Health care vote

[livinincali]

[quote=ocrenter][quote=harvey]If efficiencies and cost savings led to recessions then most of economic history would have been a recession.[/quote]

Health care doesn’t lend itself to unbridled free market forces. It is beyond easy to scare the client into doing a whole bunch of expensive and worthless treatments and procedures. In fact, client expectation is the expensive stuff. Efficiency can only come about from single payer forcing discipline in cost control.[/quote]

Free markets could solve a lot but not all of the cost side. For example allowing somehow to open an MRI imaging facility assuming they hired the necessary licensed personal would lower the cost of MRIs but Certificate of Need licensing prevents that from happening. Forcing medical providers to post prices would allow customers to shop around.

Forcing medical providers to eat the costs of their own mistakes would help. I.e. if I elect to have knee surgery for an aching knee if I get an infection while under the care of said hospital they would eat the cost of treating the infection and extra days in the hospital but instead they currently get to charge people for that.

Allowing a business that is licensed to purchase drugs in India or somewhere else where the drug company sets them much lower and re-import them here would drastically lower the price of drugs here. These are all free market forces that would lower the cost of health care here.

Forcing health care providers to post prices and always charge that price would effectively lower health care costs. If you want Medicare patients you bill everybody the Medicare price or you choose not to have any medicare patients. If you can’t make if with the medicare patients or without them because you have a lot of debt or outlays you go out of business and somebody buys your assets for pennies on the dollar and can make a profit at the medicare rates.

All of those free market forces would work to lower health care costs. Single payer is just an alternative to that and one that’s likely less efficient. It would probably work and it might involve slightly less disruption.

In the end though Health Care revenue is a component of GDP. If you lower the cost of health care you’ve lower health care revenue and GDP. By definition lower GDP means we’re in recession. Health care primarily is a service provided by people. If you materially reduce health care costs you are most certainly are either laying people off or reducing their salaries by a material amount. This is math not theory.

[Anonymous]

[quote=livinincali]This is math not theory.[/quote]

Math based on some very big assumptions.

The IT industry has seen massive cost reductions and improvements in efficiency over decades. Have advancements in technology caused any recessions?

We actually have multiple healthcare systems in the US. The biggest of those systems, Medicare, is single payer. And it’s the most efficient.

The argument that we shouldn’t improve something that is obviously very broken because any improvements could theoretically cause a recession is a terrible way to approach policy.

[SK in CV]

[quote=Harvey]The argument that we shouldn’t improve something that is obviously very broken because any improvements could theoretically cause a recession is a terrible way to approach policy.[/quote]

It can “theoretically cause a recession” only by using “theory” the way evolution deniers say “it’s only a theory”. There is no economic model that shows a recession is a possibility, much less a likelihood.

[FlyerInHi]

I think that VA is the most efficient.

Service members, retirees and family could go to VA or private insurance/providers if they have other insurance.

[ocrenter]

[quote=livinincali]

Free markets could solve a lot but not all of the cost side. For example allowing somehow to open an MRI imaging facility assuming they hired the necessary licensed personal would lower the cost of MRIs but Certificate of Need licensing prevents that from happening. Forcing medical providers to post prices would allow customers to shop around.

[/quote]

MRI would be a bad example. You got to realize the amount of incidental findings from a single MRI can generate so much more follow up MRIs or potential unnecessary procedures and surgeries. So to suggest that we reduce the threshold for MRI imaging and lower the barrier to an MRI will increase cost, not lower it.

Assuming that $1000 cost (it can be much more, $4000 sometimes), and assuming you allow the cost to go down to $500. Now you are making MRI a standard practice for ALL knee pains. the cost to the system would explode.

[quote=livinincali]

Forcing medical providers to eat the costs of their own mistakes would help. I.e. if I elect to have knee surgery for an aching knee if I get an infection while under the care of said hospital they would eat the cost of treating the infection and extra days in the hospital but instead they currently get to charge people for that.

[/quote]

I know someone who went in for spine surgery for chronic back pain, came out of the surgery as a paraplegic. The medical group that did this is absorbing all future cost related to his new paraplegic status. This is already being done. This is not the reason why cost is high.

[quote=livinincali]

Allowing a business that is licensed to purchase drugs in India or somewhere else where the drug company sets them much lower and re-import them here would drastically lower the price of drugs here. These are all free market forces that would lower the cost of health care here.

[/quote]

Big Pharma is blocking this for the obvious reason. And Big Pharma is in bed with congress.

[quote=livinincali]

Forcing health care providers to post prices and always charge that price would effectively lower health care costs. If you want Medicare patients you bill everybody the Medicare price or you choose not to have any medicare patients. If you can’t make if with the medicare patients or without them because you have a lot of debt or outlays you go out of business and somebody buys your assets for pennies on the dollar and can make a profit at the medicare rates.

