Originally Posted by ziggy29
Anyway, getting away from the politics, the bottom line from a practical standpoint is that still almost no one is emphasizing cost containment, which is really at the root of much of the health care problem.
That's certainly one of the biggest issues, and the one glossed over the most. And it is huge.
It seems to me that, conceptually, there are two fundamental ways to control costs:
-- A) From the supply side. Limit the procedures patients are allowed to have (effectively limiting the number of procedures), and limit what the insurers/government are allowed to pay for them (the unit price).
-- B) From the demand side. The customer decides which services to buy (which insurance policy to buy and which medical services to buy with his co-pay) and shops for a price.
Our present "system" uses neither of these processes very well. The govt (Medicare) has supply-side cost controls which leads to cost shifting to the private side of the system and leads to the normal resource scarcity that always results when goods or services are priced below demand. The private side has only rudimentary cost controls--there's no efficient market for individual health insurance, there's no way for patients to shop for services by price, and there are few incentives to do so.
All the other cost-saving things being discussed (electronic records, re-importation of pharmaceuticals, reduced overhead and admin, etc) will happen only within one of the two frameworks above.
The current "reform" proposals (House and Senate) concentrate on supply-side controls.
One newly surfaced possible amendment to the current Senate proposal takes a few baby steps toward recognizing the potential of demand-side controls. I can't find the link to the article (apologies!), but a democratic senator has proposed allowing nearly anyone to buy individual insurance from the "insurance exchanges" that would be set up (the present Senate bill only allows these purchases by individuals who work for small employers or who are otherwise not covered by employer-sponsored insurance). In addition, (IIRC) the amendment encourages high-deductible policies (by letting people pocket the money saved) and expands availability of HSAs. The devil is in the details, but this approach, to me, is much more attractive than putting limits on the supply of services. And, if we can cut or weaken the employer-->insurance link, that's even better.