RSS Feed MenuYuval Levin, working hard on a Saturday, seems to have been the first blogger to post on the latest bucket of ice-water thrown upon the Democrats’ health plan: the CBO’s Saturday morning release of a new study debunking the Obama administration’s plan to control Medicare costs.
Levin:
Their best assessment, in other words, is that the idea could save $2 billion over ten years, or in the neighborhood of two-tenths of one percent of the amount the Democrats want to spend on their health care program in that period. But the probability is high that it wouldn’t even save that much.
The Obama administration’s big idea about health care reduces itself to this: the US health system is so irrational and wasteful that simply by spending money more intelligently we can insure the uninsured at no additional net cost.
Nice, if true. But is it true?
The Obama administration’s big idea for saving money reduces itself to this – central command and control is so much more efficient than private competitive markets that simply by switching from one to the other they can save all the money they need. You have to wonder why such a blindingly obvious idea has never been tried before. Oh wait: It has. And it always proves wrong.
ottovbvs // Jul 26, 2009 at 10:38 am
“Oh wait: It has. And it always proves wrong.”
………….So how does every other universal healthcare system in the world, every single one, manage to provide universal coverage for all its citizens at 50-65% of the cost of our non universal, free market approach?…………Secondly what plan does the Republican party offer that will address the myriad problems that afflict our system, extend coverage to all, and will prevent the doubling in its cost that is going to occur over the next ten years?………..I won’t hold my breath waiting for an answer
sinz54 // Jul 26, 2009 at 10:51 am
ottovbvs sez: “So how does every other universal healthcare system in the world, every single one, manage to provide universal coverage for all its citizens at 50-65% of the cost of our non universal, free market approach?”
By rationing care across the board.
By having a mass transit system that reduces the need for auto travel (and hence, fewer auto accidents per capita).
By having less violent crime in which victims are brought to E.R.’s.
And by imposing price controls on prescription drugs, effectively cost-shifting those costs onto the American consumer. Each pharma company makes double profits on American sales to make up for the price controls elsewhere.
ottovbvs // Jul 26, 2009 at 11:13 am
sinz54 // Jul 26, 2009 at 10:51 am
“By rationing care across the board.”
………This is simply not true as I know from personal experience……..what’s your personal experience? ………..What seems beyond your mental compass is that healthcare is really rationed in the US……by the ability to pay!
“Each pharma company makes double profits on American sales to make up for the price controls elsewhere.”
…………Actually it’s about 2.5x………and it has nothing to do with European cost shifting and everything to do with a political system that is being paid to protect drug company profitability……looked at another way they the Europeans are great bargainers and we’re incompetent ones
VA Shepherd // Jul 26, 2009 at 11:42 am
ottovbvs // Jul 26, 2009 at 11:13 am
sinz54 // Jul 26, 2009 at 10:51 am
“By rationing care across the board.”
………This is simply not true as I know from personal experience……..what’s your personal experience? ………..
Good old Otto, you can always count on him to speak up for the Democrats. I have to side with sinz54 on this one. My family & friends in Canada have paid out of pocket to get healthcare in the U.S.A. and Mexico. This was not for unapproved or experimental procedures. I see more travel in all of our futures if Obamacare passes…
sinz54 // Jul 26, 2009 at 12:01 pm
ottovbvs sez: “healthcare is really rationed in the US……by the ability to pay!”
Don’t you think I know that???
Even in 1993, I confronted the advocates of HillaryCare (and the ever-present advocates of single-payer). I told them that those middle-class and upper-class Americans who already private insurance will NEVER accept higher costs and a lower level of care, just so the uninsured can be covered.
If ObamaCare is perceived as a program to help those who CAN’T pay, and putting the cost of that on the backs of those who CAN pay, the public will overwhelmingly reject it as “medical welfare.”
The question isn’t what ObamaCare can do for those who CAN’T pay. It’s what ObamaCare can do, if anything, for those who CAN pay. And what those who CAN pay want, is lower costs. NOT covering the uninsured. If ObamaCare cannot lower costs, by actual CBO analysis, then it’s dead in the water.
sinz54 // Jul 26, 2009 at 12:12 pm
From today’s Washington Post editorial:
“The fundamental driver of health-care inflation is technological innovation. The Congressional Budget Office (CBO) estimates that new technology accounts for about half the increase in health-care costs over the past several decades.
