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November 20, 2007
Industry Warms to Health Reform
Good piece in the WSJ detailing a recent PriceWaterhouseCoopers report showing that universal health care may have significant, positive implications for...the health care industry. Which has long been obvious. If an expansion of access is done through private insurance, that's 45 million more individuals purchasing coverage, and many millions more who'll be able to afford prescription drugs, regular treatment, and all the rest. We are, in effect, subsidizing the poor to become health care customers.
Industry has some concerns, however. Mainly, the public insurer being proposed by Democrats. They don't like that idea, and for all the obvious reasons. For all the scary stories about the dystopian hell that awaits us if we nationalize the health care system, the private insurers seem surprisingly loathe to compete against an insurer uninterested in turning a profit. It's almost as if they don't really think that Americans will hate public insurance! What're the odds!?
My hunch, sadly, is that they'll get their way on this. Barring a remarkable Democratic year, or the Democrats showing enough stones to ram this through the Budget Reconciliation process (where it only needs 50 votes), the public insurer may well get bargained away in return for a couple key Republican supporters. It'll be a shame if that happens, as the public insurer will be good for cost control and a damn useful experiment, but the Republicans -- and their corporate backers -- really are worried that if Americans have a choice, they'll choose government. And that's the sort of ideologically transformative occurrence they can't allow to happen.
November 20, 2007 in Health Care | Permalink
Comments
well, duh.
Posted by: pimp hand strikes! | Nov 20, 2007 7:14:37 AM
Ezra,
the private insurers seem surprisingly loathe to compete against an insurer uninterested in turning a profit.
Many of them are non-profit, so its the wrong argument. They are scared of a public health option because it may be able to unfairly compete (insurers can be limited in total number of covered lives in a region, no one is mentioning the same restriction with a public option)-- no different than tech providers that were concerned about the market dominance of Microsoft. Neither are good for competition.
the public insurer may well get bargained away in return for a couple key Republican supporters.
As you know, this has been precisely one of my main criticisms of the big three's plans. If we look at their plans from the standpoint of what they're likely to look like afterwards, there just simply isn't that much there relative to the necessary steps of reform. Their starting points are very timid and unimaginative, and have basically conceded key negotiation to Republicans and special interests before they made their opening offer.
I'm still horriblly disappointed that as a whole, you think these plans are satisfactory. The political climate is unlikely to be more receptive to health care reform in the relatively near future, given political cycles, it'll be another 20 years or so before the "next steps" could be taken. I don't know if its your naivete about these poltical dynamics (thinking that more significant reforms could be implemented earlier) or if the DC establishment has started to pull you in-- i.e. you don't want to ruffle any feathers being the lefty blogger/health care guy who blasted the plans of the big three. Either way, I'm confident you're extremely off in your assessment here that these are satisfactory plans.
Posted by: wisewon | Nov 20, 2007 7:25:43 AM
"an insurer uninterested in turning a profit"
Read - an insurer subsidized by the federal government because it does not have to pay income taxes, borrows money via subsidized debt and God only knows what else.
Posted by: ostap | Nov 20, 2007 8:17:35 AM
As the Democratic Party moves to nationalize health care, the first question is why would anyone go into a health care career. The government is only able to maintain civil servants by paying above market wages and benefits.
How will the government expand coverage and cut costs simultaneously? My guess that it will do it by limiting treatment options and pushing wages down.
Posted by: superdestroyer | Nov 20, 2007 9:20:59 AM
...and God only knows what else.
Shorter ostap: Boo! Communism! Eek!
Posted by: DMonteith | Nov 20, 2007 9:30:42 AM
It'll be a shame if that happens, as the public insurer will be good for cost control and a damn useful experiment, but the Republicans -- and their corporate backers -- really are worried that if Americans have a choice, they'll choose government.
The problem that I see is that the supporters of Government healthcare are saying the wrong things. They need to tell people that we are overtreated not under treated. They need to explain that the insurance companies mostly OK too much treatment and not to little. They must explain that part of the problem is a sort of arms race and that no one is looking to reduce spending. IMO the right amount of spending is what the median American would be willing to pay for a benefit with the existing likelihoods. We spend way more than we should even some of the people who are being treated would not opt to get the treatment if they had to pay for it directly. Our Government already spends more than enough to cover everyone.
The debate focuses on all the wrong issues.
