US Healthcare Expensive and Inefficient

[tomz]

Quote:

Originally Posted by FIRE'd@51 Martha, do you have any idea why Wyden's plan has gotten so little press or open Democratic support?

Part of the reason Wyden's plan is not getting much press is because it does nothing to control costs. It takes the current insurance system and jiggers it a bit so more people have coverage. There are multiple problems with healthcare in the US such as fee for service arrangements that increase cost, lack of healthcare information systems, and 45 million without insurance. If you want to see what the market has done for healthcare in this country, read Money Driven Medicine by Maggie Mahar. She makes a very good case that market forces don't work very well.

Also, I don't think anyone here is advocating what the UK has - i.e., socialized medicine. What I am looking for is national healthcare that includes cost controls and access for everyone. You can do this without having the doctors work for the government. France and Germany seem to be doing a pretty good job of it.

[tomz]

Quote:

Originally Posted by mykidslovedogs Fire'd - Did you see how rich the benefits were on Wyden's plan? (very low deductible and low low copays - no much incentive there to prevent overutilization). I have a feeling he is greatly underestimating the cost on that. That's just IMO. At least he's trying to do something, but I really do think he is greatly underestimating the cost.

We agree on something else.

[mykidslovedogs]

Quote:

Originally Posted by tomz Also, we spend almost double per capita than the next country. 51% of our spending is by or for the government (Medicaid, Medicare, SCHIP, VA, taxes used for government employees insurance, etc.) and that doesn't include the lost revenue from the tax deductions. Theoretically, if we rationalized our current system, we could provide the same level of spending as the next closest country without having to raise taxes.

Tom - Thanks for the link. I'll read through it. I have already read through some of the commonwealth posts that Martha gave earlier, and I watched a video too. They make some good points, but I still don't share their ideology, and there is definately room for improvement. I don't think our system is perfect. I think we spend twice as much as other countries because we can afford to, and we choose to.

I really don't understand how the gov't can price control without eventually affecting quality. It might work for a few years, but 20 years down the road...?

[Martha]

Quote:

Originally Posted by tomz Part of the reason Wyden's plan is not getting much press is because it does nothing to control costs. It takes the current insurance system and jiggers it a bit so more people have coverage. There are multiple problems with healthcare in the US such as fee for service arrangements that increase cost, lack of healthcare information systems, and 45 million without insurance. If you want to see what the market has done for healthcare in this country, read Money Driven Medicine by Maggie Mahar. She makes a very good case that market forces don't work very well. Also, I don't think anyone here is advocating what the UK has - i.e., socialized medicine. What I am looking for is national healthcare that includes cost controls and access for everyone. You can do this without having the doctors work for the government. France and Germany seem to be doing a pretty good job of it.

I am willing to accept Wyden's plan as a compromise position. I prefer a Medicare for all type plan. I am researching more the cost issues that Senator Durenberger is looking at. It is very hard to develop a mechanism to reward quality rather than quantity, but certainly the insurance model hasn't been successful in that regard. It compensates for quantity. We have to look both at how we pay for health care as well as how we deliver health care.

[Martha]

Specifically on the high cost of health care in the US, I suggest reading Dartmouth Medicine: The State of the Nations Health

http://dartmed.dartmouth.edu/

Investigating staggering differences in how much Medicare spends on patients in various parts of the country, the Dartmouth team has discovered that in Manhattan and Miami, chronically ill Medicare patients receive far more aggressive care than very similar patients in places like Salt Lake City, Utah, and Rochester, Minn. Their research reveals that Medicare beneficiaries in high-cost states are likely to spend twice as many days in the hospital as patients in low-cost states and are far more likely to die in an intensive care unit. The
odds are higher that patients in high-spending regions will see 10 or more specialists during their final six months of life. These facts alone aren't terribly surprising. But here's the stunner: Chronically ill patients who receive the most intensive, aggressive, and expensive treatments fare no better than those who receive more conservative care. In fact, their outcomes are often worse.

In high-cost regions, "patients with the same disease have higher mortality rates, very likely because of medical errors associated with increased use of acute-care hospitals," Wennberg and colleagues noted in a 2006 study of patients suffering from chronic diseases like cancer or congestive heart failure. As Fisher puts it, "Hospitals can be dangerous places—especially if you don't need to be there."

[FIRE'd@51]

Wyden's plan eliminates Medicaid, but retains Medicare and the Military in their present form. I know the total healthcare costs in this country are about $2 trillion, which works out to $6700 per person per year.

