Can't wait for this in the U.S.

[billvon 3,173]

>With a well functioning market, prices decline and quality (and availability)
>increase. Perhaps instead of condemning the "market" in healthcare, we ought to
>be looking for ways to actually create one--because it certainly doesn't exist
>now.

?? I agree with all that. But that doesn't change the fact that in a true free market solution, those who cannot pay do not get care. Indeed, that condition is sort of required to drive a functioning market.

>The premiums that we'd have to pay for them to participate in that insurance
>program would actually be less than what we're spending now on federal and
>state health assistance programs (medicare and medicaid).

That's an interesting suggestion. My first reaction would be that the cost would be extremely high, but your argument that it would be less than medicare (almost half a trillion in 2007) and medicaid is probably valid.

[TomAiello 26]

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Think the feds' insurer is equipped for that much of an increase in business? Other than that, wtf not?

Yes. Because the fed's "insurer" is actually more than a hundred private insurance companies. Federal employees (like employees in many large enterprises) are offered a selection of insurance plans to choose from in their benefits package.

To qualify for inclusion in the package (which of course, is highly desirable from their standpoint) the companies must agree to insure any federal employee who chooses their plan in his benefit package.

It's pretty standard, and looks a lot like the plans being used by most large corporations (and many small ones) in the US today.

I don't think it's a complete solution, but it's a quick and easy start that would solve a bunch of issues, extend universal coverage, and reduce the federal (and state) budgetary costs all at once.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[TomAiello 26]

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My first reaction would be that the cost would be extremely high, but your argument that it would be less than medicare (almost half a trillion in 2007) and medicaid is probably valid.

The cost estimates are based on research conducted by a little known student of economics--a guy by the name of Milton Friedman.

The best non-technical explanation of his findings that I've found is in this book (which also has a bunch of other interesting ideas in it).

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[TomAiello 26]

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But that doesn't change the fact that in a true free market solution, those who cannot pay do not get care. Indeed, that condition is sort of required to drive a functioning market.

I disagree. You can use the market mechanism (to drive cost down, and availability and quality up) but still create a safety net to keep people from being uninsured.

For example, you could allow people to enroll in the federal employees insurance program, then give everyone a cash payment equal to the cost of the most expensive option. People would still have an incentive to choose carefully (because they'd keep any extra cash).

Make the cash payment a totally refundable tax credit and you'll be guilty of a multi-trillion dollar tax increase, too, or at least so said the president during the last election, when his opponent suggested the idea.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[billvon 3,173]

>For example, you could allow people to enroll in the federal
>employees insurance program, then give everyone a cash payment equal
>to the cost of the most expensive option. People would still have an
>incentive to choose carefully (because they'd keep any extra cash).

Right, you've overcome the problem of no money=no care by providing people with money. Which is why your federal employee insurance plan might work, by providing people with that money. (Assuming there's a means to get it to the hospitals of course.)

[chuckakers 426]

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If the government wants to make sure *everyone* gets health care, why not simply do more of what they already do and just give it to people who can't afford it on their own.

One reason is that simply paying for it doesn't address one of the primary problems, that being that it's too expensive. More than $0.25 on each health care dollar goes to administrative expenses. Taking that into consideration let me ask everyone a question. In your experiences with health care, what aspect of it would you complain about most?

Don't get me wrong - I disagree with much of the current medical give-aways. I'm an "everyone carries their weight" guy, and I agree with you that the problem in the health care realm is the cost.

I won't argue with your 25% admin cost figure, but will add that 25% isn't out of line in some industries, especially something like medicine that requires paperwork in mountains thanks to the insurance jungle and legal prudence. I suggest that the primary causes of high health care costs are the third party payer system, lawsuits, and zero revenue treatment.

Speaking of costs, Medicare loses $60 billion annually from fraud alone. Who knows how much more from waste, red tape, attrition, and all the other silly shit the government throws into the mix. Is that the system we running the entire health care business?

As for my personal experience with the health care system - I don't really have a complaint beyond cost, but people complain about the cost of everything. That's nothing new and will never change until it's free. Even then, people will bitch that it's not free enough.

Chuck Akers
D-10855
Houston, TX

[wmw999 2,644]

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problem in the health care realm is the cost

There are a number of reasons for the cost. A smart approach would try to determine the impact of each of the reasons that we can figure out, and how to minimize the ones that are the biggest impact.

Fraud is big, but the impact of life choices and overall age are probably bigger, along with, yes, administrative costs. I believe that administrative costs are greater for private insurers, mainly because with Medicare it's one set of rules, all the time, but with others, the provider has to find out what they cover, and then make sure that what they do is billed appropriately, on the right forms, etc.

And remember that preventing fraud carries its own cost -- you don't want the cost of preventing and catching fraud to be more than the savings.

So, anyway, my point is that "the" problem in health care probably needs to be a little better defined than "cost."

Wendy W.

