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Old 12-04-2011, 06:32 PM   #81
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If we use the available information tools to facilitate the presentation of information, we'll get an efficient marketplace in health insurance. As I mentioned, I think government can have a role in this, but if experience is any guide, private entities/nonprofits, etc will take the lead and do a better job of making the information easily understood by potential customers. If the "answer" is more company brochures and sales pitches, we've probably screwed up.

Remember that sellers of products make higher profits when markets are inefficient. They are not interested in efficient markets, because efficient markets drive down margins. And we're not talking about toasters here--health insurance is a complicated product. But I'm not ready to say that people are just too stupid to make good choices.
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But choosing the policy, I think is the least of our problems for the future (hopefully). Like many here have posted above we have more serious problems to figure out in health care, like cost containment, how to achieve affordable availability- doctor shortages (primary care) -elimination (for real) of insurance company abuses and ultimately how to make it available for everyone rich and poor
An efficient (regulated) market in health insurance is key to solving the medical cost problem, the focus on treatment rather than "health and wellness," the inefficient distribution of health care resources, and many other sub-problems. Just as efficient competition between suppliers brings us the best products and services at the best prices in every other aspect of our lives.
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Old 12-04-2011, 08:44 PM   #82
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YOu think the lay person is going to be able to make informed choices about medical options?

Hard enough to figure out the insurance provisions.
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Old 12-04-2011, 09:05 PM   #83
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YOu think the lay person is going to be able to make informed choices about medical options?

Hard enough to figure out the insurance provisions.
Right. Too stupid by far.

When did "adult" lose it's meaning?

If people are too ignorant to choose their own medical procedures, how can we possibly trust them to properly choose their own spouse? I can assure you much more grief and human suffering has been caused by an ill-advised selection of a mate than by poor choices regarding medical care. Where's the government assistance when we really need it?
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Old 12-04-2011, 09:17 PM   #84
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Because making medical decisions require special knowledge.

If you're going to eschew doctor's advice to "shop around" do you really want to compare what you can glean from the Internet vs. the training a doctor has acquired, not just in med school but throughout his career?

There are just some things on which most lay people have to rely on experts.
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Old 12-04-2011, 11:00 PM   #85
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eschew doctor's advice to "shop around"
Would "shopping around" include seeking second opinions? You're saying that when I "eschewed" a specialist's decision and sought advise from another doc and did some reading on my own, I was wrong to do so?
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Old 12-04-2011, 11:19 PM   #86
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No because you'd still be relying on a doctor.

The whole idea of a transparent marketplace assumes almost equal knowledge between buyer and seller about all the choices in the marketplace./

You can't compare shop medical choices like you would compare cars to buy.
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Old 12-04-2011, 11:31 PM   #87
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You can't compare shop medical choices like you would compare cars to buy.
Sorry, but for non-emergency procedures, I find out all I can about my choices, the various pros and cons, risks with and without the procedure, experience level of the provider and the facility doing the procedure, etc. This includes, but is not limited to, consulting with alternative providers.
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Old 12-05-2011, 12:10 AM   #88
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The whole idea of a transparent marketplace assumes almost equal knowledge between buyer and seller about all the choices in the marketplace./

You can't compare shop medical choices like you would compare cars to buy.
This is 2011. We are swimming in information (which, though not the same as knowledge, is better than ignorance). If the doc told you that you had xxx disease, what would you do? You'd do what nearly everyone does--you'd scurry back home, open up Google and find out about it. And you'd find out about treatments. You wouldn't become a microbiologist, but you'd quickly learn about what is typically done to treat the disease. You might even learn something that changes your opinion of the doc's proposed treatment plan.

