Nationalized Healthcare paradox

[hubcap]

The recent debates regarding the benefits and shortcomings of having a national healthcare system sparked a lot of controversy regarding the quality of healthcare available in countries that provide national healthcare. I found it interesting to learn that one of our Canadian friends, the Premier of Newfoundland, chose to come to the United States to have heart surgery.

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ST. JOHN'S, N.L. -- Newfoundland Premier Danny Williams will undergo heart surgery later this week in the United States.

Deputy premier Kathy Dunderdale confirmed the treatment at a news conference Tuesday, but would not reveal the location of the operation or how it would be paid for.

"He has gone to a renowned expert in the procedure that he needs to have done," said Ms. Dunderdale, who will become acting premier while Mr. Williams is away for three to 12 weeks.

"In consultation with his own doctors, he's decided to go that route."

Mr. Williams' decision to leave Canada for the surgery has raised eyebrows over his apparent shunning of Canada's health-care system.

"It was never an option offered to him to have this procedure done in this province," said Ms. Dunderdale, refusing to answer whether the procedure could be done elsewhere in Canada.

[plotthickens]

Yep, he has the money for it. Good thing we all do, too.

Oh... wait.

[nacht]

The recent debates regarding the benefits and shortcomings of having a national healthcare system sparked a lot of controversy regarding the quality of healthcare available in countries that provide national healthcare. I found it interesting to learn that one of our Canadian friends, the Premier of Newfoundland, chose to come to the United States to have heart surgery.

There has always been the statement made that US healthcare is excellent if you can afford it. That isn't the problem.

Also, the Canadian system is not like what we are talking about doing in the US.

[ArtistTyrant]

i support very basic preventative care (checkups with a few tests) if you have a job, that's it

[nacht]

i support very basic preventative care (checkups with a few tests) if you have a job, that's it

Thus you do not believe in insurance, at all?

[Arkeph]

I'm very liberal-minded on the healthcare issue, and think that all preventive care and life-preserving care should be paid for through progressive taxation, free of any direct charge to the recipient. The mechanism through which care is provided can vary substantially, though.

[LaoTzu]

"It was never an option offered to him to have this procedure done in this province," said Ms. Dunderdale, refusing to answer whether the procedure could be done elsewhere in Canada.


This paradox rests on the idea that because a procedure is available, you must have it done.

If the man's life/quality of life depended on it, it would be done.


I'll wait to see what it is he's getting done to formulate any further opinion.

---------- Post added 02-03-2010 at 07:11 PM ----------

Wow... that took one search to follow up, and here you go.


Danny Williams could have stayed in Canada for top cardiac care, doctors say (To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.)


The one problem area is in treatment of some heart-rhythm problems. The waits for so-called "ablations" to fix atrial fibrillation -- an abnormal rhythm in the heart's upper chamber -- can stretch to over a year in some parts of the country, said Dr. O'Neill, though the condition is generally not life threatening.

In fact, 99% of people with the problem can be treated easily with inexpensive drugs, and the ablation procedure itself has never been proven effective in a randomized controlled trial, said Dr. Colin Rose, a Montreal cardiologist.

All that being said, heart doctors say there have always been Canadians who, like Mr. Williams, are rich enough that they can choose to get care in the United States at their own expense.


Shove it up your ass. (in a nice way)



"Having sophisticated, wealthy patients pick the places they want to go is not a new thing," said Dr. Stone. "Someone who has enough money can get on a plane and go anywhere they want for health care."

You can say the same thing in the US... but if you are poor... you're fucking lucky to get ANY treatment at all. HOO-Ray 4 YOU!!!

[ArtistTyrant]

Thus you do not believe in insurance, at all?

i meant within the context of what the government pays for...insurance should be a private business matter, with almost no regulation, and no barriers to competition such as state lines

[Warrior]

I'm very liberal-minded on the healthcare issue, and think that all preventive care and life-preserving care should be paid for through progressive taxation, free of any direct charge to the recipient. The mechanism through which care is provided can vary substantially, though.

Why would you force me to accept government funded payment when I want to pay for it myself and would prefer to do so?

[LaoTzu]

Why can't you derive similar satisfaction from paying your taxes and receiving the same outcome?

[Warrior]

Why can't you derive similar satisfaction from paying your taxes and receiving the same outcome?

Because I can manage my own money and decide what level of healthcare I want on my own without millions of other people having a say in it. Why would I want to send my money through a middle man? I dumped medical insurance all together this year because I get cheaper, better treatment from doctors that don't deal with all the red tape. The government sure isn't going to do any better.

Why do you want to make my medical decisions?

[plotthickens]

Not everyone can afford insurance.

This becomes a problem when you consider the meaning of the word "communicable".

[reb]

maybe not everyone deserves to be half killed by the medico/pharmaceutical/insurance system that's driving this 'national healthcare train'? despite the facade of 'humanitarianism', the healthcare in the u.s.s. of a. is not all its cracked up to be. being forced to pay into this system is, as Lao-Tzu said getting it 'shoved up my ass', not in a good way.

why don't those in the u.s.s. of a. who want this bullshit move to canada? i really like that idea.

[LaoTzu]

Why do you want to make my medical decisions?

Because I know what's best for you.


Ok, just kidding...


I want you to get the best treatment for your needs. That's the only kind we have.

The real difference between Canadian and US style is the "On-Demand" factor.
They'd (Cons) like you to beleive that you're going to wait for necessary services. You aren't.
You will, however find yourself waiting a reasonable amount for things that can afford to wait...but not long enough for those waits to cause further problems for you.
This is really only a problem for paranoid hypochondiracs.... but we offer psych services for free to those people.

Defining "Reasonable" is the only thing that we debate here regarding healthcare.

[Yhor]

Where do free clinics in the US fit into this discussion? Whenever people talk about routine care and such being the primary objective for health care law.. via taxation, I don't recall seeing much discussion about the free clinics that are around for this purpose. If you are poor, there are options. There are wait times, just as there are in countries with govt funded medical, but wouldn't it be better to be more charitable to these institutions than to force a tax on the population?


When government forces taxation so it can make government look charitable, at the cost of it's citizens, it makes those normally charitable citizens act less charitable, imo.

