Posted on 05/29/2008 12:24:14 AM PDT by B-Chan
I don’t have an answer but I do know part of the solution will be to recouple the costs to those who receive the care. I can’t tell you how many of my patient DO NOT CARE what the cost of a test or treatment is since they DON’T pay for it. Either their boss or insurance or the government or the hospital eats the cost. THATS got to change.
Thanks for the input.
How would a patient know what their care costs? Is there a list of prices? Is the price even the same for everyone? The answers, of course, are no and no.
IBM (my employer) has started to do just what you suggest. I now pay a percentage of the cost of care rather than the traditional copay. The problem is I can’t shop around or decide if I even want to buy a service because no one will tell me the price of anything.
There is no reason that prices couldn’t be available for all to see. Of course everyone including Uncle Sam should be paying the same for the same service.
I have a link to a movie from the NL ministry explaining&advertising the whole thing: http://www.minvws.nl/en/themes/health-insurance-system/the-new-health-care-system-in-the-Netherlands-video/
Actually to use the example of an uninsured service, laser vision correction, prices have gone way down at the same time that demand and quality have gone way up. The market works when third party payers are removed.
Well, I’m originally from Vancouver, BC, Canada and now work/reside in L.A.
You want socialized medicine? Prep yourself to wait WEEKS for a simple MRI (as an example) and this actually happened to my aunt. Well, I;m too tired to type but there are countless examples of what happened to me as well.
The illegals in L.A. have a program called ORSA, where as long as you don;t have any insurance, and don;t work (well, they’re illegal, right?) you’re home free.
Knew about this the hard way when I went for a flu shot at Mid valley in van Nuys, when almost nobody spoke English.
Very good analysis. I appreciate the historical background - which seems well though out.
Looking at some other country’s systems, it should be noted that one of the biggest myths is that European systems “ration” healthcare and that America’s system must be the best because so many people travel overseas to receive state-of-the-art treatment.
The measurement for a “good” healthcare system however is best done by focusing on the macro-economics. That means Percentage of GDP in cost versus percentage of population covered and the life-expectancy of the population. In other words, what results are achieved for the money spent.
The US spends more of GDP than any country (16% compared to Germany at 13%) and covers only 85-95% of the population compared to 100% covered. The US life expectancy is also 3-5 years lower.
By most measures in touch with reality that is not the “best” system.
The German system combines a requirement for basic coverage as well as an option for private coverage. The private costs more and brings more and better services. But, the basic is fine as well. Thus, the “rationing” is done in so far as everyone gets at least a portion and those who care to purchase more are welcome to do so.(By the way Germany also has more doctors per capita than the US and they don’t get paid quite so much).
However, you cannot sue your doctor for everything and anything. The tort system in Germany does not allow it. Doctors don’t make more mistakes as a result, it is just that the whole system is cheaper. The lawyers are not quite as rich though (I feel bad for them because they only have small yachts).
The “best” system myth is not fully untrue. The US has the best UNVERSITY system in the world. Since cutting edge medicine is essentially cutting edge science and education, that university system creates the best innovations in medicine which attracts wealthy people with exotic problems. Reforming health care will not change the university system.
But, health care will not be reformed properly in the US. It requires a grand political bargain that no politician has an interest in making. The GOP would have to sell out the pharmaceutical companies and HMOs. The DEMs would have to sell out the Trial Lawyers. Only then could a funcitoning system be put into place. Since this compromise will not happen (only the GOP could have made it when they were in power), the DEMs will shove down a disfunctional system that is costly and terrible. Then the cycle will begin again.
Have fun.
There are enormous demographic differences between Germany and the US that make such comparisons meaningless.
Now we just have to make it happen.
For instance that Germany has an older population?
You throw a statement out there without really giving me evidence.
I will make you a bet: just take the American population of German decent and I will bet whatever you want that the German system is still cheaper and better.
You can even keep the Turks and other immigrants in the system in Germany if you like.
Costs to the Medicare recipient is not cheap.
My part A costs me right at $100/month, taken out of my SS check. That takes care of 80% of my medical bills. The remaining 20% can be covered by private insurance for an additional $50 (I think). That is $1800 for one person, even if they did not see a doctor all year.