Tomz, do you know how much of the $2 trillion is Medicare and Military? IIRC, Wyden's plan starts off with premiums of about $350 per month for an individual, and $750 per month per family. As far as the "generosity" of his plan goes, that could be changed. I think the fact that he covers nearly everyone, does it through the tax system which forces compliance, and eliminates the tie between jobs and insurance, without forcing everyone into managed care are all good things. Congress can change the benefits if they are too "generous". It just seems to me, that Wyden has put something out there that is not drastically different (in terms of how we receive our health care) than the present system. By getting everyone into the system, he eliminates a lot of the cost-shifting that is present in our current system.

Why not take his proposal and work from it?

[Mwsinron]

Under his plan it would cost my wife and I more than getting our own insurance. I know damn well we wont be paying 750 a month for us. It should have some kind of adjustment built in for people who are healthy verse the more unhealthy.

[Martha]

Keep in mind that employers pay quite a bit of money for insurance and employee premiums are generally far less than employer cost. If employers are required to pay the money they used to pay insurance companies to their employees, the cost differential may be less or even non-existent.


(fixed typo)

[FIRE'd@51]

Quote:

Originally Posted by Mwsinron Under his plan it would cost my wife and I more than getting our own insurance. I know damn well we wont be paying 750 a month for us. It should have some kind of adjustment built in for people who are healthy verse the more unhealthy.

I guess you should love our current system, because it does exactly that. Wyden's plan is community rated. Everyone pays the same premium, old and young, healthy and unhealthy. At some time in your life you might look at $750 per month as realtively cheap for the coverage his plan provides. If you want to lower the premiums, just raise the deductible.

And as Martha points out, employers will be paying part of those premiums indirectly.

[tomz]

Quote:

Originally Posted by FIRE'd@51 Tomz, do you know how much of the $2 trillion is Medicare and Military?

As of 2003:
Medicare 17%
Medicaid and SHIP 16%
VA, Public Hospitals, School Programs 12%
Insurance for Gov't Employees 6%

Source - Centers for Medicare and Medicaid Services

Expenditures per Capita in US in 2004 = $6102

Here is some good commentary on the Wyden plan:
Wyden Plan

When I retire at the end of the year, my budget for health insurance for DW and me is $1200 per month. This is through a mediocre plan offered by megacorp, but it is guaranteed issue. We are going to look for cheaper private plans once we sell our house and move to a different state. We have some minor things (who doesn't when you hit 55?) which we hope won't keep us from getting private policies, but at least we will have coverage (if we can afford it) until Medicare.

[Mwsinron]

Quote:

Originally Posted by FIRE'd@51 I guess you should love our current system, because it does exactly that. Wyden's plan is community rated. Everyone pays the same premium, old and young, healthy and unhealthy. At some time in your life you might look at $750 per month as realtively cheap for the coverage his plan provides. If you want to lower the premiums, just raise the deductible.

No I dont love it. However I like having a choice. I like being in a democracy. Not some piece of **** socialist program this guy touting.

[Freein05]

Quote:

Originally Posted by mykidslovedogs So if you are a single 25 yr old, and you are employed, and you make $100,000/yr, your cost of insurance is $13,000?! Wow. How much of what's left of your income do you have to pay for other gov't sponsored programs? Just curious.

You did not read the whole post the employee pays 6.5% and this is based on income so lower income people pay less than high income. So if you make $100,000 dollars a year you would pay $6,500 Which is about what I pay now. Lets be more realestic say you make $50,000 a year you would pay $3,250. The employer also pays 6.5% which is probably less than an employer pays here. And as I said when an employee is sick their salary is paid by of their medical insurance which also saves the company money. There system takes care of all German citizens not just the wealthy. Plus there are no preexisting condition limitations. There are about 6 insurance companies writing policies in Germany. They all must offer the basic government required policy at the government stated premium. To attract business they may offer more bells and whistles than the other company but must maintain the government set premimum. It is a single payor system so a lot of money is saved on overhead.

As I said people who profit off of our system do not want it to change.

[FIRE'd@51]

Quote:

Originally Posted by Mwsinron No I dont love it. However I like having a choice. I like being in a democracy. Not some piece of **** socialist program this guy touting.

This is why nothing gets done. What Wyden is proposing is not Socialism. He is not advocating a government takeover of the healthcare delivery system?

[FIRE'd@51]

Quote:

Originally Posted by tomz As of 2003: Medicare 17% Medicaid and SHIP 16% VA, Public Hospitals, School Programs 12% Insurance for Gov't Employees 6% Source - Centers for Medicare and Medicaid Services Expenditures per Capita in US in 2004 = $6102

You didn't provide a number for the military. But, assuming 17% of the $6700 is Medicare, we cut the $6700 number to $5560 minus the amount Medigap pays which might be another 4% or so. What I'm trying to get at is the healthcare cost per person excluding those covered by Medicare and the Military to see how it squares with Wyden's premiums. I know I could dig up these numbers, but you seem to have everything at your fingertips.

