$380 per month? $2,000 deductibles?
I took a quick look at the figures – what do other industrialized countries pay for health care that has NO deductibles, NO out-of-pocket – and EVERYONE is covered?
It seems that France, which may well have the best health care in the world, spends about $263 per person per month on health care. Some other countries:
Germany: $254
UK: $209
Spain: $175
Italy: $206
Canada: $264
All of these countries provide health care that’s demonstrably as good or better than US health care. They all have longer life expectancies and lower infant mortality. And they all have universal coverage.
Why can these countries provide health care that’s probably better than ours, at costs that are far lower – costs that are, in fact, in the “sweet spot” of affordability that’s being discussed re: Chapter 58? Are Americans just not as smart as people in other industrialized nations?
No, those countries have terrible lobbyists…
Your post dances around but doesn’t really get to the central criticism of the new MA healthcare plan.
Unlike the single-payer plan we need (which would dramatically reduce administrative costs, allow for a larger negotiating pool with the drug companies and otherwise actual reduce the cost of health care), Massachusetts new “plan” does very little to control the spiraling costs.
<
p>
Making people buy private health insurance simply transfers money from individuals, employers and the taxpayers in to the pockets of the private health insurance companies, hospitals, and drug companies. In doing so little to reduce the costs of health care, I’m certain it will not be sustainable over the long term.
<
p>
I support eliminating private health insurance companies entirely (including the incredible waste spent on dealing with their different bureaucracies and the multi-million dollar salaries of their top executives).
I also support negotiating for lower drug prices with as large a pool of people as possible (how about the entire state?).
<
p>
Finally, I support, shhhhh, rationing of health care. Instead of letting the last TV advertising campaign determine which drugs we all will use, we should be allowing health care experts to determine which drug is most effective for the price. (see: http://www.crbestbuy…. Even more importantly, with rational decision-making, we can improve health care even while we reduce costly hospitalizations, tests and doctor visits for people with very serious illnesses at the end of life.
<
p>
Opposing these views are vast numbers of people who oppose “government run health care” on principle, the majority of our politicians, and the insurance/drug companies and other vested interest that benefit from the status quo while investing millions annually in our politicians.
<
p>
In my opinion, yes, it’s that we are too “stupid” (ignorant, complacent, apathetic, confused, etc) to understand the complexities of the debate. Round and round and round we go, where it stops nobody knows.
prohibit naming the “market name” or the chemical name of any prescription drug.
<
p>
You want to increase sales of Viagra? The best you should be able to do is run ads that encourage people with various erectile dysfunctions to talk to their doctor about their problem.
<
p>
I think this would really help (a) reduce the amount of money companies are spending on advertising, and (b) reduce the number of people who go in to a doctors office with a solution in search of a significant problem.
<
p>
It plays into your “rationing” game without actually rationing anything per se.
… I would definitely support your plan. Since the nifty Constitutional lawyers figured out a way to totally ban cigarette adverising on TV, I’m sure it is possible to show that there is the needed “substantial goverment interest” in this case.
<
p>
The problem is that too few politicians and/or policymakers (many if not most of whom are indebted to the drug industry and inudated by their lobbyists) are willing to take on the task of truly regulating the omnipresent and misleading drug ads.
<
p>
It is simply reprehensible that drugs like Nexium are supported by millions in consumer-directed advertising even though it works no better than many other cheaper heartburn drugs.
And Viagra ads in particular have been pulled off the air. Levitra, too.
<
p>
I’m simply suggesting that, in the case of Viagra for example, words like Viagra and Sildenafil citrate not be allowed in paid advertising. It’s that simple. You can talk about symptoms of a problem, the name of the problem, and encourage folks to talk to their doctor. All of that has public good — its good to educate people about medical conditions and its good to encourage people to talk to their doctors about symptoms.
.. and I agree. Indeed, if it were up to me, I’d ban television ads for prescription drugs completely. But your suggestion is even more practical and better. The powers that be won’t implement it but it’s a nice policy idea.
…Worse than Cialis ads!
Maybe there is another interested party – the media. Do they want to lose those billions? Are they going to run stories on how we could save Americans billions simply by prohibiting ads? BMG notably doesn’t seem to have any Viagra ads, but what would their position on this be if they did? What if we were talking about ways to lower the price of comedy shows?
<
p>
Also, can we tax advertising? I think advertising in general is obsenely wasteful. If every car company had to pay a 100% tax on the cost of an ad, maybe they wouldn’t hire so many helicopters to fly SUV’s and film crews to the tops of mountains.