Posted by: Floccina | Nov 20, 2007 9:37:07 AM
the first question is why would anyone go into a health care career. The government is only able to maintain civil servants by paying above market wages and benefits.
Yeah it sure is a shame about all the shortages of doctors in France and Germany and Canada. Oops! What I meant to say was, those countries have similar numbers of doctors per capita that the US does. Silly me!
Seriously, people, spend five minutes on google before you shoot your mouth off about how socialized medicine means x. There are lots of countries that have socialized medicine and the statistics from these countries are easily available on this amazing new thing called the internet.
Posted by: DMonteith | Nov 20, 2007 9:43:00 AM
"There are lots of countries that have socialized medicine and the statistics from these countries are easily available on this amazing new thing called the internet."
That's the thing that fascinates me about discussions on blogs. It's as if some posters think they are talking heads on CNN where one has a passive audience unwilling to relatively quickly with a few clicks determine whether they are full of it or not. I wish in the rest of the MSM there was this quick to use bullshit-meter that one could instantly take what has been said (without having to remember it or mail in for a transcript) to determine whether it's close or further away from the actual fact of the matter.
Posted by: akaison | Nov 20, 2007 10:22:12 AM
I will believe it when I see it. People are not rational actors, and as corporations are overwhelmingly run by people with identical ideologies, Corporations will behave like people. However, as none of us are as cruel as all of us, they will behave as a human without social as well as rational behavior.
Because of this, corporations will likely continue to lose money just to spite their workers, or the people their perceive as their social lessers.
Posted by: Soullite | Nov 20, 2007 10:31:26 AM
If you want to understand how people behave, study psychology. Don't waste your time on economics, it's really much more of an ideology than a science.
Posted by: Soullite | Nov 20, 2007 10:32:17 AM
DMonteith
The last time I looked the U.S. is not Germany or France. The U.S. cannot produce enough nurses or x-ray techs today. They have to import nurses on the Philippines to make up the shortfall.
What do you think will happen when the wages are cut to make up for the revenues shortfalls when the feds cut reimbursement rates to create the funds to cover 40 million uninsured.
Before talking about Germany, why don't you use the internet to look at the job postings for any large city hospital.
Posted by: superdestroyer | Nov 20, 2007 10:36:08 AM
But.... the public insurer is more or less the whole point, particularly with Obama's plan.
Posted by: Anthony Damiani | Nov 20, 2007 10:40:42 AM
The last time I looked the U.S. is not Germany or France. The U.S. cannot produce enough nurses or x-ray techs today. They have to import nurses on the Philippines to make up the shortfall.
What do you think will happen when the wages are cut to make up for the revenues shortfalls when the feds cut reimbursement rates to create the funds to cover 40 million uninsured.
superdestroyer keep in these 2 things in mind:
1. One of the goals of Government provided healthcare will be to reduce the amount of treatment that people receive rather dramatically because (google: Overtreated Brownlee and “Robin Hanson” on healthcare) some of the medical care that we receive is counter productive and much more is un-economical.
2. Most nurses today are over qualified for what they do, so you just lower requirements and you will have plenty of nurses.
IMO We could all be covered for less than Gov. already spends.
Posted by: Floccina | Nov 20, 2007 10:51:53 AM
Wisewon, bravely defending the corrupt HMA's and health insurer's of the nation. I don't think we care if universal healthcare 'unfairly competes' or not. It's hard to care about such a moral argument when you're basically fighting for the right to let some people die so you can make money.
somehow, I doubt we'll ever find government run healthcare adopting a policy of rejecting all claims...
Posted by: Soullite | Nov 20, 2007 10:52:30 AM
Lmao, we can produce enough doctors and nurses. We'd just have to lower the cost of college, especially an education that can take 7 years to complete. But pretending that there's some magic problem with our population that we could never produce enough health care workers, rather than admitting the reality that our government's policies have caused these shortages, is the lamest argument I have ever heard.
Posted by: Soullite | Nov 20, 2007 10:55:07 AM
Soullite there is no reason that one should have to run the anachronistic gantlet that American have run to become doctors in America today. To me the process in America that produces doctors seems like a fraternity hazing designed to build loyalty to the profession. I think that a 5 year under graduate program would be enough to become an MD. Presumably MDs just out of school would start working under a more experienced and capable lead.