Anyway, you've swung into the "comparison shopping for a kidney transplant" mode. As I mentioned earlier (post 81), the better place for market forces to have an impact on cost is for people to comparison shop between insurance providers--these insurance providers will then be under pressure to please customers and contain costs. When provided with the information in a clear way, people can understand what "customer satisfaction" ratings mean, what "average wait time" means, etc. If they've got a favorite doc they can see which insurance plans he accepts, etc.
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Old 12-05-2011, 01:59 PM   #89
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SamClem,

IMHO you may be a little out of touch in 2011 in the doctor category at least. You don't shop for a doctor any more (especially primary care) You hope and pray you can find one who will take you. Secondly, unless you are without insurance, you do not shop for prices for procedures. And as for having doctors tell you upfront what something cost, this does not happen unless you are the negotiator, and you never are unless you carry no insurance at all. If that is the case, the only thing you find out is the price will be negotiated up for doctor, not down for you. That's just gravy money for them. (I want to preface this by saying I do believe there are a small percentage of humanitarian doctors out there that don't fall into this category. Some even volunteer their services for free, so my hats off to them, and I offer a sincere Thank You. I'd give you a real big hug if I could) Anyway back to the subject matter.

This shortage of doctors in this country, not only primary care (though admittedly that's the worst- psychiatry second I believe) is causing the opposite to happen (theory of supply and demand) So until that problem is addressed and fixed (which in my opinion can only be fixed with government help and intervention) we will find letting the free market solve this problem inapplicable. As you realize, the end users don't negotiate and control the costs. It's the middle man that controls the costs (insurance companies or government) And yes, your proposal of the "free market" solving the cost issues is true to a point, provided we had an abundance of doctors and medical providers who were competing for the same business.

Right now we have a very strong uptick in doctors refusing to take anymore Medicare patients. I pleaded with my primary care doctor to take my mother as a patient , and was refused on several occasions (I always go back a 2nd or 3rd time) . Now whether the actual approved Medicare payment is too low for them to make a decent living, or it's more I have enough patients to chose from, I'll take the new patient who will be more profitable, I can't say with absolute certainty. But if it is because they (the doctors) have better choices, then the free market is only working for him, not for the public. If it is because they are truly not paid enough, then we need to look at that. And not necessarily by just throwing more money at it. There are ways to do that with also getting something back.

Then there's the #1 reason for preventing Early Retirement. How many people have we heard say, if it were not for the high cost of health insurance, I would be able to retire now.

As stated before, it is a very complex problem with many interwoven causes and effects. We have to un-weave these problems, one by one to be able to come up with a truly sensible solution and fix.

Lets look at shopping for policies. Only people young enough and healthy enough really get much shopping leverage. If you are say 60, or even 30 and have some pesky "condition", your leverage in the market becomes very thin. And yes, as mentioned in an earlier post, some "less sophisticated" people who buy insurance on the open market can be screwed badly by a number of unsavory companies out there very willing to take their monthly check, but not deliver when the time comes.

Here's where we differ SamClem. I elevate this category on government involvement and assistance above all other issues. It is (in my eyes) an area that needs to be closely monitored by our government for the protection of it's people. (all people) We are talking life and death here, not buying a lemon of a car. Hey, wait a minute, we have Lemon laws protecting people in that department don't we? Hmmm, I wonder which one is more important?

We need to figure out things like: how do we get more young people to go into the medical field. Maybe we have to help them pay for their medical school, and maybe enter into a contract with them to excuse X amount of dollars owed on their loans for every year they practice as a primary care physician before entering their chosen specialty field. What else is keeping them out. Can we come up with a workable plan to fix it? Where ever a problem lies, there is always a solution. We may not hit the mark the first time round, but we are bound to if we don't give up.

Personally, I'm unaffected (at least for the moment) I'm already past 65, and I've got mine, as they say. But I care about all those coming behind me, and see real problems for them, so I don't want to sit on my rump and do nothing. I think we have a crises looming out there and sooner or later, if nothing is done, it will effect everyone. The old Ostrich thing is not going to work forever.

I am a eternal optimist, so I can not accept it is not doable. Complicated yes, but always doable.
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Old 12-05-2011, 03:53 PM   #90
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I'm surprised when people tell me that they can't find a doctor who accepts new Medicare patients because the government rates are too low, but these same people believe the government will be able to impose price caps in the larger health care system and it won't result in a doctor shortage. Sometimes you even hear it in the same paragraph, or read it in the same post.

