Krugman on Health Care Crisis

[cute fuzzy bunny]

Or hibbert. Anyone who giggles inappropriately right after telling you that you've got incurable cancer isnt quite right in the head either...

 

[JohnP]

I'm pleased with the response to this topic!  It's amazing how the Krugman article dovetailed so well with the 60 Minutes 'cost of hospital care to employed wage earners without health insurance' clip. 

I don't know if the Krugman proposal is feasible... but, I know the Health Care System we have now costs a whole lot and increasingly leaves out a sizable portion of the population.  The US govt pays for approximately half the health care in the US (in the form mainly of Medicare and Medicaid)  and yet large numbers of people are left completely out of the system.  Meanwhile, the per capita expenditure of the US is twice what other countries are paying. 

Krugman 

The US health care system is more privatized than that of any other advanced country, but nearly half of total health care spending nonetheless comes from the government. Most of this government spending is accounted for by two great social insurance programs, Medicare and Medicaid...

...Medicaid has grown rapidly in recent years because it has been picking up the slack from the unraveling system of employer-based insurance. Between 2000 and 2004 the number of Americans covered by Medicaid rose by a remarkable eight million. Over the same period the ranks of the uninsured rose by six million. So without the growth of Medicaid, the uninsured population would have exploded, and we'd be facing a severe crisis in medical care...

...

In past HC topics in this forum we have identified several potential reasons for the US  per capita expenditures, including excess paperwork and overhead.  Krugman also discusses these in the article.

...The cost advantage of public health insurance appears to arise from two main sources. The first is lower administrative costs. Private insurers spend large sums fighting adverse selection, trying to identify and screen out high-cost customers. Systems such as Medicare, which covers every American sixty-five or older, or the Canadian single-payer system, which covers everyone, avoid these costs. In 2003 Medicare spent less than 2 percent of its resources on administration, while private insurance companies spent more than 13 percent.

At the same time, the fragmentation of a system that relies largely on private insurance leads both to administrative complexity because of differences in coverage among individuals and to what is, in effect, a zero-sum struggle between different players in the system, each trying to stick others with the bill. Many estimates suggest that the paperwork imposed on health care providers by the fragmentation of the US system costs several times as much as the direct costs borne by the insurers...]...

Best regards

JohnP

 

[haha]

Anyone recommending the VA as a model for nationwide healthcare must be carrying their own personal insurance.  Or else they're planning to use Bumrungrad for the big stuff.

Nords, if you go to a military hospital, your care is both paid for and delivered by the government. And TriCare has the social insurance model of Canada, Germany, etc. Which is, incidentally, the model Krugman put forth before he discusses full government provision of care with providers as employees-- same as in a military hospital like Walter Reed or Bethesda or Madigan. So you have dorect experience with these, and I assume that you are satisfied. At least satisfied enough that you are not planning to go into the individual market.

The part I can’t understand is what evidence suggests that the USA, paying twice as much as France, for less care, can possibly be doing a good job for its citizens or taxpayers. It doesn’t matter how you measure care- use lifespan, use number of visits, use consumer satisfaction, France is ahead. And they aren’t the only country either.

Regarding VA care, my buddy has hereditary spherocytosis, a blood disease. The VA correctly diagnosed him, gave him a splenectomy, and monitors and cares for him subsequently. He has work insurance, but prefers what he gets at the VA- most of whose Docs also have academic appointments.

Right now we have great medical care and can get it on demand but at very high prices and without access for everyone in the country.

My take on government run (or single payer) medical care is that there will be high medical access for everyone but at a cost of quality and on demand service.

So those other countries trade quality and timeliness for widespread access. Maybe that's a choice we should make. But at least let everyone know the trade-offs we will be making and have an even-handed debate.

Think US Post Office like service when you think of government run or single payer medical care. It gets the job done but you may wish the service and the timeliness was better.

You must not have read Krugman's article. Every knee jerk ditto head parrots this same tired and inaccurate line: “We have great care, and that is why is costs so much.” At least read and attempt to understand the article. I am only interested here because I have some hope that people who are going to be voting will have a full range of facts, and the information to see how our current system is out of keeping with our ideals as a democracy. Democracy requires some degree of social justice, and this medical situation is a clear violation of social justice. Plus, as Krugman says, it is horribly inefficient.