“This is, for the most part, a good thing. Adjusted for inflation, health-care spending per person is six times what it was 40 years ago. But no one today would settle for 1960s-style medicine. Treating patients with heart disease was inexpensive then, because there wasn’t a great way to detect problems before a heart attack and not much to do afterward. Today, angiograms can diagnose blockages. Bypasses and angioplasty can fix them. Drugs such as beta blockers can prevent repeat heart attacks. So spending for coronary care has soared, along with survival rates. Some medical innovations can save money, but the general arc has been better treatment — at higher costs….
“The current system is untenable and getting worse, with employers dropping insurance and premiums rising for those who still have it. Reform is essential. But Mr. Obama does the public a disservice by acting as if it will not require anything from them in return.”
http://tinyurl.com/nbpoyh
barker13 // Jul 26, 2009 at 1:22 pm
Re: Sinz54 // Jul 26, 2009 at 10:51 am –
“Each pharma company makes double profits on American sales to make up for the price controls elsewhere.”
That’s true, Sinz; and it’s a point I’ve brought up countless times along with promoting the idea of patent protection extension and viewing American Pharmaceutical Company R&D and product development as a national security issue just as aerospace and high tech in general should be.
If China – or Canada – reverse engineers (in other words steals) “our” patent protected technology (be it medication or intellectual property or whatever) the U.S. government response should be swift and sure.
Our problem? Because most politicians SUCK (think McCain as well as the Dems) they view our pharmaceutical industry as “the enemy” rather than one of our nation’s and our Peoples’ most valuable and crucial resources.
On “adjustment” I’d make to basic capitalism when it comes to the pharmaceutical industry though is I’d disallow “normal” bulk pricing.
Again… stipulating that “the Left” side of the healthcare debate has some valid points… medical care *is* different than food/shelter/clothing in the sense that while you can often “fudge” the other “necessities” to a large extent – at least for awhile, at least without either having to spend tens of thousands or hundreds of thousands of dollars on a single person immediately or else that person will die – medical care is different.
With medical care pricing and drug pricing I think that creating artificial classes of patients (those with heavy subsidies vs. lite subsidies vs. no subsidies) based not necessarily upon income but upon “luck of the draw” (who your employer is) creates more problems than it solves.
A hospital is not a hotel. In my view there SHOULD be a basic “rack rate” paid no matter who you are. Otto’s Viagra shouldn’t cost more – or less – than Frum’s Viagra. (*GIGGLE*)
I mean, isn’t this something most of us have at least inferred that we consider unfair – you know, if you’re insured your doctor charges X yet if you’re not your doctor charges Y and depending upon your coverage even if you’re insured sometimes the doctor is charging XYZ for the same exact treatment another insured person may being paying ABC for.
BILL
SFTor1 // Jul 26, 2009 at 6:49 pm
Barker, as far as I know 85% of med patents issued since the early 80s have been for reformulations and drug combinations, all done to extend patent protections. There has been little real development of new drugs, and a lot of the drugs that have reached the market are not more efficient than the drugs they replace. A lot of new drugs have also been for interesting new diseases and issues that I don’t think we knew were an actual problem. Shyness, restless leg syndrome, and good long-lasting hard-ons for 60-year olds come to mind.
I find it strange that it seems so important to defend the health care and pharmaceutical industries. Both are industries that know how to game the system just fine.
I am also mildly annoyed by this idea that the world travels to the United States to receive their medical care. Some of the very rich do, because health care for the very rich is very good here. But ordinary middle class people do not. Their care is sometimes rationed in their home country (my mother had to wait 3 months for an artificial hip in Norway. She’s 85.) But health care in the U.S. is just as rationed. And when you really need it, say you have a kid with cancer, it bankrupts you whether you are insured or not.
It would be very refreshing to see Republicans join the discussion based on the realization that our current system works for no one. It looks like it does, until you need it. Then it runs out, then you get dropped, then you have a pre-existing condition, and then you are screwed.
That’s no way to keep people healthy.
