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Old 08-12-2009, 03:09 PM   #1
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Platform for all Health Care Debate

This is a great article for all to read - I think we could all have a lot more heat than smoke generated if everyone started here. This was published in the New England Journal of Medicine last fall. Everyone can probably find it by googling.

Anways, here are the three inconvenient truths.

1. Over the past 30 years, U.S. health care expenditures have grown 2.8% per annum faster, on average, than the rest of the economy. If this differential continues for another 30 years, health care expenditures will absorb 30% of the gross domestic product1 a proportion that exceeds that of current government spending for all purposes combined.

2. Advances in medicine are the main reason why health care spending has grown 2.8% per annum faster than the rest of the economy.3
(Not waste, fraud, etc. - this is the price we pay to make ourselves healthier and to live longer and happy. - my comments)

3. Universal coverage requires subsidies for the poor and those too sick to afford insurance at an actuarially appropriate premium; it also requires compulsion for those who don't want to help pay for the subsidies or who want a "free ride," expecting that they will get care if they need it.

(IE, under universal health coverage, the wealthy and healthy must subsidize the poor and sick - and the former group must be compelled to pay and the latter group must be compelled to recieve - my comment)

Personally, I think that if the powers to be cannot agree upon the above three facts, nothing can be accomplished. And if we do not accomplish anything now, we will all be paying for this later. Or maybe we will be dead, and the burden (like many others) will fall upon our children, grandchildren and other descendents yet to be born.

On the hopeful side - perhaps some small changes to our healthcare web may lead to major cost reductions in the long run.


Three "Inconvenient Truths" about Health Care
Victor R. Fuchs, Ph.D.
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Old 08-12-2009, 03:41 PM   #2
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I'm not convinced about point #2. Not saying it's false, but I looked up the original reference, and the articles footnoted therein and couldn't get to any analysis supporting the statement that advances in medicine are the main reason for such fast health care cost growth. There's no question that we've had tremendous technological advances in medicine, I'm just a bit surprised that this would be the main reason for cost growth. Every other industry goes through technological advance but, if anything, such advance places pressure on prices, not vice versa. I'd like to know why the medical industry is different.

As an example, there's something called a da vinci robot that helps a surgeon performs better surgeries. It's an expensive machine, no doubt -- something like $2M a copy. But if it cuts surgery time in half, and hospital patient stay by many days, it's not clear the bottom line should translate to higher health care costs.

Regardless, accepting those three points doesn't, in my mind, alter the need for universal health care in this country. As far as compulsion, we're all under compulsion to pay for services deemed essential by the majority, through taxes -- police, fire, defense, etc.
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Old 08-12-2009, 05:24 PM   #3
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3. Universal coverage requires subsidies for the poor and those too sick to afford insurance at an actuarially appropriate premium; it also requires compulsion for those who don't want to help pay for the subsidies or who want a "free ride," expecting that they will get care if they need it.

(IE, under universal health coverage, the wealthy and healthy must subsidize the poor and sick - and the former group must be compelled to pay and the latter group must be compelled to recieve - my comment)
Um, that's sort of the idea behind any insurance policy. Not the wealthy/poor spin, but the whole idea that many individuals pool their contributions to cover the expenses of those who meet the terms of the coverage requiring payment.

If I live in Florida and buy a hurricane insurance policy, my purchase is pooled together with the purchases of all others buying that insurance policy. If no hurricane hits, there are no payouts, and the funds accumulate. If a hurricane hits the other end of the state, they get paid compensation, but I keep on paying.

If the poor and healthy buy insurance, they happen to be contributing to the same pool the wealthy and sick who have insurance draw from. Yes, some folks will read this and declare insurance to be socialism, although the workers don't actually control the means of production.

I suppose we could set up special insurance pools for just the wealthy, or just the poor, and perhaps slice and dice further to have risk pools for just the wealthy with parents who had Huntington's disease, or hurricane insurance pools just for those living on the Outer Banks without sea walls in structures not meeting code. This would result in insurance rates much higher for some pools than others, and would likely cause some folks to go without insurance, deciding that they could not afford it (poor) or to self-insure (wealthy).

Of course, that then leads to a situation where the uninsured who are not self-insured, in need of medical care, then show up in emergency rooms which must treat then under Title 42 U.S.C para 1395dd, "The Emergency Medical Treatment and Active Labor Act", if the hospital happens to have accepted Medicare or Medicaid payments.
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Old 08-12-2009, 06:22 PM   #4
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Item 2 is inconsistent with some studies that I have read. And remember the countries that have half the cost we do and as good outcomes. One author I read a while ago who discussed the cost issue came to the conclusion that the primary reason our costs are so high is that they can be.
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Old 08-12-2009, 07:02 PM   #5
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I had problems with truth number 2 also. As a health care worker I can personally relate story after story of waste and fraud. However, I do know that the author is a lot more knowledgeable than me.

Clearly modern medicine is nothing short of miraculous. What would our ancestors think of organ transplants? How much is the life-saving therapy of a new kidney, or an antibiotic, or artificial surfactant for a premature infant worth? And what about new hips or knees, and for us guys (and gals), the true youth-restorative Viagra. (Not that I need it yet). So maybe he is right, health care costs are skyrocketing because the advances are so amazing!

It doesn't really matter, because the scarey inconvenient truth lies in fact number 1.

The two pronged dilemma of decreasing costs and universal health coverage are complex, separate, yet entwined.

For the record, I am a proponent of Health Care Reform. I think that any American who thinks the "system" should not change at all 1) has great health insurance paid for his/her employer and doesn't realize how ephemeral that security is; and 2) harbors a great deal of generational selfishness, because without any reform we are just "kicking the can down the road".
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