It seems that everything I think should be taxed is instead subsidized…I was wondering if college tuition was taxed, so i did a google search, and of course got back millions of hits for tuition tax breaks.
<
p>
Of course we should end the deduction for advertising. I think it would be good to have a tax on it instead, like 100% or more.
Since I once publicly mocked (and continue to privately scorn) your ideas about government conception control, allow me to compliment you for bringing up an important aspect to this issue that I failed to bring-up.
<
p>
I 100% agree that the media (who clearly benefit from the ridiculously large amounts spent to advertise new drugs) is definitely an interested party.
<
p>
I also think advertising in general is obscenely wasteful. Just get me started talking about advertising for children’s toys and you might confuse me with some nut who thinks “we need a law that says children can only be conceived by the union of a woman’s egg and a man’s sperm.”
Perhaps in this light, you can see that the egg and sperm law is a form of rational rationing and resource allocation that would keep health care costs down, in addition to protecting children from never-before-seen birth defects that would be very expensive to treat. And the research into it costs money too, and kills animals. It’s really too bad that it involves same-sex couples, otherwise we’d easily all agree that it is ridiculous and wasteful and unethical. The bright side though is that by banning it, we could do it as part of a compromise to win practical benefits for same-sex couples that they are currently being denied, even in Massachusetts.
In other ways, absolutely no!
<
p>
I do agree that my utopian government-run health insurance system would not cover extra-ordinary (hypen intended) efforts to concieve children. Just as today in most private health plans, all but the most basic fertility methods would be too costly too include as covered services.
<
p>
HOWEVER, I continue to think your basic idea to outright ban certain scientific methods that safely and effectively help couples concieve a child is ludicrous. I’m particuarly concerned that it seems to be a direct challenge to the sexually-related privacy guarantees granted under our Constitution by Griswold v. CT, Roe v. Wade and many other cases. Your proposal is virtually the same kind of intrusion in to our private lives that radical Christianity is pushing in so many ways.
<
p>
Stay out of my bedroom!
But it wouldn’t ban any methods that safely and effectively help couples conceive children. It would ban unsafe in ineffective attempts to use genetic engineering to alter a person’s genes so that they can mate with someone of the same sex. This is proven to be unsafe in experiments in mice and pigs (success rate < .002) and is unsafe in principle, because it requires trial and error. I’m not talking about IVF procedures, or using donor gametes, I am talking about genetic engineering.
<
p>
And it’s not an intrusion into anyone’s private lives, since people’s sex is public. It is public knowledge that a same-sex couple has to use genetic engineering to have a child.
<
p>
And it wouldn’t be done in the bedroom, this would be done in labs.
<
p>
And if people claim it is a right to try it, and it requires extra-ordinary procedures, then we will have to start funding it, just like we have to fund access to other reproductive rights. IVF services are easier to exclude from insurance coverage than same-sex conception services would be, since a same-sex couple would clearly (publicly) require it while a both-sex couple has other options (keep trying in that private bedroom).
who was also dropped on his head as a young child.
I’d be happy to try to explain it to him to. What is it you don’t agree with?
And the rich come here for cash medical help.
<
p>
You need to look two things squarely in the face.
<
p>
Who will do rationing? I had a friend almost die at 56 because she was bumped from the UNOS kidney list by a woman who was 82 in worse condition (D’oh!). While she got her kidney just in time, many do not. So – who decides the cutoff age? Do prior bad acts (a history of alchoholism/diabetes/etc.) keep you off the list? Would an unrelated heart condition? What about Down’s Syndrome? How do you make medical rationing compliant with the ADA?
<
p>
Are you willing to criminalize non-list medical care for the wealthy? How would you enforce it?
<
p>
And that’s just the TIP of that iceberg…
but NOT tacitly accepting the present U.S. style rationing based on a “wallet biopsy” (when the Emergency Room clerk finds out what insurance you have before you’re even seen, which then impacts how you are treated). and the rationing that occurs to the 47 MILLION Americans who have NO INSURANCE AT ALL. isn’t that a more urgent iceburg to get all riled up about?
<
p>
of course we need to address the rationing issue too, pp, as part of devising a universal coverage system. but it’s not all that tough to do; much of it has been thought through and exists to be drawn upon already and most of us health professionals and others who have a solid understanding of the issues are ready and willing to support this process as an integral piece of reforms that will guarantee (not mandate) affordable quality coverage for all.
<
p>
what a smart, civilized approach. click this link to have a look at how 16 other countries do it – they each provide better, more affordable care with a variety of universal coverage systems.