[tomz]

Quote:

Originally Posted by mykidslovedogs I really don't understand how the gov't can price control without eventually affecting quality. It might work for a few years, but 20 years down the road...?

The VA system (which is different from Walter Reed, which is run by the Dept. of Defense) has an admirable record providing quality care at a decent price. It has had it's ups and downs, but in the last few years, the VA hospitals have had the highest quality ratings from the various accrediting agencies. There have been a number of articles/studies done on their care in Annals of Internal Medicine, New England Journal of Medicine, and Health Care Strategic Management among others. They are leader in Hospital Information Systems and they keep costs down. They negotiate directly with drug companies and their drug costs are significantly less than what Medicare recipients pay.

According to one study "When researchers compared VA Health Expenditures for all health care...they found hypothetical payments to Medicare providers would have been more than 20% greater the cost of care at VA."

The VA system is essentially socialized medicine. I'm not sure that a VA model would work for the public at large, but in the US, they probably do as good or better job than anyone.

[tomz]

Quote:

Originally Posted by FIRE'd@51 You didn't provide a number for the military.

AFAIK, it's included in the 12%, which is called "Other public spending". The link I referenced above has some good discussions on Wyden.

[Martha]

Quote:

Originally Posted by Mwsinron No I dont love it. However I like having a choice. I like being in a democracy. Not some piece of **** socialist program this guy touting.

What choice? Only healthy people with money or jobs have choices. I have no choices, there is only one plan my husband and I can buy. It is much pricier than $750 a month.

But at least I have something. And I am blessed with money. Other people have no choices. I refuse to accept that it is anti-democratic or socialist to have a national solution to the health care coverage problem. And as FIRE@51 says, it simply isn't socialism; Wyden's plan keeps the insurance model.

I grew up where most people had very little money, in the poorest area of Minnesota. Some people had subsistence farms. Some people didn't even have indoor plumbing. I know today plenty of people who make less than $20,000 a year. I knew a woman with a poor paying job and no health insurance, always lived a healthy lifestyle. In fact, she worked in a health food store. She delayed having a breast lump checked because of the cost and because, after all, most are benign. She now is dead of breast cancer. I know street kids who struggle with a childhood of abuse and neglect. They get no health care to speak of. I recently paid copays for Risperdal and Lexapro for a young woman with PTSD who lost her job and ran out of money to pay even a small copay. Without the drugs she will end up in the hospital or may even be suicidal. I know people who struggle with mental illness who are limited in the care they can be reimbursed for under insurance plans or Medicare. I filed bankruptcy for a young woman with cancer after a collection agency for a hospital told her she should have died if she had no intention of paying her bill. I spent law school working on social security disability appeals after the government decided it would deny claims based on mental illness. I am tired of them all getting ****ed.

[Martha]

Oops! Got away from a dispassionate discussion of the issues.

I will compromise, really I will.

[Freein05]

Why do people think they have a choice in the US for health insurance. United Health Care (I think that the name) has been buying insurance companies throughout the country. One of their last buys was Pacific Care. We are getting socialized health insurance the corporate way. Corporation run and dictate our health care. Remember corporations main goal is to produce profits for their share holders not for you the patient.

If the consolidation in the health insurance industry continues you will only have a hand full of choices. What than do you think you will pay for health insurance? At the current annual increases of 8% plus a year no one will be able to afford health insurance. More and more companies are dropping health care because of the costs. We need a single payer system with the government setting minimum standards. Costs controls would also be required. Private insurance companies could write policies based on the standards. Germany does this and it works. As I said in my earlier post the health care provided in Germany as is good or better than in the US. Everyone pays to fund it. Part of the national sales tax is used to fund it.

[Rich_by_the_Bay]

Quote:

Originally Posted by Martha Oops! Got away from a dispassionate discussion of the issues. I will compromise, really I will.

Actually, you never sounded more convincing. This is indeed an emotional issue -- that's the point. It is not something to be decided strictly on the basis of accounting.

Go a job? Got money? Got health? Great - this is a terrific if obscenely expensive system. You win, just like you can drive a BMW while someone else takes the bus. But we're not talking about cars, we're talking about lives.

Yes, it will take unimaginable accounting, planning, politics, and compromise, But in the end it's a highly emotional issue. It may not be politic or strategic to wave that banner all the time, but nothing wrong with acknowledging it. After all, that's the point.