If I choose to negotiate my own medical deals, I should have that right, and not be forced by my government to participate. Medical Taxation is forced participation just as Social Security is (and we all know how great that works out in the equation).

It stinks to me. I'll end up paying in to a system that I'll never get back what I put in... looking at SS, why would we think otherwise?

[Grimstad]

Health CARE. The problem is not as much with the system as much as how the insurance industry has ABUSED it. Corporations DO NOT care about people. There is nothing wrong with that unless they are in the business of CARING for people. Do I want government run hospitals? Not necessarily, though we seem to think it's okay for our veterans. What I want to eliminate is the corporate greed from the equation. Let the government (an administrative structure we are already paying for and will continue to do so as long as we have a government) manage the fund. Everyone is in the pool and no one is denied because their premium was a day late or they have a pre existing condition. Insurance is gambling. The only difference between the insurance industry and a Vegas casino is the insurance companies are the gamblers AND they are setting the odds and deciding who to kick out of the casino.

[sunlover]

Actually here in the U.S. the "poor" only have to show up at an emergency room and they'll be treated. No money no problem, no insurance no problem. We already have socialized medicine.

[LaoTzu]

When government forces taxation so it can make government look charitable, at the cost of it's citizens, it makes those normally charitable citizens act less charitable, imo.

I 'own' my healthcare by what I pay in taxes. They aren't being 'charitable' by giving me care... I goddamn paid for it.
You don't own any part of your insurer, unless you buy stock...and even that doesn't guarantee you care...


If I choose to negotiate my own medical deals, I should have that right, and not be forced by my government to participate. Medical Taxation is forced participation just as Social Security is (and we all know how great that works out in the equation).

It stinks to me. I'll end up paying in to a system that I'll never get back what I put in... looking at SS, why would we think otherwise?

You probably pay more for insurance than I do in total income tax on a middle-class income.
You already ARE getting bent over the coals... and you don't even know it... hell, you're arguing for MORE of it!


As for SS, I don't want to derail; but SS was a sound system. Regan borrowed from it to pay for his tax policy.... and never paid it back. That is when it became a problem.

[Aronnax]

Actually here in the U.S. the "poor" only have to show up at an emergency room and they'll be treated. No money no problem, no insurance no problem. We already have socialized medicine.

That's correct, so the question becomes: how can we reduce the public cost?

It costs less if you sent the same people to a normal doctor's office for similar treatment. Emergency rooms are expensive to operate, they require all kinds of equipment and specialists that aren't needed to treat little Johnny. To compound the problem Johnny's parents are going to get charged far more than an insurance company would pay because they don't get the negotiated rate. So there's an increased chance that Johnny's parents will become delinquent on the hospital bills and if total debt load is bad enough, be pushed into bankruptcy.

I'm not sure why I bothered to mention this, it's almost a waste of time to discuss the public costs associated with the "private" US system. Almost nobody on this forum seems interested in discussing what changes could be made to reduce total costs when there's philosophical absolutes to bicker about.

[Arkeph]

The nature of the issue lends it to that sort of treatment. I think the trouble is that people don't have a clear mental picture of how costs are distributed. Here's a handy pie chart:

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From here. (To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.)

[Warrior]

Because I know what's best for you.


Ok, just kidding...


I want you to get the best treatment for your needs. That's the only kind we have.

The real difference between Canadian and US style is the "On-Demand" factor.
They'd (Cons) like you to beleive that you're going to wait for necessary services. You aren't.
You will, however find yourself waiting a reasonable amount for things that can afford to wait...but not long enough for those waits to cause further problems for you.
This is really only a problem for paranoid hypochondiracs.... but we offer psych services for free to those people.

Defining "Reasonable" is the only thing that we debate here regarding healthcare.


I am not concerned about waiting.

I am concerned that the government paying creates an obligation for every citizen to know how that money is being spent and in some manner be involved in the process of determining what treatments people get, even if they don't want them. I don't think anyone should be forced to accept care they don't want. I also believe people should be able to shop around for medical treatment or a doctor that provides them the service vs. cost tradeoff they want.

---------- Post added 02-03-2010 at 09:16 PM ----------

Do I want government run hospitals? Not necessarily, though we seem to think it's okay for our veterans.

Ever been to one? For the most part, VA hospitals are not at all acceptable. It is not acceptable that veterans get the treatment they usually do at VA hospitals.

(I will add that my view is based mainly on the two VA hospitals I had relatives attend in the past.)

[Dogs]

This paradox rests on the idea that because a procedure is available, you must have it done.

If the man's life/quality of life depended on it, it would be done.


I'll wait to see what it is he's getting done to formulate any further opinion.

---------- Post added 02-03-2010 at 07:11 PM ----------

Wow... that took one search to follow up, and here you go.


Danny Williams could have stayed in Canada for top cardiac care, doctors say (To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.)





Shove it up your ass. (in a nice way)




You can say the same thing in the US... but if you are poor... you're fucking lucky to get ANY treatment at all. HOO-Ray 4 YOU!!!


Sounds like you need friends, boy.

My aunt, on her super awesome 100-200$ a week semi-consistent eldercare budget, flew to Belgium to have both of her hips replaced.

How did she do that, you ask? Well, people around the community know her, don't want her to suffer, so they chipped in.

In fact, that's how ALL MAJOR MEDICAL ISSUES have been handled in my family. Friends, family members, etc contribute.

Of course, if you're an asshole, and everyone hates you (such is my case) then maybe not so much..

[Arkeph]

I am concerned that the government paying creates an obligation for every citizen to know how that money is being spent and in some manner be involved in the process of determining what treatments people get, even if they don't want them. I don't think anyone should be forced to accept care they don't want. I also believe people should be able to shop around for medical treatment or a doctor that provides them the service vs. cost tradeoff they want.

Those would be issues with the mechanism more than the source of payment, I think. For example, the set-up might be that you get to shop around, choose your treatment, and buy whatever treatment you want. Then, if you so choose, the government can pay the bill. It's just one of many possible incarnations.

[Warrior]

Those would be issues with the mechanism more than the source of payment, I think. For example, the set-up might be that you get to shop around, choose your treatment, and buy whatever treatment you want. Then, if you so choose, the government can pay the bill. It's just one of many possible incarnations.