SFTor1 // Jul 26, 2009 at 6:56 pm
Sinz, it’s interesting that you write about angiograms, and by extension I would assume stenting. A stent mounted on a delivery system costs in the neighborhood of $1,000 to $2,000. The bill for my mothers PTCA at the Pacific Medical Center in San Francisco was $43,500. That was for an overnight stay in the hospital, the procedure, and observation. (The Norwegian Health Service paid the whole thing, after the fact, without prior approval.)
Where does the money go? Can you tell me? Frankly I don’t think it is true that procedures for heart attacks should have gotten more expensive. They should actually have gotten cheaper overall with the advent of PTCAs. These procedures are done in a cath lab, by two people, in about one hour.
But prices keep going up. Any ideas?
SFTor1 // Jul 26, 2009 at 7:10 pm
sinz, I do not mean to be antagonistic. I realize that you are honestly exploring viable avenues forward.
The post is addressed to you because you brought up care for heart disease. Others are of course welcome to comment.
sinz54 // Jul 26, 2009 at 7:13 pm
sftor1: Prices keep going up because of supply and demand. As long as there are patients willing to have whatever treatments it takes to keep from dying, the cost of those treatments will continue to stay high.
It’s a point I’ve tried to make before: For health care, the supply and demand curves will intersect at a price point so high as to bankrupt the society. That’s because the “replacement cost” of a human life–the price at which you’re prepared to stop asking for treatment and walk away–is nearly infinite.
sinz54 // Jul 26, 2009 at 7:18 pm
sftor1: I grant you that a number of new pharma drugs are copycat drugs and reformulations.
But those which are not, have proven to be literally life-saving.
I have kidney failure.
Drugs developed in the last decade, such as Aranesp, have kept me from having to get monthly blood transfusions, which were how kidney failure used to be treated. Blood transfusions are risky. Not just due to possible transmission of disease, but due to activation of the immune system against the transfused antigens, which make it much more likely that the immune system will reject a kidney transplant.
Aranesp is very expensive. But it’s keeping me alive, and keeping open the possibility of a kidney transplant in the future.
ottovbvs // Jul 26, 2009 at 7:54 pm
sinz54 // Jul 26, 2009 at 12:01 pm
“Don’t you think I know that???”
………..Unfortunately you think it’s fine for you personally to participate in a universal state healthcare plan but others in other states shouldn’t have the same privilege…….frankly I find your whole attitude perplexing when you clearly know quite a bit about this as is illustrated by this comment which is basically accurate
“Barker, as far as I know 85% of med patents issued since the early 80s have been for reformulations and drug combinations, all done to extend patent protections. There has been little real development of new drugs, and a lot of the drugs that have reached the market are not more efficient than the drugs they replace.”
………..And yet elswhere you spread misinformation because you’re against extending a system you enjoy to others……very odd.
sdspringy // Jul 26, 2009 at 8:22 pm
The comparisons of US healthcare and anywhere else, is always missing one very important point. Everyone pays for it. No matter the income level. They do not try to balance the entire cost of healthcare onto the backs of the upper 5% of the population.
Also the healthcare I enjoy come at a cost, of time and money. I am not denying that from anyone. Everyone can get jobs with healthcare as a benefit, no one is denying anyone that freedom.
If someone is unable to aquire healthcare and needs government assistant, ie.. us to pay for it, certain conditions should apply. We currently apply conditions for receiving welfare, unemployment, why not healthcare.
sftor1:….Where does the money go? Can you tell me? Frankly I don’t think it is true that procedures for heart attacks should have gotten more expensive. They should actually have gotten cheaper overall with the advent of PTCAs. These procedures are done in a cath lab, by two people, in about one hour.
But prices keep going up. Any ideas?
Because those that do pay cover the cost of those that don’t pay at all or receive care from programs such as Medicare/Medicad which do not pay the full cost of the procedure. Hospitals/doctors then pass those unreimbused costs onto the backs of insured individuals or individuals who pay out of pocket. Which is why some healthcare providers do not accept Medicare/Medicad patients. The cost of their procedures would go up to those who pay.
barker13 // Jul 26, 2009 at 9:35 pm
Re: Sftor1 // Jul 26, 2009 at 6:49 pm –
“Barker, as far as I know 85% of med patents issued since the early 80s have been for reformulations and drug combinations, all done to extend patent protections.”