[/quote]

Not if you are not paying for it. Who cares about the price printed and listed if you don’t actually have to pay for it in person.

This would only work if you move away from insurance and change to a full fee for service system.

[quote=livinincali]

All of those free market forces would work to lower health care costs. Single payer is just an alternative to that and one that’s likely less efficient. It would probably work and it might involve slightly less disruption.

In the end though Health Care revenue is a component of GDP. If you lower the cost of health care you’ve lower health care revenue and GDP. By definition lower GDP means we’re in recession. Health care primarily is a service provided by people. If you materially reduce health care costs you are most certainly are either laying people off or reducing their salaries by a material amount. This is math not theory.[/quote]

You do realize you have a huge black hole known as the ER. Where people not covered and not able to afford fee for service will simply allow whatever that ills them to worsen until it becomes bad enough to be life-threatening and thereby the ER can not turn them away.

China runs a very good free market health care system. But they allow people that can’t pay for the ER to die outside the doors.

That is a key ingredient in a successful free market health care system.

[ocrenter]

[quote=FlyerInHi]I think that VA is the most efficient.

Service members, retirees and family could go to VA or private insurance/providers if they have other insurance.[/quote]

you are kidding right?

btw, single payer does not mean the VA.

single payer means more like multiple competing entities like Kaiser and Scripps and Sharp.

[livinincali]

[quote=SK in CV][quote=Harvey]The argument that we shouldn’t improve something that is obviously very broken because any improvements could theoretically cause a recession is a terrible way to approach policy.[/quote]

It can “theoretically cause a recession” only by using “theory” the way evolution deniers say “it’s only a theory”. There is no economic model that shows a recession is a possibility, much less a likelihood.[/quote]

What are you talking about. A recession is a reduction of GDP by definition. Health care spending is included in the measurement of GDP. If GDP is 15 trillion and health care is 3 trillion of that then reducing health care spending by 1 trillion reduces GDP by 1 trillion. Therefore you have a recession by definition. Now that recession might be short lived once the economy reallocates itself but it most certainly will take some time for the economy to reallocate itself. Even if you do some sort of phase in to single payer the insurance companies and others effected are going to immediately respond by laying off as many people as they possibly can before the policies go fully into effect.

I’m not saying you won’t be better off in the end but as a politician you could lose a election cycle or two until things stabilize again. I’m also saying to don’t see how you can materially change health care spending without causing a recession just because of the way the math works.

[livinincali]

[quote=ocrenter]
You do realize you have a huge black hole known as the ER. Where people not covered and not able to afford fee for service will simply allow whatever that ills them to worsen until it becomes bad enough to be life-threatening and thereby the ER can not turn them away.

China runs a very good free market health care system. But they allow people that can’t pay for the ER to die outside the doors.

That is a key ingredient in a successful free market health care system.[/quote]

I’m not saying free market system don’t have their consequences. Every system has in consequences to various degrees. In very socialized system you wait a long time for elective procedures or you don’t get them at all. In other system you die if you can’t pay and charity refuses to save you. In our system everyone gets treated and almost everyone has access to the latest and best procedures but at a tremendous cost.

Our system’s biggest problem is it doesn’t allow for free market forces to force competition and drive down costs. At the same time is also has no regulations in place to prevent costs from rising. Every country in the world has decided to either make health care a utility that’s tightly controlled or allowed bad outcomes for some based on free market forces. Neither is perfect but they are more efficient than our current system.

The bottom line is our medical system has a lot of people being paid by health care spending that aren’t actually providing care. There’s excessive overhead in our health care spending. Free market systems prevent excessive overhead to the cost of providing care by competition. Tightly regulated system prevent excessive overhead by strictly regulating everything. We don’t do either so we have millions of paper pushers being paid by health care spending from insurance agent, to billing coders, to various administrative departments and boards.

[SK in CV]

[quote=ocrenter][quote=FlyerInHi]I think that VA is the most efficient.

Service members, retirees and family could go to VA or private insurance/providers if they have other insurance.[/quote]

you are kidding right?

btw, single payer does not mean the VA.

single payer means more like multiple competing entities like Kaiser and Scripps and Sharp.[/quote]

Actually the VA is more like single payer. (though I too question whether it’s been a very successful model.) I think a more likely model would be medicare for all, where medicare is everyone’s primary insurance. Kaiser, Sharp, and Scripps are providers, so they don’t have anything to do with what defines single payer.

