Let's have Health Care like the UK

Well Hew, of course you are right again, but then you are always right aren’t you?

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Originally Posted by Hew

It's amusing that Henry has twice poo-poo'ed a CATO Institute article that nobody has even mentioned or linked to (or is likely even aware of)

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Originally Posted by Hew

Ah, I see, you were referencing a link that was referenced by another link that nobody even commented on….

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Yes, just what was I thinking bringing up the relationship between a CATO report and this thread much less bring it up twice. I do stand corrected, both your statements above are technically correct. This thread was only started with quotes taken directly from a CATO report (actually misquoted in part). Indeed, the report was not “mentioned” or directly "linked” just as you say, but the CATO report was the only “referenced” item in the article linked to start this thread. Nothing that anyone paying attention should be "aware of". Yes, as you suggest any reference to CATO is irrelevant to this discussion despite the fact that all the sentences in the quote that started this thread came directly from their report. My bad.

On the 10%, yes, I missed that in the CATO report. Or wait, maybe I was just trying to see if the original person who started this thread or anyone else had actually read it. Congrats, you did.

Great job Hew. You sure showed me. We have the best health care in the world because we pay far and away the most and we should not look anywhere else for ideas on how to improve our system to provide good care at a lower cost. Actually, I really hope health care accounts for 30% of GDP some day because that will be a super extra good sign that we are a wealthy nation. Now that's CATO type thinking. See I can learn.

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Originally Posted by Henry V

Well Hew, of course you are right again, but then you are always right aren’t you?



Yes, just what was I thinking bringing up the relationship between a CATO report and this thread much less bring it up twice. I do stand corrected, both your statements above are technically correct. This thread was only started with quotes taken directly from a CATO report (actually misquoted in part). Indeed, the report was not “mentioned” or directly "linked” just as you say, but the CATO report was the only “referenced” item in the article linked to start this thread. Nothing that anyone paying attention should be "aware of". Yes, as you suggest any reference to CATO is irrelevant to this discussion despite the fact that all the sentences in the quote that started this thread came directly from their report. My bad.

On the 10%, yes, I missed that in the CATO report. Or wait, maybe I was just trying to see if the original person who started this thread or anyone else had actually read it. Congrats, you did.

Great job Hew. You sure showed me. We have the best health care in the world because we pay far and away the most and we should not look anywhere else for ideas on how to improve our system to provide good care at a lower cost. Actually, I really hope health care accounts for 30% of GDP some day because that will be a super extra good sign that we are a wealthy nation. Now that's CATO type thinking. See I can learn.

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We need to look at getting market factors involved rather than emulate systems lesser than ours. If shotgun shells were insured where we only paid 20% of the cost, they would be high as heck as well.

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Originally Posted by Marvin S

You can't straddle the fence between these three ideologies without ending up with wounds.

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Who says I can't. I think this labeling is a bunch of bull crap anyway. I am interested in what works and to hell with the label. I am not interested in political "religions".

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Originally Posted by tpaschal30

We need to look at getting market factors involved rather than emulate systems lesser than ours. If shotgun shells were insured where we only paid 20% of the cost, they would be high as heck as well.

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There's actually a fundamental problem with this concept that is well known to health economists. In his classic book, "Doctors, Patients, and Health Care", the late Red Summers noted that there was no comparable market where the sellers of services were the primary determinants of demand. Research as early as the 60's indicated, for example, that increasing the number of physicians in the population was directly linked to an increase in the number of physician visits per patient even after adjusting for all medical considerations. The fact is that a physician with an empty calendar is more likely to call you back for follow up. Direct to consumer advertising opened a new floodgate by giving pharmaceutical companies the ability to create demand for treatments of conditions that were not even considered real problems previously. This process was accelerated by the extension of employee health benefits to cover almost all pharmaceuticals at little to no cost to the covered patient. It fascinates me, for example, that a drug like Flomax, that produces at best marginal symptomatic relief at a huge cost, is prescribed more often that a generic drug like finasteride, which actually has curative properties in addition to symptomatic relief and costs almost nothing.

That's what happens when there is no market discipline on the demand side. Unfortunately, there is probably no way to achieve such market discipline which is the reason that we now have rationing of health services in the form of third party reviews of treatment, and in the future we will undoubtedly have more. Almost nobody in this country pays the cost of their own health care. Those who rail against "socialism" in medicine are actually complaining about the prospect that the working poor may get the same benefits now enjoyed at nominal cost by the rich, the middle class and the poor.

Socialized medicine began in this country during the Depression when hospitals banded together to form Blue Cross to increase their chances of getting paid. It expanded after WWII with broadening access to employer financed insurances, and exploded over the last 20-30 years as almost all caps were elminated on these services (I suspect one of the factors was changes in tax laws making it difficult ot create more generous plans for executives than were offered to lower paid staff).

