The Healthcare Debate, 1961

[vf-xx]

I'm curious:

For all this debate, what are ya'll DOING about it?

[Lohman446]

I'm curious:

For all this debate, what are ya'll DOING about it?

Converting my dollars to Euros (not really, not yet). Personally, I do demand reasonable prices from my doctors, and only carry a catastrophic policy.

[Shirow]

I'm curious:

For all this debate, what are ya'll DOING about it?

Me? Nothing. I'm not a citizen so I can't vote. I'm also perfectly fine with healthcare personally - I have a great policy, I don't pay much for it and the standard of care my family gets is great. While I believe that everyone is entitled to good care, I'm not politically motivated enough to get terribly involved in enacting change.

I would point out that the money your employer is paying for health coverage is money that could be going directly to you. I beleive that you are responsible enough with your money to put it where it needs to be. I trust you to do what is right and needed. I trust you to make the right choices for you and your family. See the recurring theme here. Similarly I trust me to decide where I want to give my money should I want to help out others. I do not trust the government to do either of these things efficiently for me or you.

I'd never take the money my employer pays over the health coverage I get. Imagine if my wife gets breast cancer and I have to pay out of pocket for all her treatment. Right now, she would probably die or I'd be completely financially ruined (or both!). Even if I had coverage for everything 10K+, I'm not sure I could pay to cover all the <10k treatments.

If everyone paid as they went, there would be a lot less preventative medicine going on than there is today and I think healthcare costs would probably go up, not down since all the procedures would be major ones and there wouldn't be enough small visit/procedure income to cover the doctors needed.

But on that point, I think all we can do is agree to disagree, since it's largely speculative - I can't think of a developed country with a pay as you go system to reference.

[Shirow]

And let me end with a funny picture:

[drg]

However, if prices were reasonable, individuals could afford it.

Think of it this way. What if we simply only allowed catastrophic insurance - from either private or government. Nothing under 10K is covered.

The $300 office visit would have to be justified. The $3000 an hour operating room, would have to be justified. Consumer choice and consumer control of spending generally works to keep prices in check. Take it out of consumer hands, put it in insurance companies hands and government handouts and costs become unchecked.

I really hate to bump this thread up after so long, but I saw this study today and remembered that you had been a proponent of this seemingly counterintuitive strategy.

http://blogs.wsj.com/health/2010/01/27/study-higher-co-pays-mean-more-trips-to-the-hospital/

Turns out, what sounds like a bad idea is, in fact, a bad idea. Raise copays and preventive care drops, costing more in the long run. Your proposal would have a devastating effect on health and healthcarecare in this country.

[grEnAlEins]

And with sampling and selection biases like that NEJoM study sited in that article, who could argue

You cannot site a study that primarily examined medicare participants and pretend that it has implications system wide. This was also a very short term study of people who are not used to having to be semi self sufficient, so of course they will be apprehensive and attempt to evade new financial responsibilities by avoiding the cause due to this "responsibility shock". Additionally, the full "conservative strategy" was not implemented here. It was implemented in a controlled market. If we still had a truly free market, doctors would lower costs to increase the volume of visits, and that is the desired outcome. For this to work the change would need to go system wide. It is really a moot point, as this will never happen in the US.

How about you post a study that does not only sample medicare patients, and does not eliminate most of those via the selection process.

[Lohman446]

"if you can buy health insurance for $150 a month" is a straw argument. Show me where you can get comprehensive coverage that covers preexisting conditions for that? Even the 8K the government is claiming is over $650 a month - interestingly enough it works at to $666 a month.

DRG - my issue again is that we have let the system get out of hand. $300 office visits are ridiculous. You would not except the lack of service (and lack of quality) while paying those prices in anything but healthcare. Why do we in health care? How do we check these abuses (look up the cost to have child (no complications) in 1950 vs today) that basically are the system now? Since I don't like government interference (I beleive that freedom also carries responsibilities) I am more accepting of consumer control. Yes we have to provide for the poorest (as we already do, I think this point is missed), but we also have to consider that health care costs are unreasonably high - also check our costs per capita vs any other country, we far exceed and yet do not have better care.

[Ando]

Just look at the countries that already have this type of system installed. Is it working....No!

Germany's health care system is FUBAR'ed.

[Coralis]

Just look at the countries that already have this type of system installed. Is it working....No!

Germany's health care system is FUBAR'ed.

Ours isnt much better one situation that requires a hospital stay is a huge expense unless you happen to have VERY GOOD insurance policy (that more then likely costs you and/or your employer a ton of money.

[Lohman446]

This is the issue I have:

This office visit was $300 please pay it:

The person paying directly asks why, expects quality, and if does not receive it seeks treatment elsewhere. Because of this competition creates better prices and better quality.

The person who can says "oh, well let someone else pay it for me" and doesn't care if it takes 10 more to have satisfaction.

The problem we don't seem to see is that we can't all just let someone else pay for it. That eventually comes back to all of us.

Take a common surgery (pick one). Check the complexity of open surgery, the risks involved, the time involved, and the recovery time (in hospital) and the cost in 1950 (1960, 1970) Take the same surgery today. Chances are technology will have made the surgery far less complex, with far less risks, far less time to do and far less recovery time. You will also find it far more expensive to the order of magnitudes. Then, for kicks, compare the costs to income of the itme

"But technology costs money". Yeh, to some degree. A color tube television then (I think 32" was considered huge) was also like $800. You can get flat screen LCD for the same price. Needless to say $800 in 1950 had a whole lot more buying power than $800 today. Generally increases in technology make things less expensive over time. And recall I did say common surgery, those that are performed all the time, those which are not using the cutting edge technology - frankly those that are using technology and procedures developed decade(s) ago.