When I was working (not too long ago), My employer and I together never paid $1800 total for just my medical care. (I did, however, pay more when I added my family to the insurance.)
Veterans medical care, once the vet reaches age 65, comes right out of the limited Medicare budget.
I do not have an answer to the medical cost problems, but from personal experience, I can say that not all Medicare recipients are on the public dole. Veterans, military, and a significant number of seniors are paying their way up to the limit the government will allow them to pay.
Private industry is getting out of the medical care business by letting their employees go into the medicare system at age 65.
......Bob
Our life expectancy is dragged down by 1) too many fat people, 2) disease-ridden illegal immigrants, 3) high rates of drug abuse, and 4) very premature/defective babies who are counted as "stillborn" in other countries' statistics, and "born alive, died in infancy" in ours. It is wrong to blame it on a poor health care system.
-ccm
Thanks.
1. clearly true.
2. how can illegals affect the stats of legals?
3. not sure about this. Europeans take lots of drugs too.
4. interesting. I never heard that one.
The USA has 12% African-American population. They have an average life expectancy years less than “whites” which includes Hispanics.
http://www.infoplease.com/ipa/A0005148.html
BTW, Germany’s life expectancy is 78.95 while the USA’s is 78.06. Hardly an overwhelming difference.
Agreed, but Germany spend 3% of GDP LESS per year. If the US were getting better results that would be another story. But Germany spends less.
Moreover, Turks don't live as long as Germans, so there is a fairly good counter-weight.
Lastly, do African Americans live shorter lives due to genetics or are the other factors at work that have to do with their particular American way of life?
I don’t have much current familiarity with our civilian health care system. I’ve used the military system since 1965
On a Friday night I broke my wrist in an accident up in Richmond and saw a doctor at the emergency room. He was suppose to a great orthopedist - he even taught at the local medical collage. After my wrist was X-rayed he put the cast on himself. I was surprised he didn’t have an orderly do it. It still hurt. I’m no doctor, but have a lot of experience with broken bones. I’ve never had one still hurt bad after being set and cast. As I stood to leave he handed me his card and told me I’d have to come back once a week so he could treat it.
On Monday morning I went on sick call. It was X-rayed. The Colonel went off and asked me who the idiot was who treated me. He told an orderly how to set and cast it. The private told me to make like I was holding a beer can and quickly had it recast. The pain went away.
I still think the doc in Richmond was looking for repeat business.
My other experience was when my wife had torn tendons in her knee. The orthopedist was supposed to be one of the best in the business. He gave her a brace and orders to come back in a week. Again, I’m no doctor - but I do have experience. Every week for a month he bent her leg, said it would soon heal and sent us home. I couldn’t handle her tears of pain - and Sheryl was a stoic woman. I finally mentioned to his nurse that I was getting mad and might lose it and beat the snot out of the doc if he didn’t do something. She ran to the doc, he came back and told us he’d set her up for surgery that afternoon.
After surgery he apologized to us and told me it was torn tendons.
In the military medical system doctors get paid the same no matter how many people they treat. If they do it right the first time their workload is reduced. No so with civilians.
So much for my rant.
Let patients shop for doctors and drugs.
Establish a fair price co-pay and if the patient can find a less expensive medical provider, or drugs at a lower price, then share the savings with the patient. Right now there is no incentive to shop or bargain. Whatever it costs, the system pays and the consumer only receives the healthcare itself without regard to price. If the patient had a monetary incentive to fight for lower costs then the costs will go down. Also, make it harder to sue for nuisance malpractice.
Another thing, the AMA should be broken up as a labor/trade monopoly.
Get the government out. Abolish the FDA.
A riotous politically free market would crash prices.
What you would see.
Wall Mart selling drugs.
Sales Days.
Loss leaders offered.
0 percent financing.
Shuttered hospitals.
McDonlaized care for common and popular procedures.
Vast increases in innovation and the speed of innovations.
Losts of scoundrels taking advantage of the stupid( Our present system depends upon scoundrels entering government).
Lots of procedures only done at a few centers.
As it is now, any change into a politically free medical market would cause a post-Soviet type meltdown as our ‘system’ is presently 80 percent socialism.
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