This led to dramatic increases in costs -- and dramatic improvements in the availability of many types of therapy. The dark side of this was that as these costs grew, companies began to seek out and exploit "loopholes" that would permit them to avoid paying health care costs for a growing number of their employees.

For many years, I ran a consulting company that had as its primary benefit to clients, the advantage of offering them a legal way to hire programmers without paying benefit costs for health care and pensions. Our customers included the major telecommunication companies, the major pharmaceutical companies, the major insurance companies, etc. Many of these companies used this approach to outsource 90%+ of their IT staffing requirements under contracts that imposed caps on markups over hourly wages that precluded offering any employer subsidized health or pension benefits. When the benefits of that had been fully exploited, and more savings were needed to maintain profit growth, the work was moved off-shore. This has directly added to the number of uninsured.

The reality is that our businesses must compete in a global context. When they compete they are the only companies in the world that are expected to be paying employee health care costs as a routine cost of business. Elsewhere in the world, there is either no such coverage for anyone or the coverage is provided universally by the government. Our businesses cannot remain competitive if they must continue to carry this albatross around their necks. The choice for us is do we wish to join the countries that have no employer or government subsidized health insurance programs for anyone (that would give you a free market and lower health costs), or become one of the countries that treat health insurance benefits, at some level, as a social responsibility, not a corporate one?

But when you discuss the ideological issues, you must begin with the fact that we already have socialized medicine and will continue to have socialized medicine until all of us are paying 100% of our own medical costs without subsidy.

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Originally Posted by YardleyLabs

But when you discuss the ideological issues, you must begin with the fact that we already have socialized medicine and will continue to have socialized medicine until all of us are paying 100% of our own medical costs without subsidy.

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There lies some of the the problem. Costs began skyrocketing as government became more involved. Jeff your "classic book"seems to neglect no good or service is exempt from market forces.

Milton Friedman on health care;

QUOTE]Rapid technological advances have occurred repeatedly since the Industrial Revolution—in agriculture, steam engines, railroads, telephones, electricity, automobiles, radio, television, and, most recently, computers and telecommunication. The other two features seem unique to medicine. It is true that spending initially increased after nonmedical technical advances, but the fraction of national income spent did not increase dramatically after the initial phase of widespread acceptance. On the contrary, technological development lowered cost, so that the fraction of national income spent on food, transportation, communication, and much more has gone down, releasing resources to produce new products or services. Similarly, there seems no counterpart in these other areas to the rising dissatisfaction with the delivery of medical care.

Two simple observations are key to explaining both the high level of spending on medical care and the dissatisfaction with that spending. The first is that most payments to physicians or hospitals or other caregivers for medical care are made not by the patient but by a third party—an insurance company or employer or governmental body. The second is that nobody spends somebody else’s money as wisely or as frugally as he spends his own. These statements apply equally to other OECD countries. They do not by themselves explain why the United States spends so much more than other countries.

No third party is involved when we shop at a supermarket. We pay the supermarket clerk directly: the same for gasoline for our car, clothes for our back, and so on down the line. Why, by contrast, are most medical payments made by third parties? The answer for the United States begins with the fact that medical care expenditures are exempt from the income tax if, and only if, medical care is provided by the employer. If an employee pays directly for medical care, the expenditure comes out of the employee’s after-tax income. If the employer pays for the employee’s medical care, the expenditure is treated as a tax-deductible expense for the employer and is not included as part of the employee’s income subject to income tax. That strong incentive explains why most consumers get their medical care through their employers or their spouses’ or their parents’ employer. In the next place, the enactment of Medicare and Medicaid in 1965 made the government a third-party payer for persons and medical care covered by those measures.
Third-party payment has required the bureaucratization of medical care and, in the process, has changed the character of the relation between physicians (or other caregivers) and patients. A medical transaction is not simply between a caregiver and a patient; it has to be approved as "covered" by a bureaucrat and the appropriate payment authorized. The patient—the recipient of the medical care—has little or no incentive to be concerned about the cost since it’s somebody else’s money.[/QUOTE]

Ben S Bernanke on health care;

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And I think you’re also correct that one of the main reasons why health care is so expensive in the United States has to do with the fact that we’re always buying with somebody’s money and not with our on money.

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If you read the Friedman piece you quoted, you will see that it directly supports my comment. The presence of third payments totally disrupted the effects of price limitations on demand in health care, meaning that, in contrast to other arenas of technological advancement, health care advances have been directly linked to increases in the total percentage of GDP spent on health care. To make that clearer, I've summarized health care expenditures as a percentage of GDP by decade since 1960:

$ Billions
Year______ GDP (Nominal) HCE HCE% %Private
1960__ $ 536.4___ $ 27.5____ 5.2% 75.3%
1970___ 1038.5_____ 74.9____ 7.2% 62.4%
1980___ 2789.5____ 253.4____ 9.1% 58.0%
1990___ 5803.1____ 714.1___ 12.3% 59.8%
2000___ 9817.0___ 1353.2___ 13.8% 55.9%
2007__ 13807.5___ 2241.2___ 16.2% 53.8%

(Excuse funky formatting)

The percentage of GDP going to health care has tripled from 5.2% to 16.2%. You are right that the percentage paid from private sources has declined in that period from 75.3%to 53.8% (a decline of 28.6%). In that same time period, however, the percentage paid out of picket by consumers has declined much more dramatically from 46.8% to 12.0% (a decline of 74%). The difference has come primarily from the growth of private health insurance not paid by consumers. I would be happy to provide my source data to anyone but can't provide a simple reference since I compiled it from separate tables produced by the Bureau of Economic Analysis and from Health & Human Services.

