[cherdanno]

awm, on Jul 1 2009, 05:25 PM, said:

So why does the private sector work for one brand of insurance and not the other?

cherdanno, on Jul 1 2009, 10:46 AM, said:

helene_t, on Jul 1 2009, 10:25 AM, said:

Sounds like there is plenty of scope for cost reductions. Why isn't there a market for a health insurance plan that offered sensible coverage for say 1/3 of the price other insurers ask?

The health insurance market has very high barriers for entrance.
Every single health insurance company in the US needs to:
- Negotiate payment plans with every single health care provider they want their patients to have access to (ok, of course I am exaggerating, there are networks of insurance companies that negotiate with networks of providers - which means that becoming part of such a network is a barrier to entrance to the market)
- Find his way to avoid the adverse selection problem (i.e., only people who know they will have high medical bills signing up for his plan). In practice, this means signing contracts with employers who pay health insurance as part of their benefits.

Starting a car insurance is very easy compared to starting a health care insurance. You don't have to negotiate contracts with car care providers, and the adverse selection problem is much easier to deal with.

[helene_t]

awm, on Jul 1 2009, 11:25 PM, said:

So why does the private sector work for one brand of insurance and not the other?

One difference is that while patients get less attractive for insurers the older they get, drivers get more attractive.

I don't know much about the US system but I can imagine the following is quite devastating: Say I sign up for a health insurance when I am young and healthy. At a certain point I get chronically sick. Now the insurer cannot kick me out or raise my rate to cover for the increased risk (a major point of having an insurance is to insure against future rise in risk, not only to insure against present risk). On the other hand, I suppose other insurers can refuse to accept me, or let me pay a high rate reflecting my increased risk. So nobody is competing for me.

Another thing is the sheer complexity of the health care insurance. Customers find it much easier to work out their needs for car insurance than health insurance. Free markets only work if buyers are informed about the commodities available.

[luke warm]

cherdanno, on Jul 2 2009, 02:59 AM, said:

luke warm, on Jul 1 2009, 05:19 PM, said:

cherdanno, on Jul 1 2009, 03:31 PM, said:

Lobowolf, on Jul 1 2009, 12:18 PM, said:

PassedOut, on Jul 1 2009, 07:00 AM, said:

For the most part, it can be paid for by cutting the waste, fraud, and abuse in the current system.

Do you think there's reason to believe that a government-run system would have dramatically less waste, fraud, and abuse?

Yes.

based on what? the evidence presented by other gov't run systems?

For example. Gov't run health care insurance systems in other countries. Reducing profits in a non-competitive market.

ok, maybe there would be less waste, fraud, etc in this than in most gov't run programs - it's just hard to envision

[PassedOut]

luke warm, on Jul 2 2009, 05:12 AM, said:

ok, maybe there would be less waste, fraud, etc in this than in most gov't run programs - it's just hard to envision

Although there is some waste, fraud, and abuse in government programs, there is at least as much in the private sector. In fact, much of the waste in government programs involves collusion with unethical companies in the private sector.

To get rid of waste, fraud, and abuse, you need to be aware of it and to have a way to deal with it. Proper transparency provides awareness. Fraud and abuse can be dealt with by strong enforcement (with pressure from the public).

Waste can be handled efficiently by the marketplace when consumers have plenty of options. But when a product or service is a necessity and all the options are bloated with waste, fraud, and abuse, the marketplace fails. And that is exactly where the US is today with the healthcare system.

Countries with government supported healthcare plans get better results than does the US, and at a much lower cost. There is simply no getting around that.

[jdonn]

PassedOut, on Jul 2 2009, 08:50 AM, said:

Countries with government supported healthcare plans get better results than does the US, and at a much lower cost. There is simply no getting around that.

Unless someone wants to disagree with that statement, one would think that would settle the issue. One would think...

[helene_t]

jdonn, on Jul 2 2009, 04:39 PM, said:

PassedOut, on Jul 2 2009, 08:50 AM, said:

Countries with government supported healthcare plans get better results than does the US, and at a much lower cost. There is simply no getting around that.

Unless someone wants to disagree with that statement, one would think that would settle the issue. One would think...

Not that I really disagree, but one can think of other reasons for the bad US performance. The obesity epidemic, and the malpractice claims, for example. Not everything is necessarily the insurance companies' fault.

[Lobowolf]

Yeah, for that to be a definitive end of discussion answer, we'd all have to agree on what "better" meant, on balance, and we'd have to assume that a lot of other things are equal between countries.

