alcoholics with DTs. Domestic violence victims. People with strokes. Teenagers suffering from skateboard attacks. You get the picture. > > If you have a way to “avoid those emergency situations”, bring it on. If not … well, perhaps a bit of thought about what you are calling for might be in order. Yes, people with colds and sniffles do come in to the ER, but the big ticket items are inter alia the ones listed above. Well… As I noted above there is a real issue with “delayed medicine” where someone will not see a doctor when a problem is minor because they cannot afford to. The problem then progresses and demands an ER visit which is both dramatically more expensive and the patient has a worse health outcome (because they waited and suffered further injury). Then I also have issue with ER visits for broken bones and such. Why is there no basic triage in a hospital then a tiered system of care? Broken bone…go to the Semi-Emergency Room. No need for a full blown ER staff and all the crud they must keep on hand (which equals expensive) to deal with dire emergencies to fix a broken arm or other minor issues (relatively) that need semi-immediate attention but are not genuinely critical. Arm torn off? Full-On-Emergency Room for that person. Instead it is a choice of pay to see a doctor OR walk into the ER, where costs are exorbitant, because it is the only place that HAS to see you even if you can’t pay. This either/or situation sucks, is expensive and makes waiting in the ER a stupidly lengthy experience because they are overloaded. ---
**Author:** ![intention](https://avatars.discourse-cdn.com/v4/letter/i/e95f7d/32.png) [@intention](https://boards.straightdope.com/u/intention)\ **Post date:** [July 23, 2009, 6:51am UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/110 "2009-07-23T06:51:46Z")
> [@Whack-a-Mole](#): > > Well… > > As I noted above there is a real issue with “delayed medicine” where someone will not see a doctor when a problem is minor because they cannot afford to. The problem then progresses and demands an ER visit which is both dramatically more expensive and the patient has a worse health outcome (because they waited and suffered further injury). > > Then I also have issue with ER visits for broken bones and such. Why is there no basic triage in a hospital then a tiered system of care? Broken bone…go to the Semi-Emergency Room. No need for a full blown ER staff and all the crud they must keep on hand (which equals expensive) to deal with dire emergencies to fix a broken arm or other minor issues (relatively) that need semi-immediate attention but are not genuinely critical. Arm torn off? Full-On-Emergency Room for that person. > > Instead it is a choice of pay to see a doctor OR walk into the ER, where costs are exorbitant, because it is the only place that HAS to see you even if you can’t pay. > > This either/or situation sucks, is expensive and makes waiting in the ER a stupidly lengthy experience because they are overloaded. Whack-a-mole, thanks for your thoughts. The busy ERs that my wife worked in had a triage system. True emergencies were treated first, dangerous but not urgent second, and minor stuff last. The non-busy ERs didn’t need a triage system. Not sure how opening another separate “semi-ER”, with additional personnel and machinery to treat the lowest priority would reduce operating costs over that system … perhaps you could expand on that. Where would the savings come from? Next, I’m not sure if the savings from treating “delayed” cases would save a lot. Medicine is often counter-intuitive that way. For example, contrary to what you’d expect, smokers cost the health system less than non-smokers … why? Because lung cancer is basically untreatable (and thus cheap), and kills people before they can get more treatable (and thus more expensive) diseases. So campaigns against smoking raise the health costs of the nation … go figure. Oddly, preventive medicine can be quite costly. Often the results are paradoxical. For example, preventive testing shows that many people older than 70 have thyroid cancer. If treated, the costs are high. But most people over 70 with thyroid cancer will not ever experience symptoms of the cancer, they’ll die long before that. If tested, however, many of them will insist on being treated … at a large cost. Finally, one of the largest medical costs are end-of-life costs. Huge amounts of money are often poured into the last few months of a person’s life … and preventive medicine will never change that until we can conquer death. As I said above, a broken health system does not lend itself to sound-bite fixes. ---