We will get social insurance anyway, the meltdown of employer provided insurance will see to that. But why not do it now, and save a lot of money and heartache?

And regarding the post office - try to get 6 day a week delivery to the remote places where a fair number of us live, for 40 cents no less, from anyone else other than the post office. My mail lady bags packages that she has to leave. The clod from UPS throws them on the ground in the rain. This is spite of repeated calls to the UPS office. All in all, I'll take the post office for most things.

Ha

 

[MasterBlaster]

What's with all this hostility ?

Are you are calling me a "knee jerk ditto" ??


Our system has alot to be desired and there is lots of room for improvement. There is a trade-off to be made here. Maybe we should have a great debate about what kind of system we want.

However if you believe that everyone can have the same level of care and pretty much immediate access then in my "knee jerk" opinion you are mistaken.

 

[Gone4Good]

Anyone recommending the VA as a model for nationwide healthcare must be carrying their own personal insurance.

I too wonder how many of those advocating single-payer, Canadian or European, style systems have actually experienced them first hand. Although I only have experience with the US system, I have heard many complaints from ex-pat friends about their inability to see doctors, get up to date medications or procedures, etc. etc. One friend actually waits until her periodic trips back to the states to see the doctor for routine exams.

Is there anyone here who has actually experienced both systems and has an informed opinion about the benefits / drawbacks of both?

 

[mikew]

Just my experience
I have Japanese national health insurance and am satisfied. I pay 150 dollars a month plus a 20% copay. The govt pays the rest. You can choose your doctors. Some doctors don’t know anything and there is a lot of malpractice.  I had some problems with a doctor mistreating me for my asthma. I also had a dentist who relied on laser technology over skill. The average doctor is better in the States. But there are enough good docs that if you are careful it is fine. Now I basically choose doctors with foreign licenses. My eye doctor and dentist both graduated from top US universities. My generalist graduated from a Japanese university but he knows his stuff and I trust him. 

The insurance will pay for eye exams but not glasses, dental visits but not orthodontics. I also get a yearly check up free (that may be employee sponsored) but I would have to pay 100 dollars (?) for a more intensive check up at a hospital. It also covers drugs. An MRI is 100 dollars. It will also pay for emergency treatment when I am overseas.

I haven’t gone far into the system but my experience has been basically service on demand. However, you do have to wait for good doctors. My FIL had to wait a month for his cancer surgery because he wanted to do it at Kyoto University Hospital with a specific surgeon. I had to wait 2.5 hours to see my eye doctor.

I used to wait to go back to the states to get care but as my Japanese language skills have improved and I have learned to choose my doctors, I haven’t felt the need to wait.

Also, I am not sure but you probably are not going to get the most advanced treatment or procedures in Japan. I think they are more focused on bang for the buck over buck for the bang.

Mike

 

[yakers]

I live under the US system with a "good" HMO Kaiser. I had social medicine with the Navy and when I was living in the UK and I have relatives in Canada. There are problems in each system but overall I would take Canada as the best of the lot. In the US I think we pay too much, have too much defensive medicine and far, far too many uncovered people. I think there would be a big boost to the economy if we had national medicine and small businesses as well as large ones could hire without paying for or worrying about and maybe not offering medical insurance.
Like defense I do not believe that medicine is purely a business. If it was I would vote to abolish all insurance and then the market would lower medical costs.

 

[astromeria]

In the squeeze:

My brother--a case of shock & awe:

He's a small businessman with private insurance that excludes his one prior condition, back pain. But that was lower back pain from many years ago, and last year he developed a pinched nerve in his cervical (neck) spine and after his right arm went numb and he could barely move it, he had surgery to fix it. His surgeon and anethesiologist charged him the insured rate, but the hospital charged him $30,000 for his overnight stay (the uninsured rate). His surgeon is helping him fight this, but it doesn't look good.

Me--a case of fear:

I've put on weight and am afraid to have that on my medical record, so I'm way overdue for my physical. Sheesh! A middle class person with insurance afraid to go the doctor for fear of becoming uninsurable--now that's sad.

 

[cute fuzzy bunny]

Isnt that sort of like risking a 20% loss on your investments because you want to avoid a 1% sales fee?

Maybe you should consider paying out of pocket for a physical at a low cost provider where it wont land on your insurance companies medical records? It might suck if the weight gain was a 27lb tumor or something, or if the weight gain is from some medical condition thats curable with a diet change or a little pill or something. Not that I recommend little pills.