[SK in CV]

[quote=livinincali]
What are you talking about. A recession is a reduction of GDP by definition. Health care spending is included in the measurement of GDP. If GDP is 15 trillion and health care is 3 trillion of that then reducing health care spending by 1 trillion reduces GDP by 1 trillion. Therefore you have a recession by definition. Now that recession might be short lived once the economy reallocates itself but it most certainly will take some time for the economy to reallocate itself. [/quote]

You are assuming that single payer will reduce GDP. Any economic model (or any evidence at all) that this will happen? I think there is no evidence that insuring 20 million additional people will reduce GDP, even if healthcare spending per person declines. Other than profit made by private insurance companies, private hospitals and pharma companies, I doubt there will be any hit to the economy. To the contrary, it would be beneficial to much of the economy.

[Anonymous]

[quote=livinincali]Health care spending is included in the measurement of GDP. If GDP is 15 trillion and health care is 3 trillion of that then reducing health care spending by 1 trillion reduces GDP by 1 trillion.[/quote]

You do understand that government spending is included in GDP?

Why would a third of total healthcare spending just disappear simply because the government is paying the bill instead of insurance companies or private consumers?

Where does this trillion dollars in economic activity go?

[ocrenter]

[quote=SK in CV][quote=ocrenter][quote=FlyerInHi]I think that VA is the most efficient.

Service members, retirees and family could go to VA or private insurance/providers if they have other insurance.[/quote]

you are kidding right?

btw, single payer does not mean the VA.

single payer means more like multiple competing entities like Kaiser and Scripps and Sharp.[/quote]

Actually the VA is more like single payer. (though I too question whether it’s been a very successful model.) I think a more likely model would be medicare for all, where medicare is everyone’s primary insurance. Kaiser, Sharp, and Scripps are providers, so they don’t have anything to do with what defines single payer.[/quote]

Kinda splitting hair here.

Single payer literally means there is only one payer and thus this one and only payer has the monopoly and thus the ability to dictate pricing.

Medicare for all would be single payer, but VA for all would be single payer and single provider.

[SK in CV]

[quote=ocrenter]Kinda splitting hair here.

Single payer literally means there is only one payer and thus this one and only payer has the monopoly and thus the ability to dictate pricing.

Medicare for all would be single payer, but VA for all would be single payer and single provider.[/quote]

Not splitting at all. The VA is a single payer model.

It is also the only example of government controlled health care, similar to the UK NHS. Medicare isn’t. The Canadian version isn’t.

[ocrenter]

[quote=SK in CV][quote=ocrenter]Kinda splitting hair here.

Single payer literally means there is only one payer and thus this one and only payer has the monopoly and thus the ability to dictate pricing.

Medicare for all would be single payer, but VA for all would be single payer and single provider.[/quote]

Not splitting at all. The VA is a single payer model.

It is also the only example of government controlled health care, similar to the UK NHS. Medicare isn’t. The Canadian version isn’t.[/quote]

“Single-payer healthcare is a healthcare system in which the state, financed by taxes, covers basic healthcare costs for all residents regardless of income, occupation, or health status. … In contrast, multi-payer healthcare uses a mixed public-private system.

Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). “Single-payer” describes the mechanism by which healthcare is paid for by a single public authority, not the type of delivery or for whom physicians work.”

U.K. Is a single payer system with a single provider, aka NHS. VA for all would be like the U.K.

Canada is a single payer system with multiple providers. Medicare for all would be like Canada.

[ocrenter]

[quote=livinincali]

Our system’s biggest problem is it doesn’t allow for free market forces to force competition and drive down costs. At the same time is also has no regulations in place to prevent costs from rising. Every country in the world has decided to either make health care a utility that’s tightly controlled or allowed bad outcomes for some based on free market forces. Neither is perfect but they are more efficient than our current system.

The bottom line is our medical system has a lot of people being paid by health care spending that aren’t actually providing care. There’s excessive overhead in our health care spending. Free market systems prevent excessive overhead to the cost of providing care by competition. Tightly regulated system prevent excessive overhead by strictly regulating everything. We don’t do either so we have millions of paper pushers being paid by health care spending from insurance agent, to billing coders, to various administrative departments and boards.[/quote]

Free market forces can’t force competition if government mandates emergency services.

Let’s say you have competing garages for car services. Because of market forces, the prices are lowered for routine maintenance and repairs.

But then government came out with a law mandating all garages to take in cars in event of emergencies regardless of the ability to pay. These emergency cases are all cars that do not have routine maintenance, cars that use the lowest grade gasoline engine cars running on flats.

Suddenly the garages now have to spread the cost of these emergencies to everyone else, and the cost goes up. And then some people decide to forgo routine maintenance since they can now demand car repair at any garage’s emergency bay. Forcing prices to go up even more.

If you have a government and society at large unable to stomach the idea of patients dying outside of ERs, then that free market is not truly a free market.

This is why all industrialized developed nations all move to nationalized single payer systems. Just look at Taiwan, S.Korea, and Singapore, they all followed the American model of free market capitalism to developed world status. And the moment they got there, they all switched to the European model old single payer universal coverage.

That is the natural course of development.

[Author]

Posts