Posted 19 July 2009 - 07:00 AM
Mark, in regards to your Robin Hood worry, it's actually take from a small minority to give to a slightly less small minority. The House bill is talking about increasing taxes on people making over $280K, families over $350K. I would tend to disagree with your notion about socialism, but I already posted about it in the Professor is a genius thread, so I would hope you get a chance to read my post in that thread to you.
I agree with some of your arguments, Omega, though I have read about hospitals and doctors maintaining pay per procedure but adopting a patient-first, collaborative, holistic culture to practising medicine, that vastly improved patient care quality while dramatically reducing costs. I'm uncertain if eliminating pay per procedure alone can improve quality of care, though I'd agree that costs would go down if implemented.
In regards to pharmaceuticals, I think it's unnecessary to import drugs if instead the US adopted a regulator comparable to the Patented Medicine Prices Review Board in Canada (discussed in detail in the Obama goes thread). The mandate of the PMPRB is to ensure Canadians are not gouged by drug companies. The US, as the largest market for pharmaceuticals, could theoretically have massive purchase and bargaining power, but Medicare is prohibited from adopting the same approach as the VA does, which definitely needs to change. I think in exchange for the patent, having a PMPRB-style regulator assign a pricing strategy that accounts for the costs of development and marketing, but doesn't allow the drug companies to gouge US people, would be a better idea than imports.
The reason why single payer systems have such small administrative costs is because unlike with the US system, there's only one insurance provider (the government), and there's nobody in the single payer system comparable to a private insurer approving or declining to pay for services billed. Administrative simplicity alone would still save Medicare 9% more than private insurance companies if Medicare paid the same price per procedure as a private insurer (they don't even come close). A properly assembled public insurer, as in formed based on Medicare, would have the clout to bargain for lowest prices for treatments with hospitals, and be able to reduce the cost growth of health care.
I think Omega that although universality is the driving force of this reform, long term cost sustainability is also a clear objective. While it's true the cost of treating the uninsured now will be less than what it costs to insure them, a lot of that has to do with the fact that the uninsured receive insufficient care, and this is still a worthwhile investment, since the economic losses incurred by having so many uninsured far exceeds the cost of insuring them. And because of the externalities created by the lack of universality, solving this problem is the first step towards solving the sustainability issue.
Palisade, based on my readings, I found that Medicare had a set payment per treatment process by which they paid hospitals and clinics, which does not necessarily match what it costs a hospital to perform that treatment. As for prescription drugs, that depends on the plan, it's not standardised, the Medicare client chooses which prescription plan he wants, and will know what it covers, and by how much, etc.
I'm curious, Mark, why are you not rioting in the streets over the outrageous and unamerican rationing of health care that's going on right now, just like they used to have in the USSR? For different reasons, of course. I mean, are you okay with the principle that instead of a system of equality and equal access to treatment that rations by need, you're getting rationing based on capacity to pay? I mean it's a valid point of view, I just want to make sure there's no confusion, here. And just for the record, it was not just socialism itself that did anything to the USSR, it was the result of their command system of government, a pure socialist system would never have been run in the manner in which the USSR was.
Actually, Captain Jack, this is far from an epic fail, this is in fact good progress. Now your point is rather similar to what you posted in the Obama goes there thread, and so I'll just copy and paste my rebuttal, since you never returned to engage my points, hopefully you'll have a chance to do so this time. I think you may have misunderstood the nature of the reforms being presented. First off, the government is not going to provide health care any more than they do now. There will be no nationalisation of private clinics and hospitals. Doctors and nurses will not become government employees. The new rules and regulations do not expand government, they define the scope of the private sector in the market. A public insurer is meant to increase competition and reduce externality.
I'm curious, Captain Jack How well do you truly understand socialism?. Did you know that there are some tenants of socialism and US philosophy that are actually not that different? Equality of opportunity. That all men are equal. That any man should be able to achieve his fullest potential. Do any of these sound incompatible with what the US is about? So what parts of Obama's universal health care are incompatible with US principles? Because anyone making an honest and fair comparison of what the House and Senate have proposed, will realise this is not a socialist system. It's not even a social insurance system. It mandates universality by creating a health exchange so that all people can buy insurance from any number of private companies, and creates a new public insurer to compete with private insurers. Do you think this would impress a real socialist? No socialist with any certainty of conviction would approve of the plan proposed.
Unfortunately, Captain Jack, if you pay taxes, and if you pay insurance premiums, you already are paying for other people's health care, their meds, etc.
Really, Mark? What parts of Obama's plan sounds like socialism at its finest to you? Allowing private insurers? Creating state/regional/national health exchanges where people can buy (serious emphasis) insurance from a private company or a public insurance provider? I asked it of Captain Jack, but I'd invite you to offer a reply, as well, because as far as I can tell, there's nothing here that is socialism at its finest. And requiring people to have insurance hardly sounds like the second coming of the USSR to me, seeing as how any auto on the road needs insurance. Perhaps you can elaborate on these regulations on people and their health care choices? Seems to me that he's left you with all the choices you already had, plus another one.
I would agree with Nick, Omega, preventative care will in the long run achieve a level of cost savings, not unsubstantial, and it can hardly be called free if hospitals get federal and state dollars to offset their costs of treating the uninsured/unable to pay, as well as raising prices on their treatments to those who can pay, which inevitably leads to higher insurance premiums for the insured.
I'm not sure if you're serious, Captain Jack, I'm suspicious the deliberate misspell is an indicator of that, but I'll proceed nonetheless. First off, governments should not be regulating what, exactly? The standards of safety and quality that keep the people safe from harm? Or how about we consider the effects the absence of regulations had on the ongoing unpleasantness in the economy of late? As to your comment on the USPS, I offered a rebuttal on that last time, but I'll offer it again. Because the USPS maintains unprofitable routes and subsidises the cost of shipping letters (a stamp today is pretty much the same inflation adjusted cost as it was more than half a century ago). I remember a large fuel surcharge for all the FedEx shipments I sent last year, all the plane tickets I bought also had fuel surcharges, prices were going up rather quickly in my area, which was overheating due to the oil boom, but Canada Post didn't raise the cost of mailing a letter at all. Did the USPS? Maybe by a penny?
I'm going to assume now that the capital letters is a definite indication that you're not serious, so I won't endeavour to refute the notion that governments should not be regulating any business, and I won't point out that the US while relatively close to a pure capitalist system, is still a long ways off from that. If you are in fact sincere, let me know, and I'll offer a reply.
So Captain Jack, if the solution to the health care problems the US faces is competition, please describe what this entails. Competition where, exactly? There are lots of doctors, clinics, hospitals, insurance companies, already, though. Where do we encourage more competition? And how do we do this without regulations? I'm very interested in hearing about your proposal, as I had also asked Mark to describe a capitalist solution to the health care issues the US faces.
On another note, Captain Jack, I saw your post to me in the AQG thread, thanks.