Posted by: Floccina | Nov 20, 2007 11:22:26 AM
Soulite,
To become an attending physician (able to bill the government) takes longer than 7 years. It is not only the costs, it is the sacrifice of income while learning how to be a physicians. The government politicies are not the only cause of worker shortage. Remember, all hospitals/providers are paid the same amount even though the cost of operating a hospital in NYC is much higher than say Fargo, North Dakota.
Also, in today's world, a health care facility can only have a one year planning horizon because the government changes the reimbursement rates frequently. One was once a money maker/profitable service to provide can quickly become a money loser (such as what happen to the hospitals that invested heavily in cardiac care).
Also, the government has never lowered demand. Given the political climate in the U.S. and the coming logn termdominance of the Democratic Party, more healthcare will be provided to more people. It is not hard to image that mental health spending will increase massively.
Posted by: superdestroyer | Nov 20, 2007 11:23:05 AM
Soullite there is no reason that one should have to run the anachronistic gantlet that Americans have run to become doctors in America today. The process in America that produces doctors seems like a fraternity hazing designed to build loyalty to the profession. I think that a 5 year under graduate program should be enough to become an MD. Presumably MDs just out of school would start working under a more experienced and capable lead.
Posted by: Floccina | Nov 20, 2007 11:25:16 AM
I can't go into everything that's discussed here because I am not an expert, but it should be noted that the number of healthcare professionals is kept artificially low in the U.S. Pretty much an open secret in the industry, and asked any pre- med. So, when someone uses that as an excuse as to why we shouldn't go for universal healthcare, as others have mentioned, that's kind of laughable on its face. The easy solution to that issue is to build more medical schools rather than try to increase demand by limiting supply, not, we can't have healthcare. OT: the cost of education is another one of the forces squeezing the middle class in this country. I know this guy who is conservative who like many conservatives is kind of a bit of a hypocrite. He says the government shouldn't cover the cost of his education, but so what is he doing? he's going to Europe because he can to get his education practically for free (by American standards).
Posted by: akaison | Nov 20, 2007 11:30:04 AM
by the way- that kind is going to school to become a doctor. we should separate out what people say in idealogical theory versus what they mean in actual application. i know several people who are against government healtcare, but are taking advantage of their ability to get healthcare from the state at a cheaper rate. people can tend to talk out of the both sides of their mouths-- which complicates the polls and our understanding.
Posted by: akaison | Nov 20, 2007 11:33:56 AM
floc- what you mention is true of many professional degrees- there is no reason at all for example- except tradition at this point- why lawyers need to spend 4 years in undergrad and 3 in law school. this drives up the cost unnecessarily and limits the options after graduation for what one can do with a law degree. many things i supect in this country are based on intertia rather than it being the best way to get things done. even if one is conservative in terms of politics there ought to be a way to acknowledge the flaws in how we educate people for professional positions.
Posted by: akaison | Nov 20, 2007 11:37:28 AM
Remember, all hospitals/providers are paid the same amount even though the cost of operating a hospital in NYC is much higher than say Fargo, North Dakota.
Posted by: superdestroyer | Nov 20, 2007 11:23:05 AM
So what? The dang gubmit already pumps "free" money into hundreds of hospitals around the country because otherwise these hospitals would not exist - there simply aren't enough paying customers in places like, say, rural North Dakota to sustain a fancy hospital without some hefty government (maybe you would prefer "socialist") support. Without this government ("socialist", eek!) support, people would have to drive many many many miles to get to an emergency room, if they could make it there at all. Or they could rely on their town's Rescue Squad for emergency care, yet another dang gubmit giveaway!
Posted by: chowchowchow | Nov 20, 2007 11:44:45 AM
I'm still horriblly disappointed that as a whole, you think these plans are satisfactory. The political climate is unlikely to be more receptive to health care reform in the relatively near future, given political cycles, it'll be another 20 years or so before the "next steps" could be taken.
wisewon: it seems to me the healthcare crisis in this country is intensifying yearly. The utterly bleak economics of providing healthcare and insurance are pushing the collapse of the system along continually, without respite, and with little regard for the ebb and flow of political and business cycles. I can't envision any circumstances whereby something magically materializes to transform the dysfunction of the system and remove that pressure. In short, as long as we get a plan in place that is truly universal in its coverage, I see absolutely no prospect that pressure won't continue to increase for more reforms if the initial UHC plan we adopt is less than perfect (I reckon imperfection is a pretty safe assumption). The economic facts on the ground are simply to powerful to allow for a twenty year political holiday from the healthcare crisis.
