Mounting cost of Healthcare even for the insured

[Maurice]

Interesting article in the NYT about the rising costs of health care, even for people who are insured. (co-pays, deductibles, etc)

http://www.nytimes.com/2008/05/04/business/04insure.html?_r=1&hp&oref=slogin

 

[maddythebeagle]

interesting graph...looking at around 1950, food, clothing and housing cost about 50% of disposable income...vs 30% or so now...still ahead and have better health care, so what's the problem again

 

[Midpack]

Interesting article in the NYT about the rising costs of health care, even for people who are insured. (co-pays, deductibles, etc)

Another hand wringing article about health care with no solutions, that passes for interesting journalism? With 'someone else' paying most of the costs, it's no wonder costs have skyrocketed (and forced millions into the uninsured category) in the US relative to most other life expenses. Strikes me more as another useless 'this just isn't fair' piece inferring we're entitled to unlimited cheap health care and 'somebody (not me)' should do something! Not news. Same writer is working on an interesting article about unfair gas price increases blaming oil companies for next week...

Don't get me wrong, health care is clearly a serious issue for the US. But it's not rocket science what's wrong, we just don't like the solutions and there are powerful, entrenched groups acting to maintain the profitable status quo. And we put our politicians in the 'we want more for less' box so they're reduced to promising the world to get elected with little chance of accomplishing anything in the end - and they know it. I'm a lifelong conservative but I think it's inevitable we'll have UHC, just a matter of when. If you look at existing UHC in the many developed countries that have it,
- providers (doctors, pharma companies, med equip providers, etc.) and especially administrators are paid less,
- consumers use less (take better care of themselves) for preventable issues, more significant in the US than most of us know or will admit,
- waits are a little or a lot longer for elective and non-emergency care,
- malpractice is regulated so it's not such a big factor,
- preventive care is better in many countries,
- expensive medical technologies may be less frequently used, and
- many of them have higher longevity and lower infant mortality rates than the US.
And surprise, surprise - they get effective care at lower per capita costs. Those that still argue US health care is the best for all seem to contradict the facts IMO. However, other developed countries show lower per capita costs for health care with higher tax rates --- not sure how to reconcile that.

We get what we deserve...we'll do better when we stop looking for a silver bullet that doesn't exist.

 

[youbet]

there are powerful, entrenched groups acting to maintain the profitable status quo.

Yeah....yeah..... the always popular view that protecting corporate profits is the issue is always fun to throw around, but I think the issue is something else.

In Canada, health care availability is pretty much the same for everyone except for a small percentage of wealthy folks who can afford to travel to the USA to receive faster or more elaborate care if they desire. It's "universal."

In the USA, health care availability varies tremedously across the population. The wealthy and those with private employer or public funded comprehensive insurance receive, IMO, better/faster health care than in Canada. They are a significant percentage of the population. And they, generally, don't want to give it up. They are the votes that empower the corporations and politicians to continue with status quo.

It really comes down to those citizens, and there are a lot of them, with excellent health insurance to express a willingness to give it up and accept whatever universal plan comes in its place. Then, our "average" metrics (quality, cost, etc.) will improve even though, for many, it will be a take-away.

I have good insurance. I'm willing to give it up and go on a universal plan. I don't think everyone is.

I also believe that for a universal plan to work, it will have to be universal. Everyone, without exceptions, will have to particiapate as in Canada. Even those with superior insurance now will need to give it up and go with the flow....... There should be zero exceptions. Even public sector employees (politicians included!) should be part of the new universal plan.

 

[youbet]

interesting graph...looking at around 1950, food, clothing and housing cost about 50% of disposable income...vs 30% or so now...still ahead and have better health care, so what's the problem again

A problem with relative comparisons of the cost of health care is that the health care we're paying for today includes many more high tech procedures than in 1950. It's not apples to apples. I keep looking for data comparing identical procedures such as a simple visit to the doc office where he/she takes your bp, listens to your heart, taps on your knees and asks you how you feel. Is that more expensive in real dollars today?

 

[Alan]

I also believe that for a universal plan to work, it will have to be universal. Everyone, without exceptions, will have to particiapate as in Canada. Even those with superior insurance now will need to give it up and go with the flow....... There should be zero exceptions. Even public sector employees (politicians included!) should be part of the new universal plan.

I'm curious, is there no private health insurance in Canada? I used to live in the UK and I have close family living in Australia, both of which have universal health care funded by payroll taxes. However, private insurance is available, and even back in the 80's when I was still working in the UK I had private insurance through the companies I worked for (it was optional). This insurance enabled one to get elective surgery and health services much faster. This way the "wealthy" can still support UHC but not be wholly dependent on it.

 

[Midpack]

Yeah....yeah..... the always popular view that protecting corporate profits is the issue is always fun to throw around, but I think the issue is something else.

