What is the future of funding & access in US health care

Great Debates
1

Health care is the biggest factor in our national debt (medicare, medicaid, VA & SCHIP make up something like 80% of our unfunded liabilities). It is also crippling businesses and pushing tons of people out of the market.

You’d assume with those pressure medical inflation would slow down. However it is still growing far faster than wages and general inflation and has been for a while. Prices double roughly every 10 years for health care and health insurance.

It seems there’d be a market for low cost health care opening up, because right now it seems there are only 2 options. Buy into the current system wholesale, or get nothing. But so far I have only seen scattershot attempts at creating a parallel low cost system. Medical tourism for major surgery, $4 prescription plans for generic drugs, walk in and urgent care clinics, community mental health centers, etc. But by and large the parallel low cost health care system seems disorganized. You go to a walk in clinic, get a $4 prescription, then go to Thailand if you need a knee replacement. But all those are independent of each other whereas in the current system a private or public insurer will organize and connect all of them (prescriptions, primary care, surgery, etc).

On another note a walk in clinic nearby charged me $130 to visit a NP. Fuckers. I have seen actual physicians for $50. I thought I was going to save money.

So our system doesn’t seem sustainable, it is supposed to hit $4 trillion by 2020. What is likely to happen? Do we keep doing business as usual until we hit a Greece like situation? Do we work harder on creating low cost medical alternatives (medical tourism, $4 generics, urgent care & walk in clinics, etc)?

A private insurance option made up of low cost alternatives that uses a program like the UK’s NICE program (National Institute for Health and Clinical Excellence) would be good. Maybe they could offer health insurance for a family for $400/month except they’d only cover cheap generics, community care, medical tourism, more NPs and PAs instead of MDs, etc. and not cover brand name drugs, end of life care, etc.

I guess my main question is with all of the financial pressure on the US health care system why don’t we have more of a parallel low cost system for those who are pushed out of the high cost system? The low cost system seems disorganized and scattershot. The cost of offering low cost primary care are far lower than the costs of more ER visits from people who put off medical problems until they are too great. But the two aren’t really connected or considered together.

Will our expenses grow until the entire system fails? What would that look like? It seems businesses are going to be pushing for reform soon too because they can only move so many expenses onto employers and they are stuck with the rest of the bill.

2

People don’t like the government to step in and actually change things, just to spend money on them. So yes, it’s likely that the problems won’t be solved until such time as they start to become unsustainable. That might happen either by sheer market need, or by government intervention, but until that point the best you’ll see are a few bandaids and sleight of hand.

As to why nothing cheaper comes in, it’s because if you’re a doctor and say government program offers to pay you $5 to take their client and private insurer Beta offers to pay you $10 to take their client, the doctor chooses to take Beta’s client. Ultimately, if the government or any other cheap plans want to compete for doctor time, they’ve got to meet the going price. So long as Americans or at least the businesses that choose health care plans for their employees are willing to pay exorbitant prices, all prices will be exorbitant.

3

There are clinics in the cities that charge according to your ability to pay. If you are poor, it is free or close to it.Obama added a few billion to its financing in the health care package.

4

That’s not free. The billion dollars doesn’t just rain out of the clouds to be picked up and delivered to the doctors.

5

The part that really frosts my ass is the charges for routine doctor visits. After the nurse weighs you and takes your blood pressure, the doctor has a five minute chat with you about how things are going. Still the same. Writes refills for your prescriptions, and bills the insurance $120. It doesn’t take an MD to do something so simple.

And don’t even get me started on specialists. My daughter just had her tonsils removed and that required two pre-surgery visits that the insurance was billed $265 a pop for. And they were nonsense visits. Here’s a script for antibiotics. No strenuous activity after the surgery. No alcohol for 24 hours after the surgery. (She’s six years old!) Sure thing, doc. I’ll keep the little booze hound off of the sauce after the surgery.

These might be minor expenses, but multiply by millions of patients, they add up.

6

Another thing that REALLY irks me are parents of kids or people who act totally ENTITLED to best of the best care.
Like they DEMAND that the insurance cover best of the best cochlear implants for BOTH ears (even thou the benifit is sound localization and ease of hearing in noise, which is simply something that ALL hoh including unilateral losses have to deal with) as well as ALL the costs associated with the implant!
Then there are the parents of kids with profound (sometimes extreme profound ie the kid is so profoundly affected they are in a persistent vegetative state) issues who ALSO demand “best of the best care” Yes, you love your kid…but maybe just maybe it might be better to make a very difficult decision. Some of those parents seem to be in denial that their kid doesn’t have much of a life or a life at all.