How did price caps work for gasoline in 1973-was there plenty of gas at low prices, or were cars wrapped around the block waiting to buy their 5 gallon limt? Does rent control lead to an increase in the availability of apartments, or to a decrease in availability? Price caps that "work" always result in artificial scarcity. There is a tried and true mechanism for matching the quantity of a good or service to the demand, and it doesn't involve a government pricing board. If we want more of a particular thing (good medical care, important new drugs and treatments, etc) the best we can do is let people buy it freely. And the best way to assure that their purchasing decisions reflect their true priorities is to let them, as much as possible, use their own resources to make the purchases. We may decide to tax people to help pay for the health insurance policies of the poor, but the more they are allowed to participate in paying the cost, the more judicious will be their decisionmaking.
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Old 12-05-2011, 04:00 PM   #91
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They said doctors would flee Canada when they went single-payer. In fact the AMA went up there and tried scare tactics.

Canada still has doctors.
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Old 12-05-2011, 04:02 PM   #92
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the more they are allowed to participate in paying the cost, the more judicious will be their decisionmaking.
That's pretty radical samclem! Whatever happened to that "giving according to their ability and receiving according to their need" talk?
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Old 12-05-2011, 05:05 PM   #93
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They said doctors would flee Canada when they went single-payer. In fact the AMA went up there and tried scare tactics.

Canada still has doctors.
+1

Yes, and the man(Tommy Douglas) who was ultimately responsible for actually getting universal health care started there is hailed as Canada's most respected and admired heroes (I think they have a national holiday in his honor now, but I am not certain) and voted the greatest Canadian of all time by it's citizens.

"In 2004, the Canadian Broadcasting Corporation held a national contest to determine the greatest Canadian of all time - the person who had the most profound impact on the nation. Tommy Douglas, that humble preacher who hailed from Falkirk, was declared the winner. He bested Marathon of Hope runner Terry Fox and former prime minister Pierre Elliot Trudeau"

Tommy Douglas: Hero of the common Canadian - Arts - Scotsman.com
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Old 12-05-2011, 05:49 PM   #94
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+1

Yes, and the man(Tommy Douglas) who was ultimately responsible for actually getting universal health care started there is hailed as Canada's most respected and admired heroes (I think they have a national holiday in his honor now, but I am not certain) and voted the greatest Canadian of all time by it's citizens.
At 46% less than the US private system, I can understand that.
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Old 12-05-2011, 07:35 PM   #95
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Well, you know facts don't matter.

The idea that there are just some things that should not be run for profit, is just hard for some people to get their head around. I think you can learn a lot on these forums. They can be a very good source of information worth sharing and discussing with one another. It has made me on more than one occasion, think twice about something when reading other peoples thoughts.

Embracing some form of universal health care, from everything I have read and know has never changed a free market society into anything but continuing free market society.

We will be forced to look hard at this issue again, whether it is when the Supreme Court gives it's ruling, or down the road further. But we will be forced to look at it - probably many times again.
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Old 12-05-2011, 08:05 PM   #96
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You don't shop for a doctor any more (especially primary care) .
Right. You're talking about 2011. The world where you have one insurance provider (chosen by your employer, or it's Medicare if you are over 65). Now imagine a world where you are choosing your insurer based on price and quality. You've got money in your hand--some of it yours, some or all of it from Uncle Sam through the subsidies. Insurers want your business, and you have information at hand. Do you think the insurers are going to compete to get enough doctors so they'll get customers to buy policies (the doctor availability/waiting time, etc info will be readily available to prospective customers). That's much better than the present world where insurers work to please major employers, not the actual users of the medical care. Where doctors are relegated to piecework at a government rate that is so low that they can only keep their practice afloat by seeing 8 patients per hour.