Whoever pays has an obligation to be involved in the decision. If the government is paying, the decision cannot be the patient's alone. At least with insurnace companies, there is some level of ability to buy into a plan that lines up with your needs. (Although this is limited by "state line" regulations - doing away with those would be one of the best things we could do.)

[Tristan]

...people around the community know her, don't want her to suffer, so they chipped in.

In fact, that's how ALL MAJOR MEDICAL ISSUES have been handled in my family. Friends, family members, etc contribute.

This used to be how things operated. However, the most scientific minds of our age have discarded all the old superstitions and recognized that Government is at once benevolent and omnipotent. It is, to be sure, far more efficient at loving us than a family; a family is a mortal agency, and thus it has imperfections. For contrast, Social Security, Medicare, and Medicaid have no imperfections. Any medical programs forthcoming from government will be every bit as successful as they are.

[Grimstad]

Ever been to one? For the most part, VA hospitals are not at all acceptable. It is not acceptable that veterans get the treatment they usually do at VA hospitals.

(I will add that my view is based mainly on the two VA hospitals I had relatives attend in the past.)
My view is similar but I really didn't want to pick on the VA but I felt it was worth mentioning that we subject our vets to it.

[hubcap]

As for SS, I don't want to derail; but SS was a sound system. Regan borrowed from it to pay for his tax policy.... and never paid it back. That is when it became a problem.
Uh, not true.

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The fact of the matter is that the money collected from payroll taxes that was in excess of what was paid out in benefits have were used to purchase US Government Treasuries to help finance the deficit spending in the federal budget since pretty much the beginning of the program. Yup, more than the likely the federal government owes itself a couple of trillion dollars that it has already spent and will be borrowing it from the Chinese in order to pay itself back.

---------- Post added 02-03-2010 at 09:56 PM ----------

i meant within the context of what the government pays for...insurance should be a private business matter, with almost no regulation, and no barriers to competition such as state lines
That is at least part of the problem. Insurance companies have a defacto monopoly thanks to the federal government, specifically the McCarran-Ferguson Act of 1945.

[LaoTzu]

I am concerned that the government paying creates an obligation for every citizen to know how that money is being spent and in some manner be involved in the process of determining what treatments people get, even if they don't want them. I don't think anyone should be forced to accept care they don't want. I also believe people should be able to shop around for medical treatment or a doctor that provides them the service vs. cost tradeoff they want.

The mechanism resides in Government desire to keep taxes low. (A mythical creature, you might think). But if they want to stay in power, they keep the people happy. They provide the care, and have concern with the costs; but were they to provide poor service, the people would riot... and people know, since most everyone knows someone who works in healthcare.


As for accepting treatment... it is still a free country. You can die, if you like (and are of sound mind to make such a decision). You can find a different doctor, if you think yours is an ass-hat, or checks your prostate a little too thoroughly.

There is no need for the average person to consider cost... costs are regulated.

I think you fear a runaway money machine. It might be a concern for you and your Government; but at some point, you have to trust your Government to do the right thing. It is YOUR Government, after-all. If you don't like it, you organize and turf 'em.

[Aronnax]

This used to be how things operated. However, the most scientific minds of our age have discarded all the old superstitions and recognized that Government is at once benevolent and omnipotent. It is, to be sure, far more efficient at loving us than a family; a family is a mortal agency, and thus it has imperfections. For contrast, Social Security, Medicare, and Medicaid have no imperfections. Any medical programs forthcoming from government will be every bit as successful as they are.

Just what the discussion needed, more sarcastic rhetoric about personal responsibility and the fallibility of government. These conversations always seem to degrade into the same rhetoric about responsible individualists against the evils of socialism OR those who care about the poor against the selfish pigs, depending on your perspective.

Families have been unable to prevent large numbers of people from seeking routine medical treatment in the emergency room. Families cannot negotiate group rates from health care providers and drug companies. Families are good at many things but coming up with an effective, affordable, health care system is not been one of them.

Silly things like "cost-benefit analysis", "economies of scale" and "hidden and displaced costs" apparently have no place in the conversation. I'm done with this thread, nobody is really interested in discussing the core problems. No attempts at forming a plan of action, just a bunch of mental masturbation.

[boldbidder]

Healthcare is expensive as hell in the US because of gross profiteering on the part of pharmaceutical companies and medical device makers; not because stuff actually costs that much. Like any business hospitals pass on the cost to the customer/patient. The equation is further frakked up by the Wal-Mart style negotiating tactics that the insurance companies employ which allow them to be billed for fractions of what MSRP (or what Joe with no insurance off the street pays).

[Nemesis]

I found it interesting to learn that one of our Canadian friends, the Premier of Newfoundland, chose to come to the United States to have heart surgery.

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So let me get this right... you are predicating your anti-nationalized health care "argument" on the example of one guy going to the states for treatment!?

Didn't you start a thread about confirmation biases not too long ago?

[Causa Mortis]

Where do free clinics in the US fit into this discussion? Whenever people talk about routine care and such being the primary objective for health care law.. via taxation, I don't recall seeing much discussion about the free clinics that are around for this purpose. If you are poor, there are options. There are wait times, just as there are in countries with govt funded medical, but wouldn't it be better to be more charitable to these institutions than to force a tax on the population?

The equity gains in nationalizing health care are a nice side benefit of nationalized health care.

The much more important issue is the competetive one (To view links or images in this forum your post count must be 2 or greater. You currently have 0 posts.). That is to say, everyone else's health care spending is only eating 6-12% of (much lower per capita) GDPs...ours is eating a ridiculous 18% and rising rapidly. Our government spends more per person on Medicare and Medicaid (which provide care for, what, 30% of the population?) than most european countries spend to provide full coverage for all of their citizens.

So, yeah government is doing a better job of distributing health resources than our mixed market system - its true that there is a certain amount of rationing going on, but I'm largely in favor of restricting demand for breast enhancements and nose jobs and frivilous "I have a head cold and need an MRI, you will treat me because of defensive medicine" to bring down the cost of broken limbs, heart transplants, and cancer treatments.

Equity gains are ancillary to macroeconomic necessity and international competitiveness.


It stinks to me. I'll end up paying in to a system that I'll never get back what I put in... looking at SS, why would we think otherwise?