[PassedOut]

helene_t, on Jul 2 2009, 11:29 AM, said:

Not that I really disagree, but one think of other reasons for the bad US performance. The obesity epidemic, and the malpractice claims, for example. Not everything is necessarily the insurance companies' fault.

It's more a matter of fixing a huge problem that putting blame on those who took advantage of the laws that existed.

BTW, states like Texas passed laws that greatly reduced malpractice suits. That did not fix the problem.

But it's very true that preventative healthcare measures are important to reduce costs. The current incentives in the US system work against that, and so also need to change.

[PassedOut]

Lobowolf, on Jul 2 2009, 11:43 AM, said:

Yeah, for that to be a definitive end of discussion answer, we'd all have to agree on what "better" meant...

How about objective measures like infant death rates? Is there any disagreement about what "better" means?

[Lobowolf]

PassedOut, on Jul 2 2009, 11:51 AM, said:

Lobowolf, on Jul 2 2009, 11:43 AM, said:

Yeah, for that to be a definitive end of discussion answer, we'd all have to agree on what "better" meant...

How about objective measures like infant death rates? Is there any disagreement about what "better" means?

Clearly not, with respect to that one factor.

[PassedOut]

Lobowolf, on Jul 2 2009, 11:57 AM, said:

PassedOut, on Jul 2 2009, 11:51 AM, said:

Lobowolf, on Jul 2 2009, 11:43 AM, said:

Yeah, for that to be a definitive end of discussion answer, we'd all have to agree on what "better" meant...

How about objective measures like infant death rates? Is there any disagreement about what "better" means?

Clearly not, with respect to that one factor.

Are there objective healthcare measurements upon which there is a disagreement about what "better" means? I'm seriously interested in some examples.

[Lobowolf]

PassedOut, on Jul 2 2009, 12:03 PM, said:

Lobowolf, on Jul 2 2009, 11:57 AM, said:

PassedOut, on Jul 2 2009, 11:51 AM, said:

Lobowolf, on Jul 2 2009, 11:43 AM, said:

Yeah, for that to be a definitive end of discussion answer, we'd all have to agree on what "better" meant...

How about objective measures like infant death rates? Is there any disagreement about what "better" means?

Clearly not, with respect to that one factor.

Are there objective healthcare measurements upon which there is a disagreement about what "better" means? I'm seriously interested in some examples.

I didn't mean to imply that there is disagreement as to what better means with respect to any given objective measure.

The question is as to what "better" means as a whole when a huge variety of factors is considered.

For example, a country in which everyone had insurance through their employer vs. one where that's not the case, but there's a lower unemployment rate because some employers in the first company can't afford mandatory coverage. And/or give one of them a .05% lower infant mortality rate and the other a 20% lower cost per capita. And/or give one of them cheaper care, but the other less wait time or more access to optional services. And/or give one of them lower costs, but lower pay to doctors, sending some best-and-brightest to other fields. Or the pros and cons of tort reform, malpractice suits, etc.

[helene_t]

PassedOut, on Jul 2 2009, 06:03 PM, said:

Are there objective healthcare measurements upon which there is a disagreement about what "better" means? I'm seriously interested in some examples.

One thing the Canadian system (among others) is often criticized for, is the huge waiting lists.

Anyway, I think the most relevant things to compare are those most directly related to the performance of the health care system, such as occurrence of antibiotic-resistant bacteria, hospital infection rates, survival rates for acute heart problems. Maybe infant mortality is an important indicator, too, I am not sure how much inadequate health care contributes to it.

[PassedOut]

Lobowolf, on Jul 2 2009, 12:12 PM, said:

I didn't mean to imply that there is disagreement as to what better means with respect to any given objective measure.

The question is as to what "better" means as a whole when a huge variety of factors is considered.

For example, a country in which everyone had insurance through their employer vs. one where that's not the case, but there's a lower unemployment rate because some employers in the first company can't afford mandatory coverage. And/or give one of them a .05% lower infant mortality rate and the other a 20% lower cost per capita. And/or give one of them cheaper care, but the other less wait time or more access to optional services. And/or give one of them lower costs, but lower pay to doctors, sending some best-and-brightest to other fields. Or the pros and cons of tort reform, malpractice suits, etc.

Given that few people disagree on what "better" means with respect to specific objective measurements, doesn't it come down simply to which measurements should be on the list? Survival rates after different illnesses, deaths during various kinds of surgery, infant mortality rates, the fitness of the population by age group, and so on?