Which supports my point! Instead of R&D going to “tinkering” so as to jump through the legal hoops necessary for creating “new” patents for what amount to only slightly more effective (if that) medications, R&D – supported by longer term stable profits – should be focused on “real” new breakthroughs.
“There has been little real development of new drugs…”
Well I don’t know about that, but to whatever extent that statement is true wouldn’t you agree with me that this is regrettable and that the push should be TOWARDS developing new as well as better drugs?
“A lot of new drugs have also been for interesting new diseases and issues that I don’t think we knew were an actual problem. Shyness, restless leg syndrome, and good long-lasting hard-ons for 60-year olds come to mind.”
(*SHRUG*) What’s you point…???
ONE
MORE
TIME
I support policies I believe would lead towards more new drugs – breakthrough drugs – being developed, approved, and made available to those who need them.
“I find it strange that it seems so important to defend the health care and pharmaceutical industries.”
(*SIGH*) Yes. I’m gathering that.
Call me crazy… I want disease symptoms treated and if possible cured. Since I doubt the poli-sci grads working in my congressman’s and Senators’ offices are going to come up with tomorrow’s wonder drugs I suppose I’ll have to place my hopes in the hands of the “evil” health care and pharmaceutical industries.
“I am also mildly annoyed by this idea that the world travels to the United States to receive their medical care.”
(*SNORT*) Well… I’m guessing those foreigners who have traveled to the United States and have received care available to them nowhere else are somehow able to get past the fact that this “annoys” Sfor1.
“Some of the very rich do [travel to the US for healthcare treatment], because health care for the very rich is very good here. But ordinary middle class people do not.”
While no doubt it’s more typical for rich foreigners to come to America for medical treatments than middle class or (especially) poor foreigners, I’m guess hundreds, perhaps thousands of middle class and poor foreigners do come to the U.S. each year for medical care that either they can’t get or can’t get in a timely fashion at home. In other words, Sfor1… no doubt you’re just plain wrong.
In any case, if ONE foreigner came to the U.S. and received treatment that saved his life or gave her a better quality of (physical/psychological) life than he or she would have been able to receive in his or her own country… well… then for that ONE foreigner U.S. healthcare made all the difference in their life.
“It would be very refreshing to see Republicans join the discussion based on the realization that our current system works for no one.”
(*SIGH*) You’re a nut. That’s an idiotic statement on the magnitude of a typical Otto post. (*SHRUG*)
While I wish I paid less for health insurance and I certainly wish I had the option of a true HSA/MSA catastrophic plan here in NY, my health insurance AND more importantly my health care works fine for me and fine for my wife.
“It looks like it does, until you need it. Then it runs out, then you get dropped, then you have a pre-existing condition, and then you are screwed.”
Again… you’re a frigg’n nut. My best friend is a cancer survivor. Two of my nephews (now young adults) were born THREE MONTHS premature and spent two (maybe three – I forget) months in the neo-natal ICU at Westchester County Medical Center. You’re a moron. You have absolutely no idea what the hell you’re talking about.
BILL
barker13 // Jul 26, 2009 at 9:47 pm
Re: Sdspringy // Jul 26, 2009 at 8:22 pm –
“Everyone can get jobs with healthcare as a benefit…”
ALERT THE MEDIA! THE RECESSION IS OVER! WE’RE BACK TO FULL EMPLOYMENT!
(Seriously… “everyone” can’t even get a JOB today, let alone a job with healthcare benefits.)
In any case, healthcare benefits should no more be “supplied” by your employer than should your housing, clothing, transportation, groceries or any other staple of life be “supplied” directly by your employer. You know what you’re employer should “supply” you with…??? WAGES!
“If someone is unable to acquire healthcare and needs government assistance, ie… us to pay for it, certain conditions should apply.”
Yep. You’re right there.
BILL
sdspringy // Jul 27, 2009 at 1:46 am
The current economic conditions have really no bearing on this debate. Since the healthcare issue has been a topic in both good and bad economic times.