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I elevate this category on government involvement and assistance above all other issues. It is (in my eyes) an area that needs to be closely monitored by our government for the protection of it's people.
We agree on the importance of the topic. We differ greatly in our faith in centralized command and control measures to get the job done as effectively as market forces will. The continued existence of faith in government entities to efficiently allocate resources is contrary to nearly every observable indicator. And yet it goes on.
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Old 12-05-2011, 08:51 PM   #97
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Sorry SamClem, I'm having a hard time processing the first part of your post. Maybe because it's getting late, and my brain is fried (I'll read it again in the morning) Only thing I can say for certain right now, is you appear to have zero faith in the government in most any capacity, so considering any form of government involvement in a health care plan, is not doable for you. That's fine. I respect your opinion.

I just don't see that the health care free market has been working so good for us lately in it's current form. Of course I agree that competition and more companies competing for the same dollar, is a good cost containment in the free market. Problem as you implied consolidation moves on, and big companies are allowed to swallow little companies, until like you say we only have 4 or 5 left. Maybe eventually only two. That is always bad for the consumer.

That's all the more reason to take health care out of the competitive market. One big fish, buying for everyone. Get rid of the middle man. We don't need em. Certainly not for extracting profits anyway from the money pool.
That gives the big fish a lot of negotiating power, to lower costs. Say what you want about Medicare, the government has done pretty good at squeezing there, and has a lot of happy customer to prove it. And as far health care meeting future needs, a lot of squeezing needs to be done. What if we could take that 15-25% loss ratio and give a good chunk of it to our primary care doctors.

Most other countries came to this conclusion a long time ago.

I think there is always sufficient fault to hurl at private industry as well as government, and both have been bad in one way or another. I would just for the sake of enlightenment prefer to discuss what might work. And I just don't see any evidence of the current scenario working in the future for us. There was a time it did, but that time has passed. Technology has moved on and a new day has come. So I guess for the time being, as the saying goes, we will just have to agree to disagree.
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Old 12-05-2011, 09:45 PM   #98
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That's pretty radical samclem! Whatever happened to that "giving according to their ability and receiving according to their need" talk?
Where is this generation's Milton Friedman? Somebody needs to be blasting the clay pigeons that get tossed up as valid ways to increase supply and reduce prices.
- Increasing demand (introducing more customers) increases prices, at least until supply catches up.
- Artificially capping the price of a good or service reduces supply and creates shortages
- Anything provided "free" will be subject to tremendous waste. Pricing mechanisms only work when consumers make choices involving the marginal utility of that dollar in their hand.

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Old 12-05-2011, 10:07 PM   #99
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Where is this generation's Milton Friedman? Somebody needs to be blasting the clay pigeons that get tossed up as valid ways to increase supply and reduce prices.
- Increasing demand (introducing more customers) increases prices, at least until supply catches up.
- Artificially reducing prices (with caps) reduces supply and creates shortages
- Anything provided "free" will be subject to tremendous waste. Pricing mechanisms only work when consumers make choices involving the marginal utility of that dollar in their hand.

I agree with everything said there. Except I think health care should leave the free market place. Medicare (as an example of the free aspect) is abused by some, cause it doesn't cost anything to see a doctor or specialist. Very easy to pick up the phone and make an appointment when it's free. Would save a lot of money if a co-pay was enacted. As I said, there are many modifications to be made across the board that are needed.

See, SamClem. I can agree with you too.
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Old 12-05-2011, 10:28 PM   #100
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Except I think health care should leave the free market place.
It can't leave the free market place because it's not in the free marketplace now. And neither is medical insurance (which is a different issue). Government involvement and the tremendous distortions caused by this involvement (e.g. encouragement of employer-provided medical insurance, etc) have been a primary cause of the problems we've got now.

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See, SamClem. I can agree with you too.
Great minds --well, you know.

Here's the great Milton Friedman addressing a Mayo clinic audience on the impact of government involvement on US medical care. Presented in 1978, it's amazing how things have continued along the trendlines he anticipated, though he does not pay enough attention to the problems inherent in private insurance underwriting. It's a 6 part series, approx 10 minutes each, so I'd advise anyone against starting it unless this is of burning interest.

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