Posted by: Jasper | Nov 20, 2007 11:58:32 AM
Flocc, you may well be correct. Perhaps medical school is a bit too stringent, and that is indeed part of our artificial shortage of healthcare workers. going ot school for years and having most of your classes as electives before you even enter medical school is a waste. I shouldn't have automatically jumped at such a simple option when a more comprehensive approach could yield better results. Ideally, college could be made cheaper AND the college experience of medical students could be more narrowly tailored to actual be about medicine. Obviously, the later would effectively cause the former.
Posted by: Soullite | Nov 20, 2007 12:13:56 PM
Howeve,r super, your arguments are self serving and moralistic. They do not make logical sense. There is no inherent need for sacrifice amongst med students. They should not be paid like shit for years before being able to get a good job. This is done to prevent lower income people from entering that profession, that is what internships have ALWAYS done. Everyone here knows that the supple of medical workers are kept artificially low, as much as you pretend otherwise.
Posted by: Soullite | Nov 20, 2007 12:16:29 PM
Soulite,
The supply of physicians is keep low. The supply of nurses is not kept for low because many universities by BSN programs and they do not have to be elite universities. Even then with pay starting over $50K pear year, they cannot meet demand. The same goes for pharmacist, physical therapist, x-ray technicians (an associates degree), and Physicians assistants (a BS degree). If physician pay goes down, then all other healthcare work goes down.
Why would anyone become a nurses with 24/7 work schedules, holidays and lousy working conditions when they would be paid less than a GS-11 budget analyst who works from 7:30 to 4:00?
Also, with nationalized health care. the government will determine which hospitals succeed or fail, which technologies are adopted or not, and what the pay scales are for an entire industry.
Posted by: superdestroyer | Nov 20, 2007 12:51:20 PM
again let me chime in with what I know- I k now several people who went into nursing- including one guy who was stigmatized for going into nursing to become an anethesis (spelling?- basically when you dont want to pay for an anestigialogist (again spelling) you use a nurse trained in the area for routine surgeries). my point? that its not a profession that many consider to be the top profession to get into- its not tauted as important. trying to reduce this to amount of money or being on demand is silly and false.
Posted by: akaison | Nov 20, 2007 1:06:36 PM
"Remember, all hospitals/providers are paid the same amount even though the cost of operating a hospital in NYC is much higher than say Fargo, North Dakota."
What??!! Paid by who? Even Medicare pays much, much more for a patient in a hospital in NYC than they do for a patient in Fargo. There's something called the "Area Wage Index" that's used to adjust Medicare payments based on local costs and, believe me, Medicare pays much more in NYC than it does almost anywhere else in the country. Certainly more than it pays in Fargo.
As for private insurers, I'm sure they're dealing with the same market issues. They pay more for a patient in NYC than a patient in Fargo.
Posted by: SteveH | Nov 20, 2007 1:19:03 PM
Let me add my two cents on provider shortages: the Nursing shortage is mainly due to a lack of faculty in Nursing schools. There's no shortage of people applying, there's a shortage of space because the schools lack enough faculty. Here's what the Amer. Assoc. of Colleges of Nursing said, "U.S. nursing schools turned away 42,866 qualified applicants from baccalaureate and graduate nursing programs in 2006 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Almost three quarters (71.0%) of the nursing schools responding to the 2006 survey pointed to faculty shortages as a reason for not accepting all qualified applicants into entry-level nursing programs."
Also akaison is right on one thing at least. CNAs (certified nurse anesthitists) can make a fortune. I know hospitals that pay CNAs more than physicians because they can't get an anesthesiologist and there aren't enough CNAs out there now anyway. CNAs can make over 200 grand a year in some places. Regular RNs and LPNs make a lot less, but job stress is a major factor in nurses quitting.
Posted by: SteveH | Nov 20, 2007 1:28:40 PM
Super, hospitals can not be allowed to 'fail'. They can not simply be shut down. They have to actually service people. You seem to think that if a hospital can't make money in an area, that area does not need a hospital. This pretty much makes you the biggest scumbag in here.
Posted by: Soullite | Nov 20, 2007 1:36:53 PM
steve- my views of nursing where based on what I was told from my friends rather than something I researched. Thx for posting more information.
