Is anyone talking about the cost of delivering health care?

[TheFarseer]

I hear the Republicans offering tax breaks to offset the costs and Democrats advocating the government paying more health care costs, but when are we going to address the real problem? It costs too much to deliver healthcare and no matter if individual patients or insurance companies or tax payers are paying for it, WE CAN'T AFFORD IT! I think this is where our focus should be. We pay more than any other country and we DO NOT have the best health care in the world, so it is clear we can cut costs somewhere. I think it is a failing of our "Santa Claus" government that they won't take this on. What does anyone else think?

[DaveJ]

1. Obama addressed that precisely in an early debate

I don't remember which one, but it really stuck with me, and I wondered if that approach would work politically with all healthcare jobs. But, to answer your question, yes, it's my understanding that's exactly what he plans to do.

[Selatius]

2. Single-payer health care would be cheaper simply because it does 2 things:

1. It achieves economies of scale by having a single non-profit pool represent everyone in the country. This entity that represents everybody would have tremendous bargaining power in terms of negotiating prescription drug prices and the cost of medical procedures.

2. This insurance entity, being non-profit, would not tack on a profit mark-up to the services it delivers. Private entities have a duty to deliver profits to shareholders. One way to do that is to cut costs, which means denying health care claims and people with "pre-existing medical conditions."

When I say, "cheaper," I mean on a per capita basis, which includes out-of-pocket costs as well as money paid out in the form of taxes. In France, they pay less than half on a per capita basis compared to the US, and the World Health Organization listed them as the world leader in terms of health care coverage according to their criteria.

[TheFarseer]

4. I'm not sure I agree with that

When the government is paying for it, what is the incentive to save money? I'm afraid it would be the prescription drug bill on a massive scale, where the actual cost far exceeds the quoted price. I'd like to see a whole laundry list of reforms before I can support government single payer.

[Selatius]

8. If by prescription drug bill you mean the Republican proposed reforms, it wouldn't be the same.

That "reform" was rigged so that Medicare couldn't negotiate prescription drug prices with pharmaceutical companies. The result was higher costs. That, and the Medicare Advantage program, which also resulted in higher costs than quoted.

The incentive to save money comes automatically from the desire to avoid running deficits. Once you have identified sources of revenue to fund France-style single-payer health insurance, it would be in everybody's interest that you negotiate a lower price for prescription drugs and medical procedures rather than simply paying what they quote you to save costs over the long-run.

However, given the budgetary realities of the federal government, we have major problems with cash flow as it is. It's not a popular statement, but we will likely have to concentrate on bringing back surpluses and propose a way to pay down the national debt before we address health care in this country.

[TheFarseer]

10. your last sentence

I agree with 100%

[Selatius]

11. Then you accept the possibility that we likely won't get any kind of health care reform for...

at least another decade or several. Am I reading you right?

[Cleita]

23. We won't as long as these guys are able to spread their

propaganda against meaningful health care reform. The blue prints are out there for workable health care reform, but these guys don't want it because it means the very lucrative for profit health care industry will have to go the way of the dodo so we can get true quality health care delivered to all citizens in this country.

[TheFarseer]

39. no, we can get health care reform

It just can't be the government picking up the whole tab.

[fasttense]

28. When the government is paying for it, what is the incentive to save money?

The incentive to save money is because our government, in the form of our tax dollars, is paying for it. When I use to handle a government budget the mantra to not waste our tax dollars was so often drummed into our heads that we did not need another reason to get the most bang for our bucks from the government budgets we handled. Only under the bushes did wasting government money become standard practice. True there were a few crooks but the auditors caught most of them.

Or are you implying that because it is less expensive everyone will go to the doctors for no apparent reason? Really, aside from a few people with mental illness do people really go to the doctors just for fun? Come on, are people that stupid? Is this a major problem in Canada, England or Germany? This is such a ridiculous argument I'm surprise people repeat it.

[Cleita]

32. Hear, hear!

:thumbsup:

[LeftishBrit]

37. Exactly!

In fact, the ONE real danger of a single-payer health care system is that, especially when there is a conservative government, there can be *too much* motivation for cutting costs, and health care can be run down. (E.g. in Britain under Thatcherism.) One has to guard against this danger, not the opposite one.

[PDJane]

3. The reason that it is so expensive there

Is that there is:

1. No cap on prescription prices.
2. Too many for-profit hospitals, clinics, and labs.
3. A system of advertising and promotion that is not allowed in a single-payer system.

