The two largest health care issues in America today

I think my doctor charges $140. When my girlfriend had to go to see a GP and a hand specialist about an infection from a cat bite the total was over $1500 plus a $150 prescription.

The garbage about the death panels does not illustrate what you say that it does. You are right that at some point choices have to be made about whether or not to treat various conditions. Obama’s plan was to see that a doctor gets paid when a patient needs to be counseled about making those choices when that point arrives. The doctor counsels. The PATIENT makes the choice about treatment. The doctor gets paid for the office visit.

It was never the intention of the plan that anyone besides the patient make that decision about her or his own health care. The patient decides ahead of time what should happen under several different circumstances.

I think we should skip and insurer altogether and give everyone the best medical care possible. The government should pay the medical bills. That will give those who govern a little motivation to keep those medical costs down.

Yes, that will cost a huge part of the money we make. But imagine: The best possible health care for everyone. You never have to worry about medical bills again. You don’t have to worry about the expenses of hospital bills when you or your wife has a baby. You don’t have to worry about medical problems if you have a child that needs special care. When you get old, you don’t have to worry about assisted care or nursing. That will be provided to you. Dental work at no expense. Vision care. People having the medications they need.

Think what a better world it would be! I would give up most of my income and a hell of a lot of perks to have that in this country.

Something that always gets me about these arguments. The statistics cited are the deaths. This is almost exactly the wrong statistic. Everyone eventually dies. Thus it is impossible to reduce the number of deaths. Medical care moves the statistics about, but never reduces them.

In one (slightly perverted) way, death statistics are also a metric of those sorts of conditions we should avoid treating. After all, a death is essentially a failure of treatment. So death statistics are statistics of where money was wasted. Money well spent doesn’t show up in the deaths.

Focussing on quality of life, not cause of death, might be a much more sane place to start.

On the other hand…AIDS is so freaking costly and 100% preventable.
I really think we need to take some active steps to curb sexually transmitted AIDS.
If we did, then we could save TONS of money.
Sorry, but I do think we need to have a system where people who irresponsbilty spread HIV are put in some sort of hospital.
Not sure how that would work or if its even workable. But it does seem like there’s a small percentage of folks who just don’t give a shit if they infect someone…and its not like the common cold or something…it’s a very serious chronic disease!

I keep saying the same thing about conservatism. I think there are leper colonies not being used.

Well, in my case, the insurance company delayed making a decision about whether or not to approve my EKG. They wouldn’t say that they’d cover it, but they wouldn’t say that they wouldn’t, either. I had to take some fairly powerful drugs that I really didn’t need because of this. I think that insurance companies should have to pay some pretty stiff penalties if they won’t cover a needed medical treatment, if the policy says that it’s an eligible treatment. IOW, right now, the insurance companies have nothing to lose and everything to gain by trying to deny coverage, even if it’s something that they supposedly do pay for. Give them penalties, and I think that they’ll become a little more responsive to their customers’ needs. As it is, they are accepting money while promising to pay for certain benefits, and when it comes time to approve those benefits, they don’t act very quickly.

I know, too, that they are very, very slow to pay their portion of doctors’ fees.

On the face of it, it’s not a bad idea, but how would you discriminate between those that should be penalized and those that should not?

Before penalties can be imposed, you have to make a whole new board of review, which will, in the end, cost money, be slow, and be hampered as much as any legal (or quasi-legal) system currently is.

Too late to edit - What I wanted to say was that, you’ve just invented another way to increase the cost of medical care.

At least in theory, so are other diseases and conditions. Let’s just get a grip on the fact that people aren’t perfect and we aren’t going to achieve 100% prevention. Short of something as drastic as, say, eliminating smallpox which was no small feat.

Like… what? Lock up everyone’s genitals and you need advance approval to have sex? Stop people from shooting up drugs? Working a miracle so no one ever needs another blood transfusion?

Funny… I remember a time when AIDS was a very serious death sentence. If you got it you died, usually within 6 months to a year or two. The modern medications that enabled people to go from actively dying back to a productive and quality life I’d regard as a success.

Not to derail the AIDS/HIV discussion, but this thread reminded me of one phenomenon that few health care economics discussions seem to address.

Health insurers are constantly dealing with interest groups representing various practitioners wanting to be recognized as legitimate, independent medical practices entitled to health insurance reimbursement. These are non-physician (allopathic or osteopathic) practitioners, from chiropractors who lobby to have the scope of their practice expanded (and therefore eligible for insurance payment) to independent physical therapists to massage therapists to herbalists to nurse anesthetists to physician assistants. The list goes on.

How will the definitions of “medical care provider” be determined on a federal level? Right now, it’s up to local state legislators to decide who gets to bill insurance and who does not. Who gets to jump on the payment bandwagon and who doesn’t? This would seem to have a major impact on overall health care expenditures.

Or maybe I’m thinking too far ahead. Happens.

Here in Oz the private insurers do insure for some of the better known quackery. I have always assumed that it is more from user demand than anything else. (Here it is usual for the individual to pay for their own private cover, if they want cover in addition to the government provided cover. It is unusual for employers to include it in the package.) Cynically one might also note that covering someone to go to a chiropracter is likely to be cheaper than a more mainstream therapist. So it keeps the punters happy and saves money. But the more looney fringe stuff is never covered. And I hope never will be. (One notes that the insurers will provide cover if they think it will help their bottom line, but the fringe dwellers see it as a way of becoming legitimised.)