My wife told me yesterday that they had a woman in the hospital that had a 150lb tumor removed. Thats considerably more than my wife weighs. Amazing.

 

[REWahoo]

Maybe you should consider paying out of pocket for a physical at a low cost provider where it wont land on your insurance companies medical records?

Not sure this is something I would want to do. If I recall the health insurance application I completed, it asks for ALL records for doctor visits going back X years, and spells out that any omissions could be grounds to terminate your coverage. It would be a tough sell if discovered to say you forgot about such a recent visit.

I say go see the doc about your weight gain. There are way too many risks in not doing so.

 

[cute fuzzy bunny]

Fake moustache, fake name, and when you're done with the doctor visit you can drink beer do remedial maintenance on dory's server...

 

[renferme]

Krugman's a liberal a.h.

 

[Nords]

Nords, if you go to a military hospital, your care is both paid for and delivered by the government. And TriCare has the social insurance model of Canada, Germany, etc. Which is, incidentally, the model Krugman put forth before he discusses full government provision of care with providers as employees-- same as in a military hospital like Walter Reed or Bethesda or Madigan. So you have dorect experience with these, and I assume that you are satisfied. At least satisfied enough that you are not planning to go into the individual market.

Regarding VA care, my buddy has hereditary spherocytosis, a blood disease. The VA correctly diagnosed him, gave him a splenectomy, and monitors and cares for him subsequently. He has work insurance, but prefers what he gets at the VA- most of whose Docs also have academic appointments.

Let's just say that the military healthcare system has inspired me to adopt "prevention" as my primary healthcare manager.  There's a reason that the Tripler Army Medical Center is referred to as "Crippler".

As for the rest of the system, the VA does means testing and the TRICARE system is preparing to triple its annual fees.  While neither of these is worth complaining about in respect to the remaining benefits, this salami-slicing does set an uncomfortable precedent to future Medicare/Medicaid benefits. 

It may feel pretty silly fighting back when there's so much good remaining in the system, but it's too late to fight back in 20 years when all you're holding is a salami string.

Is there anyone here who has actually experienced both systems and has an informed opinion about the benefits / drawbacks of both?

Aye, there's the rub. And let's remember that as much as half of the American doctors graduated in the lower 50% of their medical school class.

 

[Martha]

Krugman's a liberal a.h.

I wonder why you think this? Is it because of some specific information that you have not apparent from his article?

Or do you maintain that publically funded health insurance is the provence of liberal a**h***s?

 

[cute fuzzy bunny]

Well, he IS well known as "america's looniest liberal pundit"...

As far as the a.h., I cant comment. I'm not familiar with that particular degree.

 

[Nords]

As far as the a.h., I cant comment.  I'm not familiar with that particular degree.

And you said that with a straight face, too!

 

[Martha]

Well, he IS well known as "america's looniest liberal pundit"...

Is this a case where someone is labeled by others as a nut because they disagree with him? Or are there facts to back this up? Such as the guy doesn't back up his claims with data, or that his data is faked.

If we have discussions about health care dismissed with claims that people are a**h***s or nutjobs, or whatever, we are never going to get anywhere on dealing with the healthcare problem. Of course, if people don't think there is a problem, we aren't going to get very far either.

 

[MasterBlaster]

Here's the problem in a nutshell with changing the current system. Most people have (argueably) decent healthcare.

What the single payer system proposes is for most people to accept a somewhat worse system so that everyone can be covered. The degree to which the coverage for most people declines is the subject of the debate.

Some (the free lunch crowd) think that you can have all of the current goodies and still cover everyone. Others are very weary and plausibly think that we should be careful what we ask for.

The challenge is to get the majority of people to give up some of what they have now. That's a hard sell. Just look at government employees and union employee resistance to giving an inch on healthcare. That's an indication to the single payer proponents as to the uphill fight that they have.

 

[cute fuzzy bunny]

Is this a case where someone is labeled by others as a nut because they disagree with him? Or are there facts to back this up? Such as the guy doesn't back up his claims with data, or that his data is faked.

If we have discussions about health care dismissed with claims that people are a**h***s or nutjobs, or whatever, we are never going to get anywhere on dealing with the healthcare problem. Of course, if people don't think there is a problem, we aren't going to get very far either.