The bottom line, as I indicated before, is that if you do not want socialized medicine you need to eliminate those third party sources that now pay 88% of each health care dollar. The importance of that is that the 12% that is paid by consumers is paid predominantly by those people who are not covered by any of our private and public health programs -- the uninsured. For the rest of us, the percentage paid by consumers is even lower.

Personally, I don't advocate that. I simply say that if socialized medicine is good enough for 85% of the population, it's good enough for 100%.

Sorry to change the subject slightly, but did you ever wonder why there are no price lists in doctors offices and hospitals? What other good or service do you walk in and buy without knowing the price?

Matt
That is incorrect. While not posted on the wall all you have to do is ask. Most people just don't ask. All doctors and hospitals in Florida anyway have to provide you with prices if you ask. It is an even better idea to ask if you don't have insurance becasue then you know what you are going to be charged and that price can be modified to meet insurance reimbursments.....just ask.

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Originally Posted by YardleyLabs

If you read the Friedman piece you quoted, you will see that it directly supports my comment. The presence of third payments totally disrupted the effects of price limitations on demand in health care, meaning that, in contrast to other arenas of technological advancement, health care advances have been directly linked to increases in the total percentage of GDP spent on health care. To make that clearer, I've summarized health care expenditures as a percentage of GDP by decade since 1960:

$ Billions
Year______ GDP (Nominal) HCE HCE% %Private
1960__ $ 536.4___ $ 27.5____ 5.2% 75.3%
1970___ 1038.5_____ 74.9____ 7.2% 62.4%
1980___ 2789.5____ 253.4____ 9.1% 58.0%
1990___ 5803.1____ 714.1___ 12.3% 59.8%
2000___ 9817.0___ 1353.2___ 13.8% 55.9%
2007__ 13807.5___ 2241.2___ 16.2% 53.8%

(Excuse funky formatting)

The percentage of GDP going to health care has tripled from 5.2% to 16.2%. You are right that the percentage paid from private sources has declined in that period from 75.3%to 53.8% (a decline of 28.6%). In that same time period, however, the percentage paid out of picket by consumers has declined much more dramatically from 46.8% to 12.0% (a decline of 74%). The difference has come primarily from the growth of private health insurance not paid by consumers. I would be happy to provide my source data to anyone but can't provide a simple reference since I compiled it from separate tables produced by the Bureau of Economic Analysis and from Health & Human Services.

The bottom line, as I indicated before, is that if you do not want socialized medicine you need to eliminate those third party sources that now pay 88% of each health care dollar. The importance of that is that the 12% that is paid by consumers is paid predominantly by those people who are not covered by any of our private and public health programs -- the uninsured. For the rest of us, the percentage paid by consumers is even lower.

Personally, I don't advocate that. I simply say that if socialized medicine is good enough for 85% of the population, it's good enough for 100%.

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Socialize medicine becomes rationed medicine. I don't want government making those decisions. Remember the UK model

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"Waiting Times. Waiting lists are a huge problem in Great Britain. Some examples: 750,000 are on waiting lists for hospital admission; 40% of cancer patients are never able to see an oncologist; there is explicit rationing for services such as kidney dialysis, open heart surgery and care for the terminally ill. Further, minimum waiting times have been instituted to reduce costs. “A top-flight hospital like Suffolk Est PCT was ordered to impose a minimum waiting time of at least 122 days before patients could be treated or the hospital would lose a portion of its funding.”"

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I don't want higher taxes! I pay enough taxes now--actually more than enough.

I don't want to pay for more than my own!

I don't want to pay for illegal aliens!

I don't like birthright citizenship when the parents are illegal aliens!

I don't like birthright citizenship being responsible for inflating the welfare/entitlement roles!

I don't want a government analyst telling me which medical care I can have and which is not available!

Insurance companies are FOR PROFIT companies. No one has to buy insurance--they can take the gamble that they will spend less if they only spend when needed vs. monthly payments. Except--you can't do that with car insurance, home insurance, etc. because there is a greater liklihood in this country that you will be sued for some--often frivilous issue.

We need to stand up and be counted--not "taken care of". We need to assume personal responsibility and get the goverment the heck out of it.

I'm tired of being penalized for being moderately successful!