The government (Medicare) does not cover any quackery. Indeed it sets somewhat strict and sometimes contenteous limits on what it will cover. And the government follows up technological changes and reduces fees if they see it makes sense. Many surgical procedures got cheaper, and attracted lower fees, as did many diagnostic procedures.

That’s interesting, Francis Vaughan. With all the current yammer in the US over possible combinations of public and private insurance, I do wonder how similar our eventual health insurance scheme will be to yours.

Will our fringe practitioners hire huge lobbying firms to swarm the federal Senate and House of Representative offices, demanding inclusion? Are they doing it already? I’d love to know.
I guess all we can do is stay tuned and see how it all shakes out.

Oh, the review board would be a last resort, that is, AFTER the insurance company has delayed or denied a claim for so long that it’s adversely affected the patient. I’m afraid that it will cost money and probably be slow, but it will mostly affect only those insurance companies that habitually deny legitimate claims. I think that the impact on the industry would be worth the cost. And the patients would see a great deal of improvement if insurance companies were to have to consider whether it’s worth risking a penalty. Right now, they don’t risk a thing if they delay or deny a claim, they can’t be sued for damages even if the patient is harmed or dies because of lack of treatment.

I recently went to the doctor and while it was only $175.00 for the office visit I also got 5 fairly routine blood tests and my total bill was $1,600.00 (none of the tests were for lifestyle related problems).

I see one of the biggest problems with health care is that Americans, because of how health insurance has worked in the past, expect all health care to be practically free. People routinely pay $400/ month to drive a car and another few hundred to insure it but expect to pay less for their health insurance and almost nothing for their medical needs.

This combined with the ridiculously high costs of medical care has people’s contributions to their insurance so much lower than what the actual pay-outs are that the whole system is about to crash.

It is good to see more storefront clinics opening up for minor problems. There’s got to be a way for the uninsured or poorly insured to get minor problems treated so they don’t get worse. If it doesn’t cost almost a week’s pay to see if you have bronchitis you’ll probably go to see a doctor before you get pneumonia.

Plenty of countries don’t ration care nor prioritize based solely on need. And in fact, the US is at the low end for the number of cases of elective surgery compared to other countries without wait lists based on need.

None of them spend anywhere near as much as the US on overall health care. So if your contention is that not rationing care is causing our excess, I would have to reply that there is no particularly good evidence of that.

I start from the assumption that health care is one of those goods that should not be distributed merely based on ability to pay (education is another good that should not be distributed based merely on ability to pay). In order to distribute health care on some basis other than ability to pay, the government has to get involved because the market will always distribute goods based on ability to pay.

The government can pass regulations and laws that would promote better and more efficient health care cost structures but in the end, the government is going to have to pay for some significant portion of health care (I believe we already pay for more than half). Then the question is not how much health care do people need, the question is, how much health care would it be efficient for the government to pay for.

Depending on who you ask, it is everything from catastrophic health care coverage plus free basic health care to what we seem to be headed towards, everything that people can complain loudly enough about.

The government doesn’t have to pay anything. They just have to make sure that people who are paying for insurance are also covering the insurance for people who aren’t paying for it. That can go straight through insurance providers. If the lowest level of care sucks, everyone who can afford to get better will purchase it, providing the money necessary to cover those who can’t.

Is this in part becuase we are willing to do (and therefore spend) so much more to treat these diseases?

Here in MA, we have a very active judiciary-which pokes its nose into the healthcare provided to felons in state prison. In particular, the taxpayers were ordered to pay for a heart transplant (provided to an illegal alien felon). There is also a case before a judge, in which a transsexula felon wants hair removal treatments, and a sex change operation.
Thousands of dollars spend on medical treatments (of dubious worth), to the people who are violent offenders.
Makes perfect sense to me!
We also have the issue of juvenile diabetes (caused by obesity, which has a strong relationship to fast food consumption). Nobody will even talk about this (because it has implications of racism)-yet, treatment for diabetes, high blood pressure-caused by obesity, will be a major health care cost, in the years to come.

Unhealthy lifestyles are a problem, but blaming the mess we’re in on them is misdirection of the debate. In my opinion it’s spurred on by Puritanical historical roots motivating some people to “solve” problems by blaming them on the sufferer. Most of continental Europe and the UK has just as high an incidence of smoking as the United States, but they take care of everyone’s health there. French, British, and German cuisines are certainly not based on any vegetarian ideal, nor on the one that prescribes a piece of meat no bigger than a pack of cards. On the other hand, much of Europe probably has the edge on us in the exercise department. Walking is probably one of the best types of exercise in existence, but many people need the motivating factor of some meaningful destination to walk to, or other reason such as walking a dog. And aside from dogs, that motivation very often doesn’t exist.

I think the biggest problem of all is allowing the young and healthy to opt out of the market. A national insurance market can’t operate when only the older and sicker participate.

Everyone should be covered, and everyone should be taxed in an equitable manner to support it. For me, “equitable” means that such a tax should be progressive, although some other possibility, such as a flat tax, would not be an absolute deal-breaker.