The US spends, at last look, 2.8 trillion dollars per year on health care. At least 1/3 of that amount is spent trying to get someone to pay for the service! Malpractice insurance is outrageous. Why? Not because of predatory lawyers, but because the malpractice awards have to cover the damage, pain and suffering, lost time AND HEALTH CARE FOR THE REST OF THE PERSON'S LIFE, since they are uninsurable afterwards.

A single-payer system is more affordable, has a better chance of negotiating prices, and gives everyone a better chance.

[keep_it_real]

5. Reduce the defense budget

[Warpy]

6. Cost cutting is the wrong way to approach it

Clearly the cost cutting mania has gone about as far as it can, with substandard care being delivered even to the wealthy due to short staffing in hospitals and care being denied to the rest of us.

What we need to focus on is designing a system that will deliver good, basic care to all of us so that we don't have to live in fear of getting sick or injured, things completely outside our control.

We are getting sicker as a country every day the focus is so misplaced.

[Juche]

7. HR676 can save $400 billion a year

When you combine the lower overhead and bulk purchases of meds and equipment you can save $400 billion a year in healthcare. That alone is 20% of our healthcare spending.

The vast majority of medical costs go to a handful of chronic diseases. Something like 75% of the 2 trillion a year we spend. Type II diabetes, CVD, stroke, cancer, alzheimers, COPD, asthma, arthritis, mental illness, osteoperosis, parkinsons, etc. If we can figure out how to prevent those, cure them or treat them more cheaply that'll cut costs too. Basically, if you don't have a serious chronic illness, chances are you don't require too much healthcare aside from maintenance checkups and emergencies.

So the best way to cut costs IMO is to implement HR 676 or find some way to force insurers to cut overhead (I think they spend up to 30% on non-healthcare related issues), bulk purchases and cutting the costs of chronic illnesses by doing more work on raising awareness, R&D to find cures, prevention and finding better and cheaper treatments.

[WeCanWorkItOut]

9. True, we can't afford it. But Medicare is heading for big trouble too.

That means that single payer would not help us much.

Yet few politicians have chosen to intensively focus on this extremely
complex and difficult issue. (Who, if anyone, now that Hillary's out?)
So if we are going to cope with it before it gets much worse, it seems that
a lot of pressure will have to come from the ground up.
Thanks for taking it on.

Some other good people are worried too, even if the politicians are otherwise engaged.
For example, Peter Orszag, at the Congressional Budget Office, often blogs about health care costs. http://cboblog.cbo.gov/

On May 29,2008, for example, he explains that the rising cost of Medicare
is due more to rising costs per beneficiary than to rising numbers of people on Medicare.

[Cleita]

34. Medicare is headed for big trouble because our conservative government

of the past twenty years has underfunded it and semi-privatized it further draining funds into Wall Street, yet limping along as it does, it still does far superior job of delivering needed basic health care to senior citizens and those on disability than any insurance company out there that is affordable for the average American. I know, because I have been covered by both and only under Medicare have I found health care security.

[1]

12. my only fear, honestly...

if you take the millions of those not covered in any way by "insurance", and add the millions that are covered by "insurance" that don't go to doctor for fear of their rates going up (like auto insurance, whatever, you know...)



can the current medical system handle this? this incredible influx of new patients? wanting and needing care?



do any doctors, nurses, care-givers. etc. on DU have an opinion on this?

on how our current infrastructure could handle the increased volume?

[Cleita]

21. Be afraid...be very afraid!!!

All those unwashed people that need healthcare overloading the system. Dontcha know that health insurers don't want to take care of the sick which is why they insure the healthy? God forbid that their profits go for actual health care. Our infrastructure seems to be able to handle a war that is costing trillions. How much better would it be to end the war and spend for health care and education instead? I'll bet we can handle it just fine.

[tkmorris]

13. This sounds like a thinly veiled argument against reform

I'd like to hear what the OP proposes be done to deal with the health care situation.

[Cleita]

22. Yes, it is.

Looks like the general election is in full swing and all the operatives are coming on board to disembowl the Democratic platform. I'm waiting for the pro-lifers to arrive as well.

[TheFarseer]

29. We can do this

Get the excess litigation out of it. Computerize medical records so redundant tests are not run. We can also reduce the number of tests being run for fear of being sued just by reducing litigation. Also will cut costs for malpractice insurance. Deny all but lifesaving care to illegal immigrants. Cut out the frills for terminally ill - for instance no speech therapy for Alzheimer's patients and do not necessitate tags. Save the people we can save and let nature take its course on some. (Terri Schiovo anyone?) Do something about prescription drugs. This is a huge waste in my estimation to have people on expensive drugs with dubious benefits or with side effects that might outweigh the benefits. Other cost cutting is possible. The UK is already rationing care like this. Also, make sure people pay something everytime they go to the hospital or doctor - even if it's just a couple bucks. Smarter people than me have studied this problem. Do this and then see where we are or even do this in conjunction with instituting single payer. Just have the government pay for it is not an option. 20% of our budget goes just to service the debt. Your hands are tied when this is the case. Sorry this will not be popular around here.