**Author:** ![cosmosdan](https://avatars.discourse-cdn.com/v4/letter/c/a6a055/32.png) [@cosmosdan](https://boards.straightdope.com/u/cosmosdan)\ **Post date:** [July 23, 2009, 11:30am UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/111 "2009-07-23T11:30:42Z")
> [@Whack-a-Mole](#): > > Well… > > As I noted above there is a real issue with “delayed medicine” where someone will not see a doctor when a problem is minor because they cannot afford to. The problem then progresses and demands an ER visit which is both dramatically more expensive and the patient has a worse health outcome (because they waited and suffered further injury). > > Then I also have issue with ER visits for broken bones and such. Why is there no basic triage in a hospital then a tiered system of care? Broken bone…go to the Semi-Emergency Room. No need for a full blown ER staff and all the crud they must keep on hand (which equals expensive) to deal with dire emergencies to fix a broken arm or other minor issues (relatively) that need semi-immediate attention but are not genuinely critical. Arm torn off? Full-On-Emergency Room for that person. > > Instead it is a choice of pay to see a doctor OR walk into the ER, where costs are exorbitant, because it is the only place that HAS to see you even if you can’t pay. > > This either/or situation sucks, is expensive and makes waiting in the ER a stupidly lengthy experience because they are overloaded. My ex used the ER as her doctor specifically because she could go and then not pay. That meant when the kids ran a fever or any number of non emergency things that you might call your doctor for, she went to the ER. ---
**Author:** ![Squink](https://avatars.discourse-cdn.com/v4/letter/s/b5e925/32.png) [@Squink](https://boards.straightdope.com/u/Squink)\ **Post date:** [July 23, 2009, 1:08pm UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/112 "2009-07-23T13:08:53Z")
**[Research Firm Cited by GOP Is Owned by Health Insurer](http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072202216.html?hpid=topnews)** > [@](#): > > To Rep. Eric Cantor of Virginia, the House Republican whip, it is “the nonpartisan Lewin Group.” To Republicans on the House Ways and Means Committee, it is an “independent research firm.” To Sen. Orrin Hatch of Utah, the second-ranking Republican on the pivotal Finance Committee, it is “well known as one of the most nonpartisan groups in the country.” > > Generally left unsaid amid all the citations is that the Lewin Group is wholly owned by UnitedHealth Group, one of the nation’s largest insurers. ---
**Author:** ![cosmosdan](https://avatars.discourse-cdn.com/v4/letter/c/a6a055/32.png) [@cosmosdan](https://boards.straightdope.com/u/cosmosdan)\ **Post date:** [July 23, 2009, 1:36pm UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/113 "2009-07-23T13:36:29Z")
> [@Squink](#): > > **[Research Firm Cited by GOP Is Owned by Health Insurer](http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072202216.html?hpid=topnews)** Holy Crap! Beeeeyooootiful! ---
**Author:** ![intention](https://avatars.discourse-cdn.com/v4/letter/i/e95f7d/32.png) [@intention](https://boards.straightdope.com/u/intention)\ **Post date:** [July 23, 2009, 9:55pm UTC](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607/114 "2009-07-23T21:55:12Z")
> [@cosmosdan](#): > > My ex used the ER as her doctor specifically because she could go and then not pay. That meant when the kids ran a fever or any number of non emergency things that you might call your doctor for, she went to the ER. cosmosdan, your experience is not that uncommon. I understand that part. I just don’t understand why Whack-a-mole seems to think that treatment at a doctors office is cheaper (for the overall health system, not for the patient) than treatment in the ER. In the ER, minor complaints are likely to be seen by a nurse practitioner, an intern, or the lowest paid doc on the list. Why will that be cheaper than going to a private practitioner? In fact, your experience (she got treated for free) argues against Whack-a-moles idea that there would be “delayed treatment” leading to complications. Since it’s free, she’d be more likely to go for minor complaints … as I have mentioned before, health policy is often counterintuitive. [Previous page](https://boards.straightdope.com/t/reformers-claims-just-dont-add-up-health-care/503607.md?page=5)