Social Security seems like a bum deal because it is a bum deal. Its a large, regressive tax...taxes suck, regressive taxes suck a lot. More at 11.

[Undead Bonzi]

The recent debates regarding the benefits and shortcomings of having a national healthcare system sparked a lot of controversy regarding the quality of healthcare available in countries that provide national healthcare. I found it interesting to learn that one of our Canadian friends, the Premier of Newfoundland, chose to come to the United States to have heart surgery.

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Hmmm, I'll see your cherry picked rich Canadian and raise you the healthcare stats of several of the countries that have better metrics of healthcare, yet pay FAR less than we do.

Italy

Life Expectancy: 78/84
Healthy Life Expectancy: 71/75
Expenditure Per Capita: $2,623
Percentage of GDP spend on Healthcare: 9.0%


Japan

Life Expectancy: 79/86
Healthy Life Expectancy: 72/78
Expenditure Per Capita: $2,514
Percentage of GDP spend on Healthcare: 7.9%


Norway

Life Expectancy: 78/83
Healthy Life Expectancy: 70/74
Expenditure Per Capita: $4,521
Percentage of GDP spend on Healthcare: 8.7%


Switzerland

Life Expectancy: 79/84
Healthy Life Expectancy: 71/75
Expenditure Per Capita: $4,312
Percentage of GDP spend on Healthcare: 11.3%


U.S.A.

Life Expectancy: 75/80
Healthy Life Expectancy: 67/71
Expenditure Per Capita: $6,714
Percentage of GDP spend on Healthcare: 15.3%


If anyone is curious....the U.S. was ranked 38th in the world it terms of healthcare. What was the one thing we lead all other countries in? Cost. We spend more than any other country in the world on healthcare. With that expenditure we do not have the longest life expectancy. We do not have the longest healthy life expectancy. We do not have the lowest infant mortaility rates. We do not have the lowest nonsocomial infection rates in our hospitals. We do not have the best prenatal care. We do not have the lowest rates of complications after medical surgery. And the system of many of the countries that lead us? Typically heavily government regulated. Often guaranteed and mandatory insurance for all citizens. Subsidies for those too poor to afford insurance or those who have existing conditions. Yeah, all those things people scream about how they will bankrupt our system...other countries that have those systems do healthcare for far less than we do and to better overall effect.


Some enlightening reading on the state of WORLD healthcare rather than a myopic view of only the US.

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[ArtistTyrant]

zzz it's easy to bitch about the cost of healthcare in the US, but has anyone made the point that the majority of new medicines and procedures are American? it's cheaper for other countries to provide certain types of care because they didn't have to develop it

[Causa Mortis]

zzz it's easy to bitch about the cost of healthcare in the US, but has anyone made the point that the majority of new medicines and procedures are American? it's cheaper for other countries to provide certain types of care because they didn't have to develop it

Non issue:

1. THe government directly funds or subsidizes a large portion of health care research in the US
2. At the margin, about 10% of health care profits are sent to research.
3. You can cover ALL research activity in the US in the gap between US% of GDP on health care and everyone elses. Ooooh and all liability costs too. Together they're about 5% of GDP. Not the whole story.

[ArtistTyrant]

the fact that the government funds it is exactly what makes it an issue...in reality our medicine is highly government controlled, it just seems otherwise...and that brings up the issue of focus, does it make more sense to focus on groundbreaking new medicines/procedures, or setting up more universal medical standards, at the risk of becoming stagnant?

[Causa Mortis]

the fact that the government funds it is exactly what makes it an issue...in reality our medicine is highly government controlled, it just seems otherwise...and that brings up the issue of focus, does it make more sense to focus on groundbreaking new medicines/procedures, or setting up more universal medical standards, at the risk of becoming stagnant?

I'm not drawing the universal health care => stagnant. Could you clarify what you mean?

Government currently funds or subsidizes a significant portion of research. Any currently private investment can easily be replaced with public funding for the same research.

Universal coverage does not mean that all doctors must practice exactly the same way and cannot innovate. It does not mean that potentially new health care treatments can't be implemented.

[Slacker]

Sounds like you need friends, boy.

My aunt, on her super awesome 100-200$ a week semi-consistent eldercare budget, flew to Belgium to have both of her hips replaced.

How did she do that, you ask? Well, people around the community know her, don't want her to suffer, so they chipped in.

In fact, that's how ALL MAJOR MEDICAL ISSUES have been handled in my family. Friends, family members, etc contribute.

Of course, if you're an asshole, and everyone hates you (such is my case) then maybe not so much..

That sounds like a great system. Old people go around the neighborhood with a cup, begging for hip-replacement money. It'll make good reality tv, too. Why did she fly to Belgium, though?

[thod]

If your pet dog has a problem you take it to the vet and decide what to do. Simple, low cost procedures would probably be paid for. There are no heart by-pass operations on dogs. The point about a national health care system is that you can decide what should be covered. Anyone could break or bone or cut the flesh. These are simple and cheap to fix and it is worthwhile to do so, much like a farmer takes care of his cows. Other things you have to say "well, looks like you are going to die".

Not everyone can make the choice of where to spend their money. You did not choose your parents and you had no money as a child. Suppose you were unlucky enough to fall from an apple tree breaking your leg and had poor parents. The state has a vested interest in setting the bone rather than having you grow up a cripple. A nation of cripples is not an efficient nation. Children do not have ANY choices.

[LaoTzu]

What?!

"looks like you are going to die?"

What sort of nightmare is this?

God, how bad IS your Government?

[Nemesis]

...and that brings up the issue of focus, does it make more sense to focus on groundbreaking new medicines/procedures, or setting up more universal medical standards, at the risk of becoming stagnant?

Not quite. Well... not at all.

Here in Canada, funding towards medical research is not lumped into the same funding pool as health care, so both systems are very well funded... and funded quite separately. Do not overestimate the role of the U.S in medical research and development, either. In fact, the lion's share of medical advances are made outside of the U.S.

[hubcap]

So let me get this right... you are predicating your anti-nationalized health care "argument" on the example of one guy going to the states for treatment!?
No, I am not predicating any argument based on this example. I was simply pointing out the irony of a man who lives in a nation with "free" healthcare who opts to come to the United States and pay out of his pocket for healthcare.