Posted by: akaison | Nov 20, 2007 2:11:47 PM
Soullite wrote:
Super, hospitals can not be allowed to 'fail'. They can not simply be shut down. They have to actually service people. You seem to think that if a hospital can't make money in an area, that area does not need a hospital. This pretty much makes you the biggest scumbag in here.
but looking at this:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0030260&ct=1
We estimated life expectancy, the risk of mortality from specific diseases, health insurance, and health-care utilization for the eight Americas.
The eight Americas classification reveals that within the white population there is a wide variation in health experience that cannot be explained by differences in average income: low-income white rural populations in Minnesota, the Dakotas, Iowa, Montana, and Nebraska (America 2), with a life expectancy of 76.2 and 81.8 y for males and females, respectively, have a substantial advantage over the rest of white America, despite a large income disadvantage.
Since rural people seem to live longer than urban people I would guess that having a hospital near by is not important to health.
Posted by: floccina | Nov 20, 2007 3:56:13 PM
floccina-- that arguments only makes sense when you look at aggregates, when you realize that each individual number is a human being, you should realize how insane you sound.
Posted by: Soullite | Nov 20, 2007 5:11:59 PM
Basically flocc, YOU might be willing to sacrifice access to emergency rooms for some people because you can't find a statistical correlation between access to hospitcals and a longer life, that argument isn't going to help the guy who dies en route the hospital six counties away. You have to stop looking at this as an entirely statistical issue. It isn't. It's an issue involving individual people. Your attitude is exactly whats wrong with the degree to which economics has infected political science.
Of course, as you can not really compare two entirely different lifestyles, such as urban and rural living, you end up with absolutely no evidence of anything beyond a cursory relationship between the two. Unless you've found a way to control every other factor, the studies you cite are essentially worthless. You could well have a situation where the proximity to a hospital DOES have a direct, positive correlation to the length of an individual lifespan, but where the added stresses of urban living completely mitigate these benefits allowing rural people to live longer anyway.
Posted by: Soullite | Nov 20, 2007 5:17:19 PM
Soullite so your against Government ran healthcare then? The Government shuts down VA hospitals every year, so that makes them scumbags? Why would we trust scumbags with our healthcare? Know what else those bastards do, they refuse to build hospitals where there is a huge need, all about the money with them! They also ration like crazy to, they will actually tell you how many pints of blood your allowed or how many days you can stay in the hospital.
Posted by: Nate O | Nov 20, 2007 5:19:52 PM
The U.S. cannot produce enough nurses or x-ray techs today. They have to import nurses on the Philippines to make up the shortfall.
This is not an argument against universal health care. Apparently it's free market systems like ours that are failing to provide adequate incentives to potential nurses. This point is in fact an indictment of the current system because this shortage exists now, not in some hypothetical socialized future. Unlike this:
What do you think will happen when the wages are cut to make up for the revenues shortfalls when the feds cut reimbursement rates to create the funds to cover 40 million uninsured.
First of all, there is absolutely no reason to think that this is how the future will play out. There are many methods of implementation that could anticipate and mitigate or avoid obvious potential consequences. Secondly, by looking at other countries we discover that your hysterically hypothesized failure of incentives just doesn't materialize. That's just the way it is and your fantasies don't change it.
Posted by: DMonteith | Nov 20, 2007 7:13:24 PM
DMonteith,
Unless you have not noticed, the U.s. is not Europe. No country in Europe has a population that is 15% black, 15% Hispanics, and 5% Asian. It is easy for Sweden or Germany to do things that the U.S. cannot. Besides, the populations in Germany are shrinking, not expanding.
Also, the labor market is free market no matter who pays the bill. If the labor market cannot produce enough nurses at $50K per year, how is it going to do it at $40K per year. Do you expect the government to draft people into being x-ray techs or OR techs?
No one ever realy answer the question: Why would anyone want to go into a health care career when the government is about to take over the field. The pay is going to go down and the regulations are about to go up. In addition, government regulations could eliminate a career field like Nuclear Medicine Tech tomorrow by lower the reimbursement rate below costs.
Posted by: superdestroyer | Nov 20, 2007 8:16:57 PM
Following up on SteveH regarding Medicare rates, physician's fees for "Initial Hospital Care, moderate severity" code 99222, Manhattan - $134.90, Fargo, $113.56.