I did not say it was the only problem, but it's certainly one of them.

Do you think that Germany's malpractice insurance at one-tenth of the US has nothing to do with our higher costs - and that the legal profession is anxious to be more like Germany?

Do you think that adminstrative costs in many developed countries at 3-6% of their HC costs vs 16-22% for the US has nothing to do with our higher costs - and that insurers and other administrators are anxious to reduce their expenses for us?

I did say UHC, not a warmed over version of what we have...

And the wealthy will always have access to better health care, just like they do in Germany, the UK, Switzerland, Taiwan, Japan, etc. - all with UHC in some form.

 

[youbet]

I'm curious, is there no private health insurance in Canada? .

Dunno. I've never heard any of our Canadian posters mention they're paying for private insurance, but maybe some are......

My point is that here in the good ole USA, we're going to need everyone to pay into a universal plan. Otherwise it will just be another round of poitical manuvering over who is in the risk pool.

If some can afford to pay for additional private coverage or just pay cash for additional services, so be it. But, they gotta belong, and pay into, the universal plan. For public service employees, especially politicians, the universal plan should be what they are provided with.

Recall that originally fed employees didn't participate in SS, they got something better. Ugh..... A real message to the rest of us plebians who had SS mandated on us. That finally got fixed. Now only some state and municipal employees are excused from SS and their ability to rape the SS system by unfair double dipping is limited by GPO and WEP.

Same principals should apply for uhc.

 

[youbet]

Do you think..... Do you think .......
.

Uhhhh...... Why yes I do, thanks for asking!

The issues you ask my opinion of are all issues that could easily be fixed with the will of the voters. But with the majority of Americans having decent or better health insurance, there are a lot of votes being withheld by folks concerned about giving up what they have or of getting something (higher taxes maybe......) that they don't want. I think that is the root cause of the situation not getting fixed.

We're going to need a change of heart by the many Americans not supporting uhc (and accepting uhc for themselves) or a president and Congress willing to enact uhc regardless of any political repercussions or both.

 

[Meadbh]

I'm curious, is there no private health insurance in Canada?

The simple answer is yes. Canadian Medicare was designed in an era when hospitals delivered a bigger proportion of care than they do now and was mainly hospital based. There is private insurance for what's left, e.g. vision care, dental care, drugs (outside of a hospital), long term care. Most employers provide supplementary health insurance packages and they are also available to self employed people.


The Canada Health Act has five principles:

1. Public Administration
2. Comprehensiveness
3. Universality
4. Portability
5. Accessibility

Canada Health Act Overview

Physicians are supposed to be fairly compensated, but in return are not allowed to bill patients privately for services to which they are entitled, unless they "opt out" of Medicare. Of course, this is impractical for most types of health care (e.g. I couldn't just set up my own ICU) and the public would not see the point in paying (again) for most services. Provinces which allow extra billing are financially penalized. Nevertheless, there is a thriving private sector for surgical procedures not covered by Medicare, such as cosmetic surgery. Some enterprising physicians have opened private clinics and have opted out of Medicare. Their business model is based on marketing to people who need elective surgical procedures and have the means and the inclination to pay extra to bypass wait lists.

Many people feel that the Canada Health Act, which is now almost 3 decades old, needs revision for an era in which health care is more community based. However, it seems to be a bit of a "sacred cow". The equity in this system is a major societal value for Canadians. My personal view as a physician is that there is a great deal that can be done to improve the efficiency of and access to care without throwing out the baby with the bathwater.

 

[Alan]

My point is that here in the good ole USA, we're going to need everyone to pay into a universal plan. Otherwise it will just be another round of poitical manuvering over who is in the risk pool.

I agee absolutely but you are going to have the private option available for those in power otherwise it won't happen. Margaret Thatcher and later Tony Blair were absolute champions of state provided education and health care. Did they use private schools and health care for thir own family? You bet they did, and why not, although they paid into the system they could afford, and chose to go outside of the system.

MeadBH, Thanks for your post on the Canadian system - much appreciated.

 

[Maurice]

Another hand wringing article about health care with no solutions, that passes for interesting journalism?

Yeah, in this case the graph I posted was enough to make the article interesting, and not only for what it says about health care.

Personally I don't look to journalists for solutions, certainly not to problems as large as health care.

 

[chinaco]

Yes... we need healthcare reform.

 

[Meadbh]

Yes... we need healthcare reform.

Yes, but do you really want it?

 

[Meadbh]

This just in.....

Institute for Healthcare Improvement: Achieving the Triple Aim: The Simultaneous Pursuit of Excellent Health, Ideal Care, and Controlled Costs

 

[chinaco]

Yes, but do you really want it?

Yes.