We are already rationing health care, just not based on any decent crtieria but ability to pay. Try not being able to afford health insurance for 6 years. (And even now, I really, really am disappointed with the crappy service of my mid-tier HMO.)
<
p>
For every anecdote about rationing care, I could give you one of someone who otherwise might have died that had the care they needed thanks to universal governemental coverage, and who swears by their system (and wouldn’t move to the US for all the tea in China). I am so sick of hearing anecdotes. I am so very sick of the lack of caring on the part of many Americans for their 45M+ uninsured fellow citizens.
<
p>
Have health care? There but for the grace of {deity] goes you.
That is beneath you.
She’s talkin’ about the ER.
<
p>
A few years ago, a friend of mine was denied treatment for abdominal pain at one hospital’s ER because his insurance, for some reason, required him to go to another ER twenty minutes away.
<
p>
His appendix burst on the way over. Good fun for all!
Very sadly, people in the US die every day because they canot get a kidney. Is there any reason to believe that Europeans do a worse job of allocating kidneys than we do?
<
p>
We ration here like crazy – and even you are in favor of it. We have to ration. Let’s suppose that there is a potion that can extend life by one hour, and it costs $1 trillion. Are you in favor of forcing insurers to cover it so we can say we don’t ration? Should we put $50,000 implantable defibrillators in every adult? Heck, they would virtually eliminate sudden cardiac arrest, the most common form of death in the US (1 in 7 of all deaths). Should we do mammograms daily?
<
p>
Realistically, we ration because of inability to pay, or because the cost is too high for the benefit, or because of plain old ignorance ignorance. The same patient with the same diagnosis might have a procedure covered by one insurer, but not by another. Vaccines are effectively very rationed in this country – we have a low vaccination rate compared to the rest of the industrialized world.
<
p>
We also push things that make money even if they’re not a good idea – something that happens far less often in other countries. 50,000 Americans were killed by Vioxx – 15 times more than were killed by al Qaeda. Since nobody ever thought that Vioxx was any more effective than ibuprofin (e.g., Advil), and since ibuprofin is extremely safe, it’s fair to say that there was no good reason for the vast bulk of those 50,000 to be on Vioxx instead of ibuprofin. But Vioxx cost $100 a month or so, whereas ibuprofin is $5 a month. What do you think happened here? Vioxx was not used nearly as much in Europe, precisely because it was expensive and unproven.
<
p>
Rich people coming here is not really significant. First off, it’s very, very rare for a person to come here from another industrialized country for a procedure. When they do come here for procedures, it’s typically for something that has not been proven to be safe and effective, and thus it’s not reimbursed in their country. In the US, drugs and devices have to be shown to be safe and effective before the FDA will allow them on the market. Surgical procedures, on the other hand, do not have to be demonstrated to be safe and effective via any rational route – basically, the doctors decide for themselves. So we do things here, such as spinal fusions, which other countries won’t normally pay for because there is no objective evidence that they’re beneficial.
<
p>
We can discuss details, but really this is all pretty simple: European-style healthcare simply works better and costs a lot less. What’s not to like?
Rationing is indeed key (though single-payer systems also benefit from reduced adminstrative waste – i.e. profits and high wages for health insurance companies – and from the increased bargaining power of a nationwide pool).
<
p>
It’s also, as you point ought, fraught with difficult and controversial issues. Yes, the decisions are difficult but so is governing today.
<
p>
In my utopia, the rationing would be done by a panel of health care experts. Heck, there might even be a few spots for former health insurance company executives who are now out of work.
<
p>
No, I would not support criminalizing non-list medical care for the wealthy. Though it reinforces class distinctions to allow differnet care for those who can afford it, that is a neagative to single-payer health care that we simply have to live with. The wealthy do get to buy health care that goes over and above what my panel of experts believes is essential to provide under the government’s insurance plan (just as wealthy seniors may pay for care not covered my Medicare). We’ll all just have to get over the “unfairness” of that.
if you think private insurance companies don’t ration care right now.
I’d be more than a little leery of entrusting decisions about my health care to a comittee of beaurocrat-politicians, let alone ones who make such decisions based on how a doctor chosen for me decided to fill out Form 14587/25-KJU, and whether he remembered to check the box on line 1458(b)(i)(A). Maybe they could use the same committee that decides where our kids are allowed to attend public school, or who “save” us money on our car insurance. I have chosen doctors to make those decisions, thank you.
<
p>
Rationing necessarily implies a black market for health care services. That one sought cancer treatment from a specialist, and she doesn’t qualify as being useful! Throw the book at her!