There is nothing more dangerous than breaking a basic safety rule and getting away with it. It removes fear of the consequences and builds false confidence. (tbrown)

[chuckakers 426]

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problem in the health care realm is the cost

There are a number of reasons for the cost. A smart approach would try to determine the impact of each of the reasons that we can figure out, and how to minimize the ones that are the biggest impact.

Fraud is big, but the impact of life choices and overall age are probably bigger, along with, yes, administrative costs. I believe that administrative costs are greater for private insurers, mainly because with Medicare it's one set of rules, all the time, but with others, the provider has to find out what they cover, and then make sure that what they do is billed appropriately, on the right forms, etc.

And remember that preventing fraud carries its own cost -- you don't want the cost of preventing and catching fraud to be more than the savings.

So, anyway, my point is that "the" problem in health care probably needs to be a little better defined than "cost."

Wendy W.

I wasn't trying to define the problem as cost, per se. That's why I included the disclaimer that people bitch about the cost of everything.

Chuck Akers
D-10855
Houston, TX

[jcd11235 0]

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Speaking of costs, Medicare loses $60 billion annually from fraud alone. Who knows how much more from waste, red tape, attrition, and all the other silly shit the government throws into the mix. Is that the system we running the entire health care business?

Medicare's administration costs are, at 2 - 8% of total costs, far less than private side of the industry.

Math tutoring available. Only $6! per hour! First lesson: Factorials!

[chuckakers 426]

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Speaking of costs, Medicare loses $60 billion annually from fraud alone. Who knows how much more from waste, red tape, attrition, and all the other silly shit the government throws into the mix. Is that the system we running the entire health care business?

Medicare's administration costs are, at 2 - 8% of total costs....

$60 billion a year in fraud will do that to percentages.

Chuck Akers
D-10855
Houston, TX

[TomAiello 26]

Quote

Right, you've overcome the problem of no money=no care by providing people with money.

Yes, but simply providing the money does not destroy the market mechanism.

A well functioning market can generate varying outcomes by simply changing the inputs. You can change the inputs without eliminating the market.

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[chuckakers 426]

Quote

>>In other words, we'd be better off if we just gave those poor patients the cash
>to pay for their care . .

OK. How do we accomplish that?

No need for the cash handout. We have Medicaid, S-Chip, state and local aid, and free services with the tab picked up by any number of charity organizations, hospital systems, and private assistance.

Only 18% of Amersicans don't have health insurance (according to The National Coalition on Health Care). There's a program listed above for the vast majority of them.

Chuck Akers
D-10855
Houston, TX

[TomAiello 26]

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I believe that administrative costs are greater for private insurers, mainly because with Medicare it's one set of rules, all the time, but with others, the provider has to find out what they cover, and then make sure that what they do is billed appropriately, on the right forms, etc.

Holding up the current US healthcare system as an example of a market is a strawman frequently used in debate, but it's totally fallacious. Currently, healthcare is the most heavily regulated, and most frequently subject to government intervention, major segment of our economy by a wide margin. Saying that failures of our system show that the market doesn't work makes no sense. A far more logical conclusion, observing the relative failures of our healthcare system (especially when contrasted with relative successes in other sectors of the economy) would be to say that obviously government intervention is the problem, and that we ought to return to a freer market in health care, which we haven't even been close to in the post WW II era.

Quote

...with Medicare it's one set of rules, all the time, but with others, the provider has to find out what they cover, and then make sure that what they do is billed appropriately, on the right forms, etc.

You've never actually tried to navigate Medicare, have you?

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[TomAiello 26]

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Speaking of costs, Medicare loses $60 billion annually from fraud alone. Who knows how much more from waste, red tape, attrition, and all the other silly shit the government throws into the mix. Is that the system we running the entire health care business?

Medicare's administration costs are, at 2 - 8% of total costs, far less than private side of the industry.

Cite?

-- Tom Aiello

Tom@SnakeRiverBASE.com
SnakeRiverBASE.com

[chuckakers 426]

Quote

But I gotta play devil's advocate. Think the feds' insurer is equipped for that much of an increase in business? Other than that, wtf not?

Wendy W.

Doesn't matter. The idiots in Washington will just print the damn money to cover it.

Chuck Akers
D-10855
Houston, TX

[billvon 3,173]

>Yes, but simply providing the money does not destroy the market
>mechanism.

I agree - thus you avoid that particular problem (as long as you can make sure the money actually gets to the caregiver, of course, which should be doable.)

[jcd11235 0]

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Medicare's administration costs are, at 2 - 8% of total costs, far less than private side of the industry.

Cite?

[TomAiello 26]

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Medicare's administration costs are, at 2 - 8% of total costs, far less than private side of the industry.

Cite?

Sorry, I was in error. Apparently, 2-5 percent is a more accurate approximation.

The first source I found via Google (keywords: medicare administration cost): Clicky

[jcd11235 0]

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From your link:
…

Right. They were critical of Medicare, and even their high number for Medicare is lower than their low number for the private side.

Math tutoring available. Only $6! per hour! First lesson: Factorials!