[themuzicman]

Healthcare is expensive as hell in the US because of gross profiteering on the part of pharmaceutical companies and medical device makers; not because stuff actually costs that much.

And profiteering is possible because no one cares what anything costs anymore because we don't pay for it directly.

This is the problem with being overinsured. And our overinsurance is induced by the federal government offering a HUGE tax break to businesses for overinsuring us.

Like any business hospitals pass on the cost to the customer/patient. The equation is further frakked up by the Wal-Mart style negotiating tactics that the insurance companies employ which allow them to be billed for fractions of what MSRP (or what Joe with no insurance off the street pays).

Insurance companies don't have this power. They have to pay "reasonable and customary", which is going up all the time, because we don't care what it costs.

The only organization that pays hospitals and doctors at a loss is the Federal Government.

If you want to eliminate profiteering, eliminate the huge tax break for offering overinsurance. Let Joe Middle Class pay for non-catastrophic care and pharmaceuticals. When we start caring what individual items cost, companies will charge less.

[Nemesis]

No, I am not predicating any argument based on this example. I was simply pointing out the irony of a man who lives in a nation with "free" healthcare who opts to come to the United States and pay out of his pocket for healthcare.

Ah, thank you for clarifying.

However, there is still the issue that was raised in the quote you used in the OP. It was explicitly stated that he went to the states to seek a specialist in the area of surgery that he required. This is not uncommon. In fact, Canadian specialists routinely treat American citizens seeking specific forms of treatment not available in the U.S. Can we then assume that they are showing a yearning for nationalized health care? Not at all. Not all surgeons/medical practitioners are created equal, and sometimes people have to travel to have their needs met... this has much less to do with health care policy than it does with finding the best treatment for yourself.

I very much like the health-care system up here and am happy to provide a small sum of my hard-earned cash into it, but if my specific needs could be better met elsewhere (and I had the means to afford it), I would book the flight without hesitation. However, I do understand the point you are trying to make, but this was a very poor choice of article to use to back up your position. As nacht pointed out, the system up here is not at all like the one being proposed down there, so at best, comparing the two is irrelevant.

[boldbidder]

If you want to eliminate profiteering, eliminate the huge tax break for offering overinsurance. Let Joe Middle Class pay for non-catastrophic care and pharmaceuticals. When we start caring what individual items cost, companies will charge less.

You're preaching to the quire. Just like getting work done on your vehicle, routine physicals, prenatal care, etc... shouldn't cost an arm and a leg. If I could get the same price that my insurance company is charged I would have zero problem paying for it out of my own pocket. My wife just had an ultrasound done a few weeks back and the cost to insurance was only about 1/4th of what it would have been if we had walked in off the street; therein lies the problem. Insurance should only be really needed for catastrophic events (car accidents, etc...).

Regarding the profiteering, I have first hand accounts of these practices in both the pharmaceutical and especially the medical devices industries. Shiite like slapping a certain logo on a low end Dell PC and labeling it as a "medical grade workstation" in tow with a 1000% mark up (not an exaggeration) is the kind of crap that needs to stop. Hospitals pass (or attempt to pass) that cost onto patients. If we eliminate such practices the cost of healthcare wouldn't balloon in the manner it is.

Oh, and for the record, regarding stuff being invented here. That's a great big ole crock of horse pucky. 85% of healthcare institutions in the US are using 20 year old tech. If you want state of the art technology then you should go to Bangalore.

[phej]

Regarding the profiteering, I have first hand accounts of these practices in both the pharmaceutical and especially the medical devices industries. Shiite like slapping a certain logo on a low end Dell PC and labeling it as a "medical grade workstation" in tow with a 1000% mark up (not an exaggeration) is the kind of crap that needs to stop. Hospitals pass (or attempt to pass) that cost onto patients. If we eliminate such practices the cost of healthcare wouldn't balloon in the manner it is.

Stupid question about the "medical grade workstation:" does it come with a super-beefy service contract to make sure that the machine is always working? I'd expect the 10x markup to include the service contract that includes the TCO. If not, then the hospital is wasting money.

[boldbidder]

Stupid question about the "medical grade workstation:" does it come with a super-beefy service contract to make sure that the machine is always working? I'd expect the 10x markup to include the service contract that includes the TCO. If not, then the hospital is wasting money.

General practice would be for the support contract to be a separate beast entirely. There'd be some professional services time included with the initial onsite support for installation, but any ongoing support would be extra and doesn't effect the hardware costs. Yes, hospitals waste TONS of money.

[hubcap]

However, I do understand the point you are trying to make, but this was a very poor choice of article to use to back up your position. As nacht pointed out, the system up here is not at all like the one being proposed down there, so at best, comparing the two is irrelevant.
Yes, I understand there are differences between the Canadian system and the system that is currently being discussed in the U.S. I wouldn't compare the two other than the fact that the man chose to pay for healthcare in the U.S. rather than get it for free at home.

[reb]

two semi-related stories, and a principle. principle first-if YOU do not participate in your healthcare, YOU are the problem, not the system.

1. got a new cpap machine. i saw on the invoice the insurance was paying 'rental by the month'. told the appliance salesman i was going to ask insurance 'why?'. have had a cpap for almost 15 years. last one lasted a decade. why would insurance pay $100 a month in perpetuity for a $1000 machine? (yes, it's MY money that pays into both the insurance, the taxes and the deductible, so i'm involved...whether anyone likes it or not). answer..it's 'rent to own'. when the purchase price is reached, the rental stops. asked the insurance lady 'is this so if i get a dud machine, you're not out the whole wad?'. she said she dint know...fine. i see the advantage.

2. listening to cnn (yes, some of you socialists, i do listen to your socialist network), Clark Howard put forth this website which supposedly helps you check medical prices:

pricedoc.com

i have not checked it out, but have a sticky on the screen to do so soon. if it's any good, i will be using it.

get involved in driving the train, or you're along for the ride....if we all get involved, then things will slowly change. otherwise, whine for me...i love the whining.

oh, and a VA story....when i went to work there several years ago, they had a pharmaceutical contract for 'short term' local issue meds. when i advertised the contract for renewal, i set up the prices to be 'list -', since the national contract was one of the cheapest prices available (i could not get the national prices for the local hospital, per the national administrator). i got ZERO bids. the pharmas stonewalled me. before the contract ran out, i had to negotiate their list prices and conform to the pharma companies system (forget the proper term for them, but there is jargon) in order to keep our short term veterans in their drugs. also caught hell from my management for advertising to get a better price in the first place. the embedded bureaucracy is the basic problem with all of the government i have dealt with.