Your doctor is a terrible person to ask to ration health care for you. He/she (and, even more so, the specialists they send you two) have every incentive to provide more care than we as a society can afford to provide for everyone.
<
p>
If the policymakers decided that we (the taxpayers) ought to provide insurance to everyone, then they have a responsibility to be careful with our money. This principle requires that we only pay for health care that has been shown to be safe, effective and significantly better than the cheaper alternatives.
<
p>
Take Medicare, for example. “We” (through our elected representatives) decided to offer free health insurance to all of our seniors. But we don’t let doctors decide what services are covered. That’s done by your dreaded bureaucrats and the politicians. Their decisions are controversial and difficult but at least they are made based upon medical considerations.
<
p>
Your black market concerns are unfounded. In my system, those who can afford it can seek any additional non-covered medical care they want. They just can’t ask me to pay for it with my income taxes.
how ironic to have such a reacton to this post and your comment, LL. but it’s the truth; what is said is based on facts and logic and makes several well-argued points (that I happen to strongly agree with). these points are ultimately shaped into an interesting, cohesive, persuasive thesis.
<
p>
wel, yeah, at the same time the conclusions are a tad discouraging but let’s not get bogged down by that. reality is what it is, so let’s set about changing the present reality of things if that’s what’s needed. ok, so what do we do next?!
certainly we should not simply stand by while the increasingly insane disinformation go-round picks up steam. here’s one idea-you could sign up to be a part of MassCare’s work, for one thing. does anybody else have other ideas to add?
Adding in the “kidding on the square” comment below. Most Americans are easily spoonfed crap that leads them to vote against their best interests. (Refer to the British Daily Mirror headline.)
There are significant downsides to nationwide universal single payer healthcare coverage, we all know them, higher taxes, longer lines, less incentives for doctors to work in the United States. Seriously a lot of British, continental European, and Indian doctors come here to make more money off our private system then they can back home in countries with socialized systems. Granted if the US went universal I doubt they would have anywhere better to go seeing that we are the last industrialized country relying on poor healthcare coverage. But the only way universal healthcare can be passed is if we compromise on the issue of tort reform and give doctors an incentive to lose some money but also gain a lot more security from a universal system.
<
p>
Essentially only three things stand in the way of universal healthcare: Big HMOs, big pharma, and doctors.
<
p>
The HMO and Big Pharma lobby have no incentive to support universal healthcare since they make more money now and its cheaper to lobby Congress and state legislatures than they amount of money they would lose in a universal system. I see very little options or incentives that would placate them since either industry would be destroyed by universal coverage. But I do think that were universal coverage to include universal malpractice coverage as well with tort reform to limit the amount plaintiffs can gain off of individual doctors than I do think the vast majority of doctors would join a universal system which would allow them to refuse the malpractice insurance from HMO’s and private hospitals, and refuse the gifts and treats from Big Pharma, with doctors on our side essentially all the healthcare arguments against universal coverage would be moot and voters would be left with a stark choice between legislators that like big pharma and HMOs, or legislators that like the people and medical professionals.
<
p>
If we were to get a universal system like Canada or Europe, this drastically decreases the cost of healthcare, drastically reduces the costs of making pharmaceuticals, and drastically improves the profits of big companies such as GE which is losing billions on healthcare its foreign competitors don’t have to pay, and also drastically reduces cost for small businesses which will be more eager to hire new employees. Personally I feel that from even the neutral perspective of simple economics this would improve our economy drastically.
The English Rule made applicable in medical malpractice cases, which would have the effect of filtering out most of the truly frivolous claims that may be more costly to litigate than settle.
Anyone know what percentage of all US health care spending is for malpractice insurance and settlement payouts?
<
p>
How about the how much extra we spend in the US, as a percentage of health care spending, due to defensive medicine?
<
p>
(The results may blow your mind)
Total malpractice payouts is about $4-5 billion. Total health care spending in the U.S. is more than $2 trillion. That’s a lot less than 1%, right?
<
p>
Quantafying “defensive medicine” is tough to quantify but I would suspect is relatively small as well as a percentage of overall health care spending.
<
p>
A few other relevent statistics:
<
p>
Although excact numbers are difficult to come by, approximately 50,000 people die every year because of preventable medical errors.
<
p>
Only 1% of malpractice claims are for over $1 million.
<
p>
5% of doctors are responsable for nearly 60% of all medical malpractice payouts.
<
p>
For the source of these statistics and much more on why the system is not as out-of-control as people think, see:
http://www.citizen.o…
but I have seen data that shows malpractice ins. costs and settlements DO NOT ADD UP to being the big bad boogeyman of high health costs that they are made out to be. It’s just a way to distract us from the real causes of and real solutions to the high healthcare cost crisis.