However there are many skilled and none skilled jobs, in good and bad times which offer healthcare benefits. Now notice I refer to them as benefits, not a right.
VA Shepherd // Jul 27, 2009 at 7:44 am
Peter Fleckstein (aka Fleckman) has been reading the 1000 page house bill and has been posting his findings on Twitter. This is from his postings (Note: All comments are Fleckman’s). It seems unbelievable. Lean on your Congressmen and Senators. The communists have landed…
Pg 22 of the HC Bill MANDATES the Govt will audit books of ALL EMPLOYERS that self insure!!
Pg 30 Sec 123 of HC bill – THERE WILL BE A GOVT COMMITTEE that decides what treatments and benefits you get
Pg 29 lines 4-16 in the HC bill – YOUR HEALTHCARE IS RATIONED!!!
Pg 42 of HC Bill – The Health Choices Commissioner will choose your HC benefits for you. You have no choice!
Pg 50 Section 152 in HC bill – HC will be provided to ALL non US citizens, illegal or otherwise
Pg 58HC Bill – Govt will have real-time access to individuals’ finances and a National ID Healthcard will be issued!
Pg 59 HC Bill lines 21-24 Govt will have direct access to your banks’ accounts for election funds transfer
Pg 65 Sec 164 is a payoff subsidized plan for retirees and their families in unions & community orgs (ACORN).
Pg 72 Lines 8-14 Govt is creating a HC Exchange to bring private HC plans under Govt control.
Pg 84 Sec 203 HC bill – Govt mandates ALL benefit pkgs for private HC plans in the Exchange
Pg 85 Line 7 HC Bill – Specs for Benefit Levels for Plans = The Govt will ration your Healthcare!
Pg 91 Lines 4-7 HC Bill – Govt mandates linguistic-appropriate services. Example: Translation for illegal aliens
Pg 95 HC Bill Lines 8-18 The Govt will use groups (i.e., ACORN & Americorps) to sign up individuals for Govt HC plan
Pg 85 Line 7 HC Bill – Specs of Ben Levels for Plans. #AARP members – your health care will be rationed.
Pg 102 Lines 12-18 HC Bill – Medicaid-eligible individuals will be automatically enrolled in Medicaid. No choice.
pg 124 lines 24-25 HC No company can sue GOVT on price fixing. No “judicial review” against Govt Monopoly.
pg 127 Lines 1-16 HC Bill – Doctors/ #AMA – The Govt will tell YOU what you can make.
Pg 145 Line 15-17 An Employer MUST automatically enroll employees into pub opt plan. NO CHOICE
Pg 126 Lines 22-25 Employers MUST pay for health care for part-time employees AND their families.
Pg 149 Lines 16-24 ANY employer with a payroll of $400k and above who does not provide pub opt. pays 8% tax on all payroll
pg 150 Lines 9-13 Businesses with payroll between $251k & 400k who don’t provide pub. opt pays 2-6% tax on all payroll
Pg 167 Lines 18-23 ANY individual who doesn’t have acceptable HC according to Govt will be taxed 2.5% of income
Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay)
Pg 195 HC Bill – Officers and employees of HC Admin (GOVT) will have access to ALL Americans’ financial and personal records.
Pg 203 Line 14-15 HC – “The tax imposed under this section shall not be treated as tax” Yes, it says that.
Pg 239 Line 14-24 HC Bill Govt will reduce physician services for Medicaid. Seniors, low income, poor affected
Pg 241 Line 6-8 HC Bill – Doctors will all be paid the same, regardless of what specialty you have.
Pg 253 Line 10-18 Govt sets value of doctor’s time, professional judgment, etc. Literally value of humans.
Pg 265 Sec 1131 Govt mandates and controls productivity for private HC industries
Pg 268 Sec 1141 Fed Govt regulates rental and purchase of power driven wheelchairs
Pg 272 SEC. 1145. Treatment of certain cancer hospitals. Cancer patients: welcome to rationing!
Pg 280 Sec 1151 The Govt will penalize hospitals for what it deems preventable readmissions.
Pg 298 Lines 9-11 Doctors who treat a patient during initial admission that results in a readmission will be penalized by the Govt.