[nacht]

i meant within the context of what the government pays for...insurance should be a private business matter, with almost no regulation, and no barriers to competition such as state lines

So in short, you support the government funding one of the least effective areas of medicine, but only for people who have a job, while completely ignoring pre-existing conditions?

[Tristan]

Healthcare is expensive as hell in the US because of gross profiteering on the part of pharmaceutical companies and medical device makers; not because stuff actually costs that much. Like any business hospitals pass on the cost to the customer/patient. The equation is further frakked up by the Wal-Mart style negotiating tactics that the insurance companies employ which allow them to be billed for fractions of what MSRP (or what Joe with no insurance off the street pays).

Let's examine this based on some consolidated information. Just the straight facts. I don't know many profit margins off the top of my head. I'm interested in finding out the degree to which profits are an element of the high cost of medicine, so this will be an educational process for me.


Industry Market Cap Net Profit Margin N.P.M. Rank
REIT - Healthcare Facilities $28.82B 36.3% #2
Healthcare Information Services $13.02B 19% #7
Drug Manufacturers - Major $950.39B 18.4% #8
Medical Instruments & Supplies $226.78B 8.2% #35
Drug Delivery $17.27B 8% #37
Medical Laboratories & Research $30.26B 7.1% #47
Home Health Care $7.07B 7% #51
Accident & Health Insurance $39.42B 5.6% #63
Drug Manufacturers - Minor $168.76B 4.7% #70
Medical Appliances & Equipment $136.51B 4.5% #71
Health Care Plans $109.73B 3.4% #85
Hospitals $15.02B 2.2% #102
Drugs Wholesale $71.99B 1.1% #118
Biotechnology $233.84B 0.3% #133
Drugs - Generic $10.96B -0.4% #143


Source: Yahoo! Finance

"REIT - Healthcare Facilities" are real estate investment trusts specifically aimed at hospitals. They buy the mortgages on hospitals' land. REITs' income is not taxed, which is important when considering the profit margin, because they distribute 90% of profits to shareholders. This leaves an operative profit margin of 3.6%, for them.

"Drug Manufacturers - Major" is Big Pharma. Its profit margin is very high, ranked #8 out of 200+ industries, but has a smaller margin than Publishing, Cigarettes, Agricultural Chemicals, and some other oddballs, none of which are presently accused of confiscatory profiteering. Nevertheless, at $950b, it is the biggest fish in the top twenty NPM's.

With Big Pharma's profit margin of 18.4%, medical supplies' profits of 8.2%, and medical hardwares' profits of 4.5%, I don't think there is a basis for saying that the high cost of drugs is due to profiteering. Hospital visits cost many times what they should, not a mere 18.4% more than what they should.

Insurers are the other primary political target in the health care debate. Their profit margin is 3.4%. The national average profit margin across all industries is 2.2%. Given the huge range of profit margins, these profits are hardly more than dead-on average.

We're all free to speculate on why health care costs are so high. An examination of the facts flatly challenges the common notion that profiteering is at fault, though. I don't have precise information about why they are this way, and although I have some guesses, this just isn't the right post to do guesswork.

[Grimstad]

Ever been to one? For the most part, VA hospitals are not at all acceptable. It is not acceptable that veterans get the treatment they usually do at VA hospitals.

(I will add that my view is based mainly on the two VA hospitals I had relatives attend in the past.)

I just thought I'd follow up with a discussion I had today. Working with a guy I've known for many years but never knew he was a Vet. He mentioned some recent trips to the VA so I asked him what he thought of it because I had recently been discussing it on line. He's very happy with it. Sure theres wait time's but IT'S FREE. He filed some kind of hardship thing due to lack of employment recently, so even his meds are 100% covered for now. All in all he's happy with it.

[boldbidder]

Let's examine this based on some consolidated information. Just the straight facts. I don't know many profit margins off the top of my head. I'm interested in finding out the degree to which profits are an element of the high cost of medicine, so this will be an educational process for me.


Industry Market Cap Net Profit Margin N.P.M. Rank
REIT - Healthcare Facilities $28.82B 36.3% #2
Healthcare Information Services $13.02B 19% #7
Drug Manufacturers - Major $950.39B 18.4% #8
Medical Instruments & Supplies $226.78B 8.2% #35
Drug Delivery $17.27B 8% #37
Medical Laboratories & Research $30.26B 7.1% #47
Home Health Care $7.07B 7% #51
Accident & Health Insurance $39.42B 5.6% #63
Drug Manufacturers - Minor $168.76B 4.7% #70
Medical Appliances & Equipment $136.51B 4.5% #71
Health Care Plans $109.73B 3.4% #85
Hospitals $15.02B 2.2% #102
Drugs Wholesale $71.99B 1.1% #118
Biotechnology $233.84B 0.3% #133
Drugs - Generic $10.96B -0.4% #143


Source: Yahoo! Finance

"REIT - Healthcare Facilities" are real estate investment trusts specifically aimed at hospitals. They buy the mortgages on hospitals' land. REITs' income is not taxed, which is important when considering the profit margin, because they distribute 90% of profits to shareholders. This leaves an operative profit margin of 3.6%, for them.

"Drug Manufacturers - Major" is Big Pharma. Its profit margin is very high, ranked #8 out of 200+ industries, but has a smaller margin than Publishing, Cigarettes, Agricultural Chemicals, and some other oddballs, none of which are presently accused of confiscatory profiteering. Nevertheless, at $950b, it is the biggest fish in the top twenty NPM's.

With Big Pharma's profit margin of 18.4%, medical supplies' profits of 8.2%, and medical hardwares' profits of 4.5%, I don't think there is a basis for saying that the high cost of drugs is due to profiteering. Hospital visits cost many times what they should, not a mere 18.4% more than what they should.

Insurers are the other primary political target in the health care debate. Their profit margin is 3.4%. The national average profit margin across all industries is 2.2%. Given the huge range of profit margins, these profits are hardly more than dead-on average.