Posted by: umbrelladoc | Nov 20, 2007 9:23:31 PM
Why not send people from the urban coast to rural america for their hospitl care? This will give the small hospitals the revenue they need to stay open and also reduce the cost of healthcare 16%. Sounds like a win win deal for everyone no?
Posted by: Nate O | Nov 20, 2007 9:52:00 PM
Nate O,
The main problem with that is that most people don't want to have a long schlep to get to their hospital. You certainly couldn't force them to as a rule.
For those who aren't insured and want to save money, you can save a lot more than 16% by going abroad. Medical tourism is a growth industry for that reason.
Posted by: jd | Nov 20, 2007 11:59:27 PM
Unless you have not noticed, the U.s. is not Europe. No country in Europe has a population that is 15% black, 15% Hispanics, and 5% Asian. It is easy for Sweden or Germany to do things that the U.S. cannot. Besides, the populations in Germany are shrinking, not expanding.
Shorter superdestroyer: we can't have universal coverage cause then brown people will get it. But its even worse that that. What if I claimed that it's impossible for the US to have the most powerful military in the world because it's hard for us due to our ethnic diversity. Well, I'd look just about as stupid as you do.
By the way, 2 minutes on Google reveals that 18% of Germany's population is of non-German descent. Also, for the past five years Germany's population growth rate is close to zero, but actually slightly positive. So, once again, I prove that your entire argument is composed of ignorant conjecture.
Why would anyone want to go into a health care career when the government is about to take over the field.
According to this logic, there is no one working for the government right now. After all, the government has taken it over. Better trolls please.
Posted by: DMonteith | Nov 21, 2007 8:48:35 AM
There is a strong argument for Government run healthcare, it is based on the idea that we are in the USA are overtreated. That because we pay for healthcare through third parties and because the third parties are such wimps we buy much more medical care than is optimal. Governments do know how to be tough and stingy and deny care. This has been demonstrated in healthcare in France and the other socialized medicine countries. People in France get far less care than Americans do but they are just about as healthy as Americans. An example is that most people would rather forgo much of the end of life care that we get but it is hard to do that when everyone else is getting it, but in a socialized medicine system people can say we all agreed on this.
Advocates of single payer sometimes say that government will deliver healthcare more efficiently. I find that very hard to believe, in fact I believe the opposite, government tends to be the least efficient supplier of goods and services but they are much better at saying no, so they may be more able to control spending.
Since USA governments already spend more per capita on healthcare than France does we might be able to get government to cover everyone for less than they spend now with only a very small negative affect on our health. We may end up 1/3 of the care that we get now for less than half of what we spend now.
Posted by: Floccina | Nov 21, 2007 10:16:46 AM
Floccina,
Governments do know how to be tough and stingy and deny care.
I don't think this statement is actually true.
Other countries' systems have lower costs because they were able to manage cost growth better than the US-- in the 1980's.
Ratio of health care growth to GDP growth since 1990 (source: OECD)
The best:
Canada 1.06
Norway 0.97
Ireland 1.06
Sweden 1.13
The policy wonk "favorites":
France 1.60
Germany 1.75
Others frequently cited:
Japan 3.85
UK 1.90
Australia 1.85
Spain 1.46
New Zealand 2.00
Here are the totals:
OECD average of 28 countries 1.51
European Union average of 14 countries 1.44
And the suspense... US 1.50
So the US is no different than the average of OECD countries or the EU. A few single-payer systems are better than most single-payer systems. The favored "hybrid approaches" have performed worse than the US. The more restrictive Canada/UK approach was a mixed bag- one better than the US, one worse than the US. This isn't good evidence that single-payer systems work better on cost growth than the status quo in the US, which we know is broken.
The solution for the US simply does not exist today-- we need a better system than what any country has right now if we are planning on controlling costs.
Posted by: wisewon | Nov 21, 2007 11:12:55 AM
"People in France get far less care than Americans do but they are just about as healthy as Americans."
This is simply wrong. I work on health policy and the idea that people in the US use more health care than people in other countries and that is why we spend more money than other countries is just wrong. We have insurance companies whose primary method of cost control is to discourage their beneficiaries from seeing docs or getting care and, to some extent, they succeed. Other countries do not kick new mothers and their babies out of the hospital to save money. That happens a lot in the US, but having a baby here costs more not less.