Whoa, whoa......whoa! Dont git your squirrel tail in a bunch, m'am! I'm in agreement on dealing with the healthcare issue. The 'label' is in fact that. But I dont equate a lack of data or facts with liberalism either. It appears from reading his stuff that he's liberally bent. Not that theres anything wrong with that.

And you said that with a straight face, too!

Yes I Did.

 

[Martha]

Whoa, whoa......whoa! Dont git your squirrel tail in a bunch, m'am! I'm in agreement on dealing with the healthcare issue. The 'label' is in fact that. But I dont equate a lack of data or facts with liberalism either. It appears from reading his stuff that he's liberally bent. Not that theres anything wrong with that.Yes I Did.

Yeah, I know that. I just wondered where Bennevis was coming from. I know where you come from.

 

[cute fuzzy bunny]

Ok, I didnt post ANY of the first 5 things i thought of.

Just so you know there IS actually SOME restraint...

 

[Martha]

Here's the problem in a nutshell with changing the current system. Most people have (argueably) decent healthcare.

What the single payer system proposes is for most people to accept a somewhat worse system so that everyone can be covered. The degree to which the coverage for most people declines is the subject of the debate.

Some (the free lunch crowd) think that you can have all of the current goodies and still cover everyone. Others are very weary and plausibly think that we should be careful what we ask for.

The challenge is to get the majority of people to give up some of what they have now. That's a hard sell. Just look at government employees and union employee resistance to giving an inch on healthcare. That's an indication to the single payer proponents as to the uphill fight that they have.

Good points here. Medicaid is being cut throughout the county. Small employers are having a hard time providing insurance. Insurance companies want to insure healthy people not sick people. 45.8 million were uninsured in 2004 http://www.cbpp.org/8-30-05health.htm At some point they may be pissed.

 

[maddythebeagle]

The challenge is to get the majority of people to give up some of what they have now. That's a hard sell. Just look at government employees and union employee resistance to giving an inch on healthcare. That's an indication to the single payer proponents as to the uphill fight that they have.

It seems reasonable that folks with employer sponsored health care dont want to pick up the tab of huge cost increases esp. when some of it is from cost shifting (somebody has to pay the true costs of health care for low medicaid and medicare reimbursements). Employers dont want to pay it either, so I figure they will be the a.h.'s that actually have the power to get things changed.

 

[work4beer]

What the single payer system proposes is for most people to accept a somewhat worse system so that everyone can be covered. The degree to which the coverage for most people declines is the subject of the debate.

Some (the free lunch crowd) think that you can have all of the current goodies and still cover everyone. Others are very weary and plausibly think that we should be careful what we ask for.

I don't think single payer with provider choice guarantees a worse system for everyone, if we did something like a HDHP for everyone. You and/or your employer contribute tax-free to an HSA. Maybe add credits for those with low income. The gov't only pays for those that exceed the high deductible, for the tax break, and for any low income contributions, and the only time doctors deal with the feds is when you go over the deductible. If you have the dough, you can always just pay the doctor more or go to private only doctors. The feds only act as an insurer, and give most tax incentives.

I don't think it's "the free lunch crowd" behind this. The government is already paying for 40-60% of the health care. The difference is, it has entirely different programs for veterans, old people, old poor people, poor people, and gov't employees. And YOU are already paying for the uninsured to get the most expensive health care available, at the ER. We pay so much and get so little currently, it's almost impossible to think of a more expensive, less effective system.

 

[JohnP]

I'll certainly second WW4Beer's above sentiment!

...The government is already paying for 40-60% of the health care.  The difference is, it has entirely different programs for veterans, old people, old poor people, poor people, and gov't employees.  And YOU are already paying for the uninsured to get the most expensive health care available, at the ER...

The US govt already pays as much (on a per capita basis) to insure "...veterans, old people, old poor people, poor people, and gov't employees... " as other countries pay to insure ALL of their citizens.    

This would be one thing if this 'inefficiency' were a fraction of a percent or less of the CDP but, in this case, we are talking about 16-20% of the entire US GDP.  These huge cost inefficiencies are occurring and increasing numbers of American citizens are not being provided for.

Currently, this govt oversight impacts "only" 48 M citizens but I fear that even more citizens will be soon cut loose to fend for themselves in the HC minefields.

JohnP