[Cleita]

35. Smarter people have crunched the numbers and you will find

them at the Physicians for a National Health Plan website: http://www.pnhp.org.

They have come to the conclusion that the best and optimal way to deliver health care that will benefit both patients and health care providers is single payer universal coverage. Your position is not popular here because it's flawed, not well thought out, and reeks of talking points from the health insurance lobby.

[napi21]

14. There are a LOT of things that cause our hx to be as expensive as it is.

The ONE that buggs the hell out of me are the mandatory tests & xrays that aren't necessary in many instances. ie: 5 years ago I had the winter flu, but when the cough & feaver hadn't gone away after 3 weeks, I decided I probably had to go to the Dr. for some meds. He took my temp, BP, and listened to my breathing. I could tell by the look on his face he knew what was wrong, but instead of prescribing something, he sent me to an xray clinic. The following AM, his office called to tell me I had pneumonia, and they would call in a prescription to cure it. I KNOW that Dr. knew that while I was in his office, but insisted on that damn xray to CYA.

A close friend of mine is the Dir. of Accounting for a large Pgh. Pa. hospital conglomerate. I bitched to her about it, and she told me the malpractice insurance carriers REQUIRE Drs. to do that kind of stuff to eliminate all possibility of any lawsuits! THAT'S BS IMO! All it does is add to the costs of medical treatment. I have no problem with tests, xrays, MRI's etc. if they are really needed to diagnose a problem, but the CYA stuff is BS! My husband experienced a similar situation. He's taken Lipitor for over 12 years. One Dr. he went to insisted on blood tests every 3 months to make sure there were no adverse side effects. When we moved, the different Dr. he went to said the blood tests every 6 months is more than sufficient.

I think there's collusion in the medical community, partly to keep everybody making money!

[1]

15. oh, dear napi...

abandon your child like dreams that medical care is something that should be presented at the lowest cost possible.

the reason doctors do the "cya" tests and xrays and whatnot is to avoid the increasingly prevalent million dollar lawsuits that occur everyday.

doctors do the tests to ensure they are not sued out of business. these test occur because of our "sue them" philosophy that is the united states now. and you fault the doctors?


are you so simple to think that there are not many that are looking for a "lottery" payday that drive these tests and costs up? you blame doctors for making sure?

please...

[napi21]

30. If you re-read y post, you will see that I wasn't blaming the Drs.

for all the "unnecessary" testing, but blaming their ins. co. for forcing them to do so. YES, I know there are people looking for "lottery day", but I honestly don't think there are as many as you may think. Personally I would never sue for anything except the most extreme negligence, like removing the wrong leg, or transplanting a mismatched heart. I also can't completely blame the people who DO sue. I blame the many jurors who make the judgements. If the opportunities weren't there, lawyers wouldn't try to take advantage!

[Cleita]

33. Don't waste your time napi21.

This poster isn't interested in facts just in making national health care look like it's going to bankrupt the country because those scare tactics are the only way the for profit insurers and HMO's can keep their stranglehold on our health care.

[Cleita]

16. Obama says he can cut costs of health care.

Single payer universal health care or extending Medicare to all as set out in HR676 would deliver quality health care to all for half of what health care costs today, but Obama isn't promising that. However, the way our free market system is run today is far more expensive than anything Obama is offering. Please stop repeating talking points propagandized by the health care lobbyists who gave us this mess to begin with. A good place to inform yourself with facts is this website:

http://www.pnhp.org, the website for Physicians for a National Health Plan.

[1]

17. how exaclty does HR676 remove 50% of health care costs?

yeah, i understand redundant and complicated systems and all.

but a 50% return? 50% really?

explain that...

[Cleita]

18. Read the bill.

It promises to cut costs in half over a period of five years. Here's some references:

http://thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r.00676:

http://www.hr676.org/

[1]

19. i read the bill...

it promises to increase the amount of health care, and it's promised to everyone. health coverage from birth to death. it promises to eliminate "pre-existing conditions" from the mix, it promises to eliminate co-pays and deductibles, it promises to include dental and eye care, it promises mental health and substance abuse care, it promises long term nursing home care...


all good ideas. god bless and salute. but that shit is going to cost some serious money.



so. since you are the one that promised a 50% savings if hr676 gets passed, explain to me how you can add all of that health care benefit and do it for one half of the current cost?

and stop asking me to prove your argument. an argument that you refuse to address.

step up. tell us. or shut the fuck up...