Maybe there would be some minor quibbles about how to weight items on that list, but that would be important to this discussion only if the US had some especially good measurements to counterbalance the poor measurements. And, frankly, I don't know of any.

Helene: if the waits are too long in Canada, wouldn't the adverse effects show up in more objective measures?

[PassedOut]

Looks like we're on our way: Obama praises sweeping healthcare bill

Quote

WASHINGTON, July 2 (UPI) -- President Barack Obama praised Senate legislation Thursday that would include government-run healthcare as part of a sweeping $611 billion reform plan.

Obama said the measure, approved Thursday morning by the Health, Education, Labor and Pensions Committee, would pave the way for Congress to enact a reform package that would reduce healthcare costs and cover 97 percent of Americans, without increasing the deficit.

Seems like this bill would fix some of the glaring problems with health insurance in the US:

Quote

The Senate bill, Obama said, would prevent insurance companies from denying coverage because of pre-existing conditions, ensure people get alternative coverage if they lose jobs or get sick, and provide "one-stop shopping" for families and small businesses seeking coverage.

The public health option would reduce healthcare costs by increasing competition, providing more choices and "keeping the insurance companies honest," the president said.

It's good to see that Obama is keeping the focus on fixing this problem.

[jdonn]

I love the fact that (admittedly with more examination surely required) they seem to have something that will create a major overhaul, but not cost nearly as much as earlier plans where I heard numbers as high as 1.6 trillion dollars.

[helene_t]

PassedOut, on Jul 2 2009, 06:52 PM, said:

Helene: if the waits are too long in Canada, wouldn't the adverse effects show up in more objective measures?

Yes, but patients with acute life-threatening conditions rarely have to wait long. Typical waiting list patients need a lense transplant or hip replacement. So those objective measures should include the vision and mobility of the general population. Those are not among the figures you find on WHO site I think.

Anyway, I think it is obvious to everyone that the US health care system sucks. Multi-resistant drugs abound, infant mortality is higher than in most OECD countries, life expectancy lower than in most OECD countries, costs are more than twice what almost everybody else pays.

What is more relevant to the discussion is what the impact of a proposed reform would be. I think a government-run health insurance would be a good thing, it works reasonably elsewhere. But there are probably a lot of other things that need to change. As I understand it, there is a doctor shopping culture, a second opinion culture, a random testing culture, a caesarian section culture, an antibiotic overuse culture, a claim culture, and probably lots of other aspects of US patients' and health care providors' mentality that would have to change. And probably also some areas where the US is doing better than other countries.

[luke warm]

PassedOut, on Jul 2 2009, 12:52 PM, said:

Given that few people disagree on what "better" means with respect to specific objective measurements, doesn't it come down simply to which measurements should be on the list? Survival rates after different illnesses, deaths during various kinds of surgery, infant mortality rates, the fitness of the population by age group, and so on?

Maybe there would be some minor quibbles about how to weight items on that list, but that would be important to this discussion only if the US had some especially good measurements to counterbalance the poor measurements. And, frankly, I don't know of any.

Helene: if the waits are too long in Canada, wouldn't the adverse effects show up in more objective measures?

i think (i could be reading wrong) that the discussion isn't so much on the 'better' as it is the 'objective measurements'... as helene said, infant mortality in and of itself is attributed to more than health care... the same can be said of other mortality rates (and this is assuming those are the only criteria you're using)

does an objective measurement of infant mortality take into account things like low birth weight due to poor lifestyle choices made by the mother? it seems to me that comparing apples to apples would be a better indication

in any event, if canada's (or any other country's) system is superior and costs less than america's system, it makes no sense - economic or otherwise - not to change... i still don't know what to do about the rx problem, though... there's a reason drugs are less expensive elsewhere, although i don't know if that reason is accurate

[mycroft]

Some people consider prenatal care to be just the kind of cheap(er) health care that, if available to everybody, minimizes "poor lifestyle choices made by the mother" and for some reason, lowers the infant mortality rate. You can't stop everybody, no, but education works, at least better than no education.

Sort of the same way that a few visits to the doctor each year for preventive purposes - including warning of "poor lifestyle choices" while the consequences are less critical; or just in case that cold isn't a cold, cost less than the emergency treatment for pneumonia, save one cancer treatment (or make it treatable rather than something requiring surgery or palliative care), so lower the health cost while simultaneously improving health.

[Winstonm]

With the worldwide nature of BBO, it would be nice to hear how healthcare works for them from those who actually live in countries other than the U.S. and use non-U.S.-based healthcare - especially social-type healthcare such as in France, Britain, or Canada