See Exhibit I Health Care Resources And Utilization, France And United States, 1989 - 1991 at
http://www.nyu.edu/projects/rodwin/french.html
The problem is not that we use more health care here, the problem is that health care costs a lot more here than anywhere else.
Posted by: SteveH | Nov 21, 2007 11:31:03 AM
wisewon and SteveH both mae good points. wisewon is some of that due to greater economic growth in the USA?
SteveH I understood that in the USA people get much more MRIs CT scanes ect. am I mistaken? Also it is not sucha simple thing to prove that they get the same care.
Also say you have Government healthcare and you cap Doctors pay you may not have a shortage but it may get easier to get into medical school. One could presume that you are buying less brains.
Posted by: Floccina | Nov 21, 2007 11:53:44 AM
PS SteveH wrote:
The problem is not that we use more health care here, the problem is that health care costs a lot more here than anywhere else.
I am curious, why do think this is so? Is it the power of teh AMA?
Posted by: Floccina | Nov 21, 2007 11:57:27 AM
SteveH
Ambulatory care. In France there are more physicians than in the United States, and they are less specialized (Exhibit 1). Although physicians in general and family practice represent only 16 percent of all physicians in office-based private practice in the United States, they make up 53 percent in France.4 Nurses, physical therapists, speech therapists, and a range of other professionals also contribute to the provision of ambulatory care, mostly upon referral and mostly in private practice. Also, in contrast to the United States, where many simple laboratory tests are performed in a doctor's office, in France laboratory tests ordered by all office-based private practitioners and many hospital-based physicians are performed in independent laboratories. Pharmaceutical products other than those intended for hospital patients are purchased almost exclusively in private pharmacies whose locations and prices are regulated by the Ministry of Health.
This gives evindence to those who say deregulation would be helpful.
BTW I love to find out I am wrong, it is much better than staying ignorant.
Posted by: Floccina | Nov 21, 2007 12:06:01 PM
DMonteith |
According to the CIA Factbook, https://www.cia.gov/library/publications/the-world-factbook/geos/gm.html#People
The 2007 population growth rate for Germany was negative, the population is 82 million (about one fourth the U.S.), and the population is over 91% ethnic Germans and with about 14% of the population 14 y/o and younger.
For France, population 60 million with a growth rate of .58% and with a population that is about 88% native French.
You still have not answered the question, why would anyone want to go into healthcare with the government about to take over the industry. The government can get all of the budget analyst or program mangers it wants. However, it uses contractors to get physicians, engineers, and computer experts because the government cannot pay enough under civil service rules.
Of course it is easy to understand how legislative aids who are willing to work for free to get their foot in the door of a Congressman or Senator believe that everyone else is willing to work for free.
Floccina ,
Cutting physician pay will lower the total supply of physicians because many of them will end up leaving the industry early instead of working their entire professional lives as physicians. In addition, as physician pay goes down, every other healthcare workers pay will have to go down. Physicians will definitely walk out the door with nurses/PA/therapist in the same field are making more. And as pay goes down, the number of pharmacist, nurses, x-ray techs, PA’s and the rest will go down.
Why would anyone go into healthcare when they can make more money will better working hours and working conditions being a budget analyst for the government?
Posted by: superdestroyer | Nov 21, 2007 12:14:20 PM
Other countries do not kick new mothers and their babies out of the hospital to save money.
Doctors have told me that this best for health reasons. Is that disputed?
Posted by: Floccina | Nov 21, 2007 12:24:53 PM
wisewon is some of that due to greater economic growth in the USA?
Floccina,
Europe's GDP growth has been around a percentage point less-- but most health policy analysts look at the rising costs of health care relative to GDP. If health care is growing at the rate of the general economy, than we aren't at risk of it crowding out other parts of our lives. Given the nature of demand in health care and the specialized/technological nature of the field, its difficult to see where health care costs growth is less than general economy growth (this is a somewhat complex topic). When its growing 50% faster than the economy, as is the case in Europe and the US, then there is the potential for a problem. (Some experts still think this is OK, for now.) Getting the US and Europe to equal cost growth is the primary focus of those looking at the issue.
Regardless of whether the numbers above should be slightly adjusted, it is clear that the cost growth problem isn't solved in single-payer systems. Policy papers from Europe further back this assessment. Many of these countries are searching for better reforms as well-- with more market-oriented solutions being considered.