7

Post like this burn my butt. First of all, you say what the physician billed. For that 120 dollar office visit he/she would be lucky to get 60 bucks from Medicare and less from other insurance carriers that they have contracts with. Currently a surgeon can pay upwards of 150K a year for mal practice insurance. Not to mention running a practice, employing professionals that aren’t cheap, overhead and paying off student loans. A primary care doctor’saverage income is 150,000 a year and this is for being on call nights, weekends and making life and death decision on a daily basis. Many times for patients that don’t think their expertise is worth 120 bucks. Funny how no one complains about a vet getting that for fido but so many people are all over doctor’s fees.

I am sure you can find a doctor cheaper than 120 dollars if you are a self pay patient. But keep in mind you get what you pay for. Personallly I wouldn’t be inclined to see a doctor that charges less than Medicare’s terrible rates to get patients.

8

The part I don’t like is we spend so much to FIX people but so few to PREVENT the problems in the first place.

9

Excellent post, Wesley Clark! A public option might lead, sooner or later, to such an appropriate “two-tier” system. Recently passed legislation lacks the public option and, AFAIK, didn’t address cost reductions appropriately. I wonder if it was a pro-industry bill we’d have been better off without.

This recent legislation may exacerbate problems. GOP will be laughing its way to the voting booths; right-wing financed health-care industry will be laughing its way to the banks; and the stupider liberals will be wondering who killed the tooth fairy this time.

Yes. But some of the simpest prevention ideas (e.g. taxes on sugared drinks) lead to severe squawking.

And posts like yours annoy me. jtgain was complaining more about what he had to pay, not what doctor received. If malpractice costs are a problem, let’s push for tort reform. It is annoying to pay more than $100 when doctor’s attention is completely unnecessary though legally required. Most Americans are shielded from awareness of excessive costs due to their insurance; this systemic shielding can be considered a huge (trillion dollar!) scam.

10

This. If I know how to fix the leaky sink myself, the law doesn’t require me to pay a plumber. If I know what is medically wrong with me, the law and the doctors’ monopoly STILL require the $120 office visit. Whether it is me, the insurance, or the government paying, it adds unneeded expense to the whole system.

NPs could do a lot of stuff that require MDs now.

11

I do wish America would Get Over It and implement UHC. If America were to implement a U.K. style NHS it would cost about $0.7T (we pay £100M for a bit under 60M people, so you just multiply by 5). That’s vastly less than Americans currently pay.

12

The future is that the system carries on much as it is right now until about 2020 when Medicare and healthcare costs in general are projected to explode. At that point the deficit will do the same, the bond vigilantes will jump in and suddenly the US will face double digit bond yields if they want to sell their debt and eventual double digit interest rates. Increasing interest payments on the debt and rising interest rates will eventually concentrate the politicians’ minds on finding an alternative, economic desperation will overrule the lobbying power of the medical-industrial complex and we’ll end up with a universal healthcare system.

13

I wish I shared your optimism, Dick Dastardly, but if the mistakes during GWB’s terms didn’t cause a drift toward reality-based governance I’m not sure anything will.

Voltaire once wrote Le mieux est l’ennemi du bien. I’m afraid the opposite applies to recent health-care legislation which entrenches a bad system but creates an excuse for future inaction.

My prediction for 2020? If GOP is in power we’ll be fighting several Asian wars and enacting UHC will “mean the terrorists have won.” Otherwise, GOP will have enough Congressional power to focus all attention on another semen-stained dress or whatever.

14

By what logic? Why isn’t the gap between Medicare taxes and expenditures funded, and the cost of the military and other programs unfunded?

15

No, we’ll end up back in robber-baron land or in some kind of wild racial-scapegoating scheme (actually that’s where we are now).

A phobia of socialism is carefully inculcated in Yanks.

16

Right now corporations own government. That will continue until something upsets the system dramatically enough for the order to change, and that something will be soaring payments on the deficit and soaring interest rates.

17

There’ll be total mayhem in a few years but with Medicare under a death sentence and peoples’ healthcare payments soaring into the stratosphere coupled with double digit and rising interest rates and massive interest payments on the deficit there’ll be a huge mandate for somebody to bring in a universla system. We may well see a few years with a robber-baron, everyone for himself system and we’ll deficitely have the GOP scapegoating and dissembling, especially if they’re not in the White House when things blow up. But healthcare will be the single biggest issue everybody cares about and the vast majority of the people will support what the rest of the world has at a fraction of the cost of the collapsing US system.