Krugman on Health Care Crisis

[JohnP]

Some things to consider in health care in the US, by economist Paul Krugman and Robin Wells.  Notice - long article packed with facts http://www.nybooks.com/articles/18802

"...The good news is that we know more about the economics of health care than we did when Clinton tried and failed to remake the system. There's now a large body of evidence on what works and what doesn't work in health care, and it's not hard to see how to make dramatic improvements in US practice. As we'll see, the evidence clearly shows that the key problem with the US health care system is its fragmentation. A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from "integrated" systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.

The bad news is that Washington currently seems incapable of accepting what the evidence on health care says. In particular, the Bush administration is under the influence of both industry lobbyists, especially those representing the drug companies, and a free-market ideology that is wholly inappropriate to health care issues. As a result, it seems determined to pursue policies that will increase the fragmentation of our system and swell the ranks of the uninsured..."

JohnP

 

[haha]

I guess this article is too good to draw much interest here. Krugman knows whereof he speaks.

Ha

 

[Rich_by_the_Bay]

Aaargh.. If you only knew how bad our current system is to practice in, too.

[soapbox]
Aside from gigantic economic chaos, there are daily examples of where I (and virtually my non-cosmetic surgery or "concierge medicine" colleagues) must compromise, defer, or redirect care to folks who need and deserve it simply due to the failed system. I try not to even know the patient's reimbursement status, but sooner or later many, many can't afford their prescriptions, fail to follow through for important tests or appts, defer preventive care, etc. etc. Then, when they do get sick it is serious, requires ICUs and high tech, and costs 3 x as much money as it would have, not to mention the inferior outcomes. And if they lose their jobs, forget it. They ain't thinking about COBRA like us, they are thinking of tonight's dinner.

I happen to be a believer in national health care at least as a safetynet with deductible based on income (does not always go over well at medical society meetings, I might add). It is not just the poor who are suffering here - look at all the posts about COBRA, exorbitant insurance premiums for the ER or self-employed, etc. etc.]
[/soapbox]
Like their plan or not, you gotta give the Clintons credit for trying to tackle this issue. Doubt we will see any improvement before I take my turn as an elderly, needy patient but... you never know.

 

[wildcat]

Did anyone catch the '60 Minutes' segment on health care last night?  Anyway if not, the segment was about the huge disparities in what hospitals charge uninsured vs. insured.  Pretty interesting stuff.  The uninsured cases they investigated found the patients were getting ripped by the hospitals -- about 4-5x what the bill would have been for an insured person.  One guy in California had a $225,000 bill.  It also brought up the fact that about 1/2 of the bankruptcies in the US are from medical related bills.

 

[Outtahere]

Interesting that they would air that the night of the Oscars, like they didn't want anyone to watch it?

 

[NYCGuy]

Articles like this breed despair. The means to provide cheaper health care to all Americans lies within our grasp and we won't take it. Well, maybe at some point the crisis will be large enough to provoke fundamental change.

These days I get as much of my dentistry as possible done in Bangkok. Prices are 15% to 25% of New York, all staff are English-speaking, quality is as good or better, and my dental plan is willing to pay for it. It is only worthwhile because we are there once or twice a year anyway to visit my wife's family. I have to say that I enjoy providing competition for my current dentist and checking the opinions of each dentist against the other.

Of course, not a general solution to the problem.

 

[Martha]

Very good article. In fact, it is the first article ever cited on this forum that I actually sent to the printer.

The discussion of medicaid and its unraveling is very perceptive.

Articles like this breed despair. The means to provide cheaper health care to all Americans lies within our grasp and we won't take it. Well, maybe at some point the crisis will be large enough to provoke fundamental change.

I think you are right. No fundamental change until there is a crisis. And the crisis has to be in the middle class.


Also a good discussion of problems with so called consumer directed health reform, promoted by the current administration. Excessive consumption of routine care (going to the doctor for a sore throat) is not a major share of medical costs. "The great bulk of medical expenses are accounted for by a small number of people requiring very expensive treatment." This has been my problem with medicaid cuts occuring in many states. A small number of people need a lot of expensive care. As a result, many other people get no care.

It is time for a public health insurance system.

 

[wildcat]

And the crisis has to be in the middle class.

The '60 Minutes' segment mentioned the middle class as being the typical case in their investigation. Too wealthy to receive govt assistance but too poor to pay for health issues out of pocket. A lot of small business owners.

 

[Nords]

I guess this article is too good to draw much interest here.

Consider the possibility that this reciprocated diatribe discussion frequently degenerates to attacks of "You're military, you have yours" or "You geezer Boomers will $%^ up the whole system before we get to it anyway" or "It's all Hillary's fault" or "It's time to invade Canada for their healthcare system". 

Unlike most of the other topics we debate here, healthcare & insurance is filled with too much emotional anger