The Health Care Crisis and What to Do About It .... Paul Krugman

[RedEarth]

Thirteen years ago Bill Clinton became president partly because he promised to do something about rising health care costs. Although Clinton's chances of reforming the US health care system looked quite good at first, the effort soon ran aground. Since then a combination of factors—the unwillingness of other politicians to confront the insurance and other lobbies that so successfully frustrated the Clinton effort, a temporary remission in the growth of health care spending as HMOs briefly managed to limit cost increases, and the general distraction of a nation focused first on the gloriousness of getting rich, then on terrorism—have kept health care off the top of the agenda.

But medical costs are once again rising rapidly, forcing health care back into political prominence. Indeed, the problem of medical costs is so pervasive that it underlies three quite different policy crises. First is the increasingly rapid unraveling of employer- based health insurance. Second is the plight of Medicaid, an increasingly crucial program that is under both fiscal and political attack. Third is the long-term problem of the federal government's solvency, which is, as we'll explain, largely a problem of health care costs.

.........

If US politicians could be persuaded of the advantages of a public health insurance system, the next step would be to convince them of the virtues, in at least some cases, of honest-to-God socialized medicine, in which government employees provide the care as well as the money. Exhibit A for the advantages of government provision is the Veterans' Administration, which runs its own hospitals and clinics, and provides some of the best-quality health care in America at far lower cost than the private sector. How does the VA do it? It turns out that there are many advantages to having a single health care organization provide individuals with what amounts to lifetime care. For example, the VA has taken the lead in introducing electronic medical records, which it can do far more easily than a private hospital chain because its patients stay with it for decades. The VA also invests heavily and systematically in preventive care, because unlike private health care providers it can expect to realize financial benefits from measures that keep its clients out of the hospital.

In summary, then, the obvious way to make the US health care system more efficient is to make it more like the systems of other advanced countries, and more like the most efficient parts of our own system. That means a shift from private insurance to public insurance, and greater government involvement in the provision of health care—if not publicly run hospitals and clinics, at least a much larger government role in creating integrated record-keeping and quality control. Such a system would probably allow individuals to purchase additional medical care, as they can in Britain (although not in Canada). But the core of the system would be government insurance—"Medicare for all," as Ted Kennedy puts it.



much more.........

http://www.nybooks.com/articles/18802

[Warpy]

1. He's right

The insurance industry has to be eliminated from the system. Period. Their business is making a profit and their focus is denying as much care as they can in order to maximize the profit.

Hospitals often own for profit insurance plans. Their focus is cutting costs so that plan can turn a profit, and that means slashing staff and degrading care.

National health wouldn't have bottomless pockets, though, and there will always be people who think they can snap their fingers and get concierge care who will be dissatisfied. However, given the horrible state of care in this country today (http://www.msnbc.msn.com/id/11842861/) we can't do any worse delivering national health insurance to 100% of us.

The alternative is having the system fall apart completely and become a system that only the very rich can access. Right now, people are going bankrupt due to copays alone, even with insurance. That is too much to ask for such piss poor care.

[Phoebe Loosinhouse]

2. In order to finance a public health care system

I suggest a dedicated US Savings Bond program where the proceeds go directly to fund a public health-care system. What's not to love?
Taxpayers funding something directly that they care about and want, plus promoting the savings rate which is horrible in this country, plus they are saving real dollars towards their retirement. What if we had an automatic payroll savings plan at work everywhere were these health bonds were purchased with pre-tax dollars just like a 401K? I think this idea is much better than the health savings account program which almost no one seems to understand or use.

[MockSwede]

4. Save the Bonds - Would not cost MORE

Costs to run (administration) of state Medicaid plans is about 1% - costs 1 cent overhead to deliver 1 dollar in care.

'Not-for-profit' and 'non-profit' and for-profit insurance companies charge other groups anywhere from 25 to 35 cents to administer plans delivering that same 1 dollar of care.

So you can save 25% off the top or have 25% better covereage or have 25% more people covered by switching to universal insurance mimicking Medicaid or VA type programs.

And they would be accountable to the citizenry since they would receive their funding out of taxes and we'd vote in or vote out the folks that would select the directors and administrators, etc, that run these programs now.

Who wudda thunk?!

[BootinUp]

3. Thanks for posting it, very informative. n/t

[Denver Dave]

5. Access to Health Care Discussion

There are lots of people that feel passionately that everyone should have access to at least basic health care. Unfortunately, others seem more interested in profits than coverage. Let's share ideas, information and that is going on in other areas. I think you might find the Massachusetts discussion interesting (Let's insure profits not health care): www.HCTalk.com - please join in and share your experience and ideas.