[Cleita]

20. If you read it then you would see it spelled out under the financing.

If you read anything in the links I have provided you, you would see that. John Conyers provided the estimate on an interview when he proposed the bill a year or so ago. So you shut the fuck up. It's well known that our health care costs twice as much for less care and less coverage than most of the industrialized nations of the world with national health care costs including our neighbors to the north, Canada who spend less than $3,000 a year per person to our $6,500 a year per person. It's all spelled out in those websites particularly the Physicians for a National Health Care one, which covers about everything there is to know about the subject. So try reading about it first before you huff and puff at me.

[1]

24. really?

you are so positive and hopeful...

don't you think that if this were really possible that it wouldn't have been tried before? don't you think that if someone could have provided this health care at 50% before it would have been attempted? do you understand at all the concept of business. i know there is this concept of corporations, but the truth is businesses provide a service that people will flock to, not a price to screw everyone. not a price people run from.

do you really think a bill passed by congress is going to turn the entire health care industry to all of a sudden provide like 80% more of what they do now, and they will do it for 50% of what they used to charge? that makes sense in your world?


really?

sorry, you are foolish...

[Cleita]

25. Sorry buddy, but you just gave yourself away.

Health care is not a business. It has been run like a business in this country delivering profits to wall street at the expense of the ill and those who need health care. This is what has to stop and what health care reform is about. Every industrialized nation in the world delivers health care to their citizens on a need basis, not for profit except this nation and they are able to do it efficiently and for less than half the cost that we do. The stats are out there and there is no denying them. It's time for change. Go back to your insurance or HMO lobby or wherever you came from because your ideas are not welcome to progressive thinkers.

[1]

27. heh. i "gave myself away" because you can not explain your argument...

i've been trying to be nice here...


but cleita, it is time for you to step up and answer some questions. and fuck you and your "go read the links" bullshit. i read your links. i responded.

if you know what you are talking about then you can explain your argument to me.

i asked you how hr676 is going to save 50%.

you haven't said word shit about how that could happen. you just go with links.

fuck your links.




explain to me, cleita, in your own fucking words, how that is going to happen.



and that's the beauty part here. you can't.

[Cleita]

31. I have answered and you don't comprehend.

Our health care today costs twice and often more than what it does in every country in the world that has national health care. It's a documented fact backed by sources in the links I have given you. If we go to single payer universal health care, the cost of delivering health care in this country will drop to half of what we spend today. For profit health care uses 8% to 30% for administrative costs. Medicare uses 2% to 3% for administrative costs. Efficiency of setting fee schedules will also bring down costs. It's a mathematical fact if you can in fact do arithmetic. This is in my own words, but my words mean nothing. It's the experts who have studied and gathered the data in the links I gave you that have the facts.

You are right that I can't explain anything to you nor can anyone else because you won't listen and I'm suspicious it's because you will lose your job. If you want to go disrupt at other websites let me give you some pointers. Your posts done in small caps are commonly seen at conservative website message boards, but rarely in liberal ones because liberals really have a disdain for bad grammar, bad spelling and badly written English.

[supernova]

36. Why don't you explain to us

how the free market is going to solve all our problems with healthcare access and delivery.

Do, go on.

[Selatius]

38. It removes profit-taking from the notion of insurance.

As it stands, private health insurance companies have a fiduciary responsibility to enrich the shareholders. A way to boost profit margins is to fight health care claims from people who are sick and wish to levy a claim and deny care based on "pre-existing conditions." In the US system, health insurance entities tack on a profit mark-up to the services they provide.

With single-payer health insurance, France for example, the health insurance entity is non-profit, no profit mark-up on services. It exists first and foremost to cover everyone, not enrich shareholders. As a result, there isn't a fight between the patient and a health insurance corporation, which wastes time and resources.

Single-payer is also more efficient because it achieves economies of scale. Multiple health insurance companies, as with the US system, is fragmented, and as a result, economies of scale cannot be achieved, thus higher costs.

[sandnsea]

26. All hail the beloved market

Is that it?

If private enterprise can deliver a good or service for the same price as the govt - then why is college more expensive at private schools.

Removing profit, in itself, would reduce costs. Why would Republicans try it when they're making so much money not trying it?

[Postman]

40. How 'bout cutting the war budget in half by a hundred-gazillion dollars?

n/t