We're all free to speculate on why health care costs are so high. An examination of the facts flatly challenges the common notion that profiteering is at fault, though. I don't have precise information about why they are this way, and although I have some guesses, this just isn't the right post to do guesswork.

No, it doesn't. Whether a hospital is successful as making money is the wrong part of the equation to be examining. You need to be looking at their equipment outlays and year-to-year basis and more importantly (not that the data would exist), what the margin is from those suppliers. The fact hospitals struggle to make money is actually more evidence of the profiteering at play because they are getting violated so badly that they struggle to make money. If their supply costs for hardware and software were much lower then profiting would be nearly the struggle that it is.

[Tristan]

No, it doesn't. Whether a hospital is successful as making money is the wrong part of the equation to be examining. You need to be looking at their equipment outlays and year-to-year basis and more importantly (not that the data would exist), what the margin is from those suppliers. The fact hospitals struggle to make money is actually more evidence of the profiteering at play because they are getting violated so badly that they struggle to make money. If their supply costs for hardware and software were much lower then profiting would be nearly the struggle that it is.

I posted all the stats. The medical hardware suppliers are in at 8.2% and 4.5%, and the IT for medicine, here labeled "Healthcare Information Services," is 19%. While I realize that these margins are relatively high, they are not the right order of magnitude to explain the high cost of health care.

Even though hospitals are paying out the ass for equipment, the suppliers do not seem to be profiting accordingly. But the sheer amount of business being done is massive. Look at the size of those three industries... thirteen billion, 227 billion, 136 billion. If I had to draw a stand-alone conclusion from that, it quite simply means that there is waste. Hospitals have to buy large amounts of equipment that does not necessarily yield a profit from its usage, but is probably employed in redundant/unnecessary/CYA medical procedures or even wasted outright. Hardware in any business is basically stored labor. Syringes and heart monitors are not fundamentally different from any other machines, in that regard. Labor costs capital, so if it does not spit more capital back, it is failing to justify its existence.

Anecdotally, this rampant waste was put on display for me recently. I went to get my toenail worked on. The doctor wanted me to get an X-ray. I told him I was paying for all work out-of-pocket, rather than using insurance. He changed tack at once, and said we could easily knock off the X-ray since it's not important to the procedure. Most people that walk into his office use their insurance. The insurer is pretty blind to individual cases, so it buys everyone X-rays and other expensive diagnostics for the most piddly stuff. Insurers are not the only thing at fault; there are government regulations, liability worries, and tons of free emergency care. These things generate a lot of waste. It raises prices to many times what they should be.

[Causa Mortis]

Was mulling this over today.

I think the problem with the current system is twofold:
1. Health care providers have a strong incentive to overtreat because of profits and defensive medicine.
2. Individuals do not have any incentive to economize on health care treatment to consider costs under most plans.

As a result, its really more of a pre-paid medical care treatment system than an insurance market where the providers have an incentive to provide more than is needed.

Resolving the second problem is fairly simple - a market system for insurance only (note: only unforseeable risks are insurable, meaning that the obese person who develops a heart problem on their own) resolves this problem - but it doesn't really represent the kind of society where I want to live.

But the first problem remains under a market system. I suppose you could argue that local knowledge would get rid of this issue - but I'm more inclined to think that imperfect information and time urgency problems (you don't have time to shop around during a heart attack) would still lead to overcharging and overtreating to persist.

So how do you design a system that maintains incentives for individuals to economize and for health care providers to perform necessary? Europeans have government ration treatment, and this seems to be more effective than our current system, however I'm not sure that its most optimal system.

[Warrior]

I don't have a problem with doctors making a profit. I wouldn't want to go to a doctor that didn't think his service was good enough to make a profit on.

I think the defensive medicine issue can be largely mitigated through legal changes malpratice lawsuites. In addition, I think giving individuals more incentive to take control of their own health care will help. Too many people go to a doctor and expect him to solve all their problems with a scan, pill, or surgery. When that doesn't happen, or when some complication occurs, lawsuites follow. The more proactive people are in their own healthcare, the less these things will occur.

[ya lyublyu tebya]

Specialists are specialists. It's not related to the country; it's just a coincidence where they end up. I've heard of Americans going to the UK for neurology specialists and Indians going to France for specialists in certain surgeries. There are people from all over the world who go to Thailand for their renowned sex-change operations. It's just who has the need and the money.

[DavidHasselhoff]

Maybe healthcare insurance should just be for major medical operations. I am just wondering what % of doctors visits are from temporary illness', that normally don't need anything more than prescriptions. These should be cash only, but possibly allow you to see a nurse or just call your doctor to save money and expedite the process. This will make doctors office visits for less identifiable illness', and treatment of young children and elderly.

[Lucid]

Maybe healthcare insurance should just be for major medical operations. I am just wondering what % of doctors visits are from temporary illness', that normally don't need anything more than prescriptions. These should be cash only, but possibly allow you to see a nurse or just call your doctor to save money and expedite the process. This will make doctors office visits for less identifiable illness', and treatment of young children and elderly.

As a relatively young person who went something like 7 years without insurance, going to the doctor and paying out of pocket cost me about $80 for the actual visit, $110 for any lab work and between $20 and $60 for prescription meds, depending on what was prescribed. So going to the doctor for strep throat could actually be pretty expensive, especially for someone making $25,000 or less, which I was. I'm not sure that your idea is a bad one, perhaps it would be cheaper to visit just a nurse, but it's the lab work that always killed me anyway, not the charge for the visit itself.

I think a two tiered system would be best. If you have the money for private insurance then you don't have to wait as long and get the extra x rays. But I think most people without that kind of money would rather wait, get acceptable treatment instead of Cadillac treatment and pay less. At least I would have.

[Cooper]

So if there isn't health care reform, please tell me who will help me pay for doctor bills, meds, etc. after I can no longer afford COBRA. I have pre-existing conditions, so no insurance for me. My sister had agressive breast cancer, no insurance for her, either. Same with one of my neighbors. Of the three of us, not a single one quaifies for Medicare or Medicaid. Two do not qualify for the VA. I do, but do you really want to know what that program does for vets? My father is dead because the VA was too slow to accecpt an application from him for help. You can't just walk in , show your DD 214 and BAM! here is your help. But, all of that is another thread. I would love it if someone on the Left, Right, or Teabag would tell me how to pay the medical bills, or where to get help for paying them, because without money or insurance the only place to go is the ER and that is not the answer. Doctors do not treat the uninsured and underfunded in their office. This country needs healthcare reform, period.