Pg 317 L 13-20 PROHIBITION on ownership/investment. Govt tells doctors what/how much they can own.
Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion- Govt is mandating hospitals cannot expand
Pg 321 2-13 Hospitals have opportunity to apply for exception BUT community input required. Can you say ACORN?!!
Pg 335 16-25 Pg 336-339 – Govt mandates establishment of outcome-based measures. HC the way they want. Rationing
Pg 341 Lines 3-9 Govt has authority to disqualify Medicare Adv Plans, HMOs, etc. Forcing peeps into Govt plan
Pg 354 Sec 1177 – Govt will RESTRICT enrollment of special needs people.! WTF. My sis has down syndrome!!
Pg 379 Sec 1191 Govt creates more bureaucracy – Telehealth Advisory Committee. Can you say HC by phone?
Pg 425 Lines 4-12 Govt mandates Advance Care Planning Consult. Think Senior Citizens end of life
Pg 425 Lines 17-19 Govt will instruct and consult regarding living wills, durable powers of atty. Mandatory!
Pg 425 Lines 22-25, 426 Lines 1-3 Govt provides approved list of end of life resources, guiding you in death. Excuse me???!?!?!?
Pg 427 Lines 15-24 Govt mandates program for orders for end of life. The Govt has a say in how your life ends
Pg 429 Lines 1-9 An “advance care planning consult” will be used frequently as patient’s health deteriorates
Pg 429 Lines 10-12 “Advance care consultation” may include an ORDER for end of life plans. AN ORDER from GOV
Pg 429 Lines 13-25 – The govt will specify which Doctors can write an end of life order.
Pg 430 Lines 11-15 The Govt will decide what level of treatment you will have at end of life
Pg 469 – Community Based Home Medical Services=Non profit orgs. Hello, ACORN Medical Svcs here!!?
Pg 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORG. One monthly payment to a community-based org. Like ACORN?
Pg 489 Sec 1308 The Govt will cover Marriage & Family therapy. Which means they will insert Govt into your marriage
Pg 494-498 Govt will cover Mental Health Services including defining, creating, rationing those same services
VA Shepherd // Jul 27, 2009 at 7:48 am
You gotta love pages 425 – 430…those pesky seniors aren’t contributing anything to society anymore anyway…
barker13 // Jul 27, 2009 at 8:21 am
Re: VA Shepherd // Jul 27, 2009 at 7:44 am –
VAS, ya got a link?
Which bill…??? I thought there were three floating around.
Thanks!
BILL
sinz54 // Jul 27, 2009 at 9:26 am
ottovbs sez: “Unfortunately you think others in other states shouldn’t have the same privilege”
I don’t know why I have to keep explaining this.
If ObamaCare looked like a scaled-up version of RomneyCare (plus cost-containment built in from the outset), I would support it.
Let me repeat that:
I would support a national version of RomneyCare + cost containment. OK???
ObamaCare does not look like RomneyCare. It looks much more like a steppingstone to single-payer, which RomneyCare is not.
sinz54 // Jul 27, 2009 at 9:32 am
ottovbvs: Would you actually like center-right Independents like me to support ObamaCare?
Fine. Here’s what has to happen:
The Dems have to modify ObamaCare and remove all the provisions that currently make ObamaCare a steppingstone on the road to single-payer. (That means putting some real constraints on how much the public option can grow.) And they have to tell their liberal activist friends that they must GIVE UP permanently on their single-payer dream.
Then, ObamaCare would be a bit closer to RomneyCare. It would still be a liberal-oriented health care plan. But I would support it.
It’s because ObamaCare in 2009 is a steppingstone to single-payer in 2020 or so that is the reason that I don’t support it.
Spartacus // Jul 27, 2009 at 1:52 pm
Sinz says, ” I would support a national version of RomneyCare + cost containment.”
Please describe what RomneyCare + cost containment looks like. How do you actually get cost containment into RomneyCare without a public option or some other large-scale government intervention that moves in that direction? Which of the stakeholders in the healthcare arena are going to voluntarily give up profits?
The other day I asked you a similar question and you never responded. As I’ve said before, I have no ideological commitment to a public option or to a single-payer system, but I know of no other way to get cost containment.