<
p>
Defensive medicine is likely a bigger cost driver, and add to that the costs we pay for care that is really unneccessary profit-driven treatments (ie the explosion of invasive cardiology tx when cheap beta-blockers, diet and behavior changes along with watchful waiting make more sense both clinically and economically.
<
p>
You can look at data and reports on this at the Health Economics and Healthcare Delivery Research site HealthReformProgram.og
The system does a very poor job of weeding out dubious claims without causing defense expense. Your big picture is likely true, but that doesn’t make it any less galling for an obstetrician to have to defend a claim because some dip wanted a girl, and not a boy. Make the claimant and their sleazy lawyer pay, and an awful lot of irritant is removed from the system.
<
p>
The problem is that the medical system does a poor job weeding out the few bad doctors, and the legal system does a very poor job weeding out frivolous claims, all of which is good for no one except medical malpractice trial lawyers.
According to the Congressional Budget Office:
<
p>
1. Total malpractice expense is less than 2%.
<
p>
2. It’s not at all clear that defensive medicine is responsible for [i]any[/i] additional costs.
<
p>
Thanks for the link to the BU site.
Everyone has to get a peice of the action in every transaction here.
In a way I begrudgingly respect our convoluted and overly expensive health system because it provides a lot of make-work paper pushing jobs for people who answer the phone, have to sit on hold, have to produce different formularies and guidelines etc etc. It is like one big WPA project.
<
p>
Inefficiency pays the rent.
not Canada, UK, Spain or France. Why is that?
<
p>
I’ve spent a lot of time at Mayo Clinic in MN. You can’t swing a cat by the tail without hitting a foreigner. BTW, their front desk has translators available for 30 different languages.)
<
p>
Something similar applies to many US hospitals and clinics in and around the Michigan/Canadian border … they’re JAMMED with Canadians, arriving by the bus load. I’ve done real estate work with brokers in this region looking for clinical space just to serve Canadians fleeing their own health care system.
<
p>
In Canada, I would not be able to get Lipitor because it is not on the Canadian Rx formulary … it’s the only anti-statin that works for me, and many other high-lipids sufferers. In Canada, tough luck.
<
p>
Try getting an MRI in Toronto. The wait is 6 months to a year. In MA, next day (or at least same week.) Why is this? National health care plans RATION care. Maybe US insurance plans do too, but not to the extent of socialized medicine.
<
p>
Ours is an insurance problem. I pay out-of-pocket for many services, and nobody tells me what to do. It’s between me and my doctor. You cannot do that in Canada (but you can in the UK.) HillaryCare would have criminalized private payments. It was a political loser. Why is that?
<
p>
“Single-payer,” nationalized health care? Not for me. And probably not for a solid majority of Americans.
<
p>
PS — Our own out-of-control nationalized health care, Medicare, is going to ruin our country financially, and this is the model Ted Kennedy and AnnEm want to install for EVERYONE.
<
p>
PPS — Health care is not a constitutional right. And never should be.
It’s true that the Mayo Clinic (and the Harvard Hospitals) have lots of foreigners come – but not from industrialized countries. How do you know that great hospitals in other countries don’t attract foreigners?
<
p>
The Canadians coming to the US for service is largely a myth – other than coming for unproven procedures which are not typically reimbursed in Canada (because they’re unproven), but are available in the US.
<
p>
You can absolutely get Lipitor in Canada. Where did you hear otherwise?
<
p>
And so forth. I’ll be happy to debunk the rest if you want.
<
p>
The only legit complaint is that they do have longer waiting times for some elective surgeries. But they live longer than we do, and their health care costs A LOT less than ours, and their medical outcomes are at least as good – and everyone’s covered. Why don’t you like better outcomes at a lower cost?
<
p>
I’m not arguing that MRI wait time in Toronto is the same as Boston. However, I googled “wait time mri toronto” and here’s what I found:
<
p> * “Some elective patients can wait as long as six months for an MRI Scan”. That’s elective, and that’s some. To me, that implies a wait time of under six months since presumably elective MRIs take a lower priority to non-electives, and he didn’t say that the wait time was six months, only that some wait that long. * Ontario wait times are 7 days for an MRI
<
p>
While it does seem that MRI wait times for non-emergency type surgeries are longer in Toronto than Boston, I could find evidence that the wait time has decreased and furthermore I could find no evidence that the longer wait times had a significant impact on overall health since they are using a priority queue for the MRI — triage, effectively.
<
p>
So… where do you get 6-12 months for an MRI?