[Tristan]

So if there isn't health care reform, please tell me who will help me pay for doctor bills, meds, etc. after I can no longer afford COBRA. I have pre-existing conditions, so no insurance for me. My sister had agressive breast cancer, no insurance for her, either. Same with one of my neighbors. Of the three of us, not a single one quaifies for Medicare or Medicaid. Two do not qualify for the VA. I do, but do you really want to know what that program does for vets? My father is dead because the VA was too slow to accecpt an application from him for help. You can't just walk in , show your DD 214 and BAM! here is your help. But, all of that is another thread. I would love it if someone on the Left, Right, or Teabag would tell me how to pay the medical bills, or where to get help for paying them, because without money or insurance the only place to go is the ER and that is not the answer. Doctors do not treat the uninsured and underfunded in their office. This country needs healthcare reform, period.

You're not alone. Like the droves of people who cannot afford for insurance but also do not qualify for medicaid, so they simply don't get any care at all. These gaps are the arbitrary creations of systems. Like I said above, there is an incredible level of systemic waste. I think we should breach, and not expand, systems in order to make our problems less... well, "systemic." Suppose, for example, the AMA's grip on qualifying doctors had no teeth, and you could go see practitioners on the cheap who might not have MD degrees. Medicine is a guild now; you either see a top professional whose time is extremely expensive, or you see nobody at all. Or suppose you could buy a really cheap, high-deductible insurance package that didn't cover your routine needs, but only catastrophic illnesses. These two things have their own pitfalls, but I'd rather you had some choice. If there were larger systems, you might qualify to get on the dole. But if medicine were cheaper, you wouldn't even have to. If medicine were cheaper, you needn't wear this entitlement attitude of "Who's going to pay for my medical bills?" because in your position you should be able to pay your way through most of your problems. But if the system only permits the sale of health care which is too expensive for you, you cannot.

Fight the power.

[themuzicman]

As a relatively young person who went something like 7 years without insurance, going to the doctor and paying out of pocket cost me about $80 for the actual visit, $110 for any lab work and between $20 and $60 for prescription meds, depending on what was prescribed. So going to the doctor for strep throat could actually be pretty expensive, especially for someone making $25,000 or less, which I was. I'm not sure that your idea is a bad one, perhaps it would be cheaper to visit just a nurse, but it's the lab work that always killed me anyway, not the charge for the visit itself.

Insurance is ALWAYS more expensive than paying directly for it, given the odds. If you forced someone making $25K/year to have health insurance, they'd have LESS money for these expenses.

I think a two tiered system would be best. If you have the money for private insurance then you don't have to wait as long and get the extra x rays. But I think most people without that kind of money would rather wait, get acceptable treatment instead of Cadillac treatment and pay less. At least I would have.

If you look at how much a Cadillac plan costs, you'd think otherwise. The amount of money we waste sending it to insurance companies each year is absolutely insane.

if you want to curtail costs, stop giving employers incentives to shove every kind of benefit they can into medical benefits, which is done by repealing the huge tax break businesses get for doing just that.

When the middle class starts paying for non-catastrophic care, costs will come down fairly quickly.

[Lucid]

Insurance is ALWAYS more expensive than paying directly for it, given the odds. If you forced someone making $25K/year to have health insurance, they'd have LESS money for these expenses.

I agree. But if someone making $25K a year gets hit by a car and needs to have, for example, a metal rod put in their thigh to stabilize their femur, how are they to afford this?

If you look at how much a Cadillac plan costs, you'd think otherwise. The amount of money we waste sending it to insurance companies each year is absolutely insane.

Again, I agree.

When the middle class starts paying for non-catastrophic care, costs will come down fairly quickly.

And in the mean time, what am I to do when I have strep throat?

[Slacker]

I don't have a problem with doctors making a profit. I wouldn't want to go to a doctor that didn't think his service was good enough to make a profit on.

I have a problem with doctors being desperate to make a profit, because they are $x00,000 in debt after medical school. So every time I step into a doctor's office and hand over my insurance card, I feel like they're trying to smooth talk me into some procedure or test. As a result, I trust doctors about as much as I trust used car salesmen.

When the middle class starts paying for non-catastrophic care, costs will come down fairly quickly.

I wonder. The service that insurance (theoretically) offers is that they can poll a large sample of procedures and determine a reasonable price. As an individual who has already tipped his hand by going to a doctor, you are in a very weak bargaining position. You can't just step back out and wait a week until you can get an appointment elsewhere. Wouldn't it be reasonable to assume that they'll take you for all they can? It's only good business.

[Warrior]

I have a problem with doctors being desperate to make a profit, because they are $x00,000 in debt after medical school. So every time I step into a doctor's office and hand over my insurance card, I feel like they're trying to smooth talk me into some procedure or test. As a result, I trust doctors about as much as I trust used car salesmen.

I do agree with this, although I think defensive medicine is also largely to blame. I always have to have the talk with a new doctor where I explain that I'm in charge of my health care.

I wonder. The service that insurance (theoretically) offers is that they can poll a large sample of procedures and determine a reasonable price. As an individual who has already tipped his hand by going to a doctor, you are in a very weak bargaining position. You can't just step back out and wait a week until you can get an appointment elsewhere. Wouldn't it be reasonable to assume that they'll take you for all they can? It's only good business.

I do not find this to be the case. I now pay cash when I see a doctor. I have found several common costs to be lower than what my co-pay for the same thing used to be. (To be fair, my annual checkup costs more, but I also get a heck of a lot more out of it.) People willing to pay cash is a valuable thing to doctors. Much less paperwork for them, no waiting to get paid, generally (so I'm told) better informed and engaged patients. Shop around, especially to doctors that don't take insurance and only work on a cash basis. Many are willing to negotiate.

At any rate, it is never good business to take customers for all they are worth. Customers need to perceive value for what they pay. Health care isn't any different.