Posted by: wisewon | Nov 21, 2007 12:32:04 PM
Superdestroyer wrote:
Cutting physician pay will lower the total supply of physicians because many of them will end up leaving the industry early instead of working their entire professional lives as physicians. In addition, as physician pay goes down, every other healthcare workers pay will have to go down. Physicians will definitely walk out the door with nurses/PA/therapist in the same field are making more. And as pay goes down, the number of pharmacist, nurses, x-ray techs, PA’s and the rest will go down.
Yes but as others point out there are an excess of people willing to be physicians nurses/PA/therapists etc. Quality of the practitioners may fall but supply can be maintained. Now at some point the quality of the practitioners would be a problem. Admittedly at some very low point you could not get enough people to do the job.
Also one of the goals would be to give less care. Thus needing fewer practitioners.
Wisewon wrote:
The solution for the US simply does not exist today-- we need a better system than what any country has right now if we are planning on controlling costs.
Wisewon have you ever given thought to a system where the insured would be given a lump sum on diagnosis? The insurer could be Government or private.
But their are an execess of
Posted by: Floccina | Nov 21, 2007 12:37:16 PM
Oh good gosh. France has more physicians per capita than the US, and so do plenty of other countries. "Despite the relatively high level of health expenditure in the United States, there are fewer physicians per capita than in most other OECD countries. In 2002, the United States had 2.3 practising physicians per 1 000 population, below the OECD average of 2.9."
http://www.oecd.org/dataoecd/15/23/34970246.pdf
How do they do that when their physicians make less money than physicians in the US and their gov'ts have greater involvement in the health care system? The gov't in the US is not about to take over the whole health care system and we'll still have plenty of docs and resources. There are a lot more openings for docs than there are for budget analysts too.
Posted by: SteveH | Nov 21, 2007 12:38:55 PM
"The problem is not that we use more health care here, the problem is that health care costs a lot more here than anywhere else.
I am curious, why do think this is so? Is it the power of teh AMA?"
No, it's not the AMA. We pay too much for drugs, for health care, for hospitalization, for medical education, and way too much for health insurance bureaucracy.
Posted by: SteveH | Nov 21, 2007 12:41:09 PM
have you ever given thought to a system where the insured would be given a lump sum on diagnosis?
I think this is an interesting idea in concept, extremely difficult in practice (diagnoses evolve, the short-term incentives to keep all of the money may lead to more expensive problems down the road, etc.). I'd suggest that the principle you're after with that-- putting dollars in consumers hands so they have incentives to choose more cost-effective treatment options-- could be achieved through more feasible means. Specifically, targeted co-pays based on known/presumed areas of cost-ineffective medicine, where people are given a pool of dollars annually, to either use for the co-pays or save for future health care costs.
Posted by: wisewon | Nov 21, 2007 12:58:41 PM
superdestroyer,
re population growth: Your sources disagree with mine and I'm not interested in tracking down the particulars on this little diversionary jaunt so let's agree to disagree on this one.
This still leaves the absolute incomprehensibility of your claim that we can't do universal health care because black people live here. We do plenty of things here very well, and black people even live here. And so do people who speak Spanish. Is health care more racially sensitive than other endeavors? In short, what the hell is your point? Are you a racist, or are you just hoping that racism is virulent enough to derail something you dislike? Either way you're not looking too good here.
You still have not answered the question, why would anyone want to go into healthcare with the government about to take over the industry.
Why should I answer this question when I've already proven that the answer is irrelevant because in countries with socialized medicine there is no shortage of doctors? This is even more risible when your only counterexample concerns shortages of health care workers here in the US. But I'll try to help you out of your conundrum. Why the hell does anyone do anything? Riddle me that and maybe you'll have your answer. Hint: it doesn't always involve Econ 101-style financial incentives.
Posted by: DMonteith | Nov 21, 2007 8:42:52 PM
Yeah the AMA is so powerful they killed Medicare in 1964.
Oh wait a minute.... oops
Posted by: joe blow | Nov 22, 2007 6:40:05 PM
Doctors incomes account for only 10% of total healthcare costs. Total reimbursements account for about 20% but half of that is for overhead (paying nurses, secretaries, billing personnel to fight insurance companies, utilities,
Posted by: joe blow | Nov 22, 2007 7:07:25 PM