Every intelligent person who’s looked at these issues knows in his heart that some form of rationing has to occur. There is no way to expand coverage without limiting how much we spend. And, there is no way to limit how much we spend without (1) expanding coverage so that everyone can get early/preventative (i.e. less costly) treatment, and (2) spending money only on those things that actually work. So, if we decide to spend money only on what works we will, by definition, be rationing the care that does not work. We will also be reducing the profits of the providers of the rationed care (these are the losers Frum referenced in another thread today).
Moreover, someone is going to have to make the decision about what works and what doesn’t work. Contrary to popular belief, doctors and patients are not the ones that always make those decisions. Very often, insurers make those decisions. So, is it better to have a profit-motivated insurance executive or a member of some Federal Reserve-type agency (which would be comprised of representatives from the various stakeholders) make those decisions? They both have potential incentives to make decisions that conflict with the wishes of the doctor or patient.
sinz54 // Jul 27, 2009 at 2:36 pm
Spartacus: In Massachusetts, RomneyCare includes a public option, Commonwealth Care. But these public plans are strictly means-tested. They’re for the long-term unemployed and the poor who simply can’t afford to pay the premiums of any private insurers. The public plans are NOT available to any middle-class person with a decent income.
In this way, CommonwealthCare can never crowd out the private insurers for the middle-class and upper-class markets.
In Massachusetts, cost containment may be effected by imposing capitation, and by encouraging doctors to join together into groups which will pay each member doctor a fixed salary. I agree that will probably be insufficient.
BTW: Numerous studies have exploded the myth that preventive medicine will save money. If anything, it increases costs. The reason is that preventive medicine to prevent the diseases that can be prevented, just guarantees that the patient will live longer, till he inevitably contracts an incurable disease and draws down Medicare. You can’t put off the Grim Reaper forever.
I’m a perfect example of that. I did all the right things: Exercised, ate right, low cholesterol, normal blood pressure, regular checkups of suspicious things–to ensure that I would not get heart disease or cancer. So what happened? I got kidney failure instead, cause unknown.
Or look at it another way. Medicine was a lot cheaper in the 19th century, when doctors could diagnose cancer, heart disease, kidney failure, etc., but couldn’t effectively treat any of them. The patient just died within months after diagnosis. At least that was inexpensive.
Spartacus // Jul 27, 2009 at 3:26 pm
sinz54 // Jul 27, 2009 at 2:36 pm: “In Massachusetts, RomneyCare includes a public option, Commonwealth Care. But these public plans are strictly means-tested. ”
The public option has to to be available to the entire consumer base – not just a segment of it. Otherwise, you’ll get cost containment only for the affected segment. This is exactly what happens with Medicare. Compared to the rest of the sector, you have greater efficiencies and more cost containment. Of course, many people call this cost-shifting, but at the end day it really means compressed profit margins for providers of Medicare services. You’re going to have to have a public option for the entire market and that will result in lower profit margins for the entire market. These will be the necessary losers that Frum wrote about this morning.
With respect to the savings from early treatment/preventative care, I’m familiar with some of the studies you referenced. I’m not suggesting those studies are all wrong, but I am familiar with other studies that dispute some of their findings. First of all, I would distinguish early treatment from preventative care. The case for early treatment is much more compelling than the case for preventative care. Also, the person that, through preventative care, lives long enough to draw down Medicare will use up resources, but (1) that person generally will have made a larger economic contribution to society, and (2) we still need reform about the utility of certain kinds of care – particularly end-of-life care.
Intuitively, I think for every person with kidney failure or some other disease that is not one of the big killers in this country who ends up costing Medicare more money, you will find at least more than one person who saves money because of the less costly early treatments for the more common diseases of cardiovascular disease and diabetes. Nevertheless, I do agree that preventative care (vs. early treatment) is not the gold mine that everyone thinks it is.
As you probably know, about 1/3 of the Medicare budget is spent on the last few months of life, and 25% of that 1/3 is spent on the last few weeks of life. Most people, would conclude that that money is probably not well spent. This is why I’ve always said that, in addition to cost containment and universal coverage, we also have to achieve better outcomes for the services we consume. Again, this is another form of rationing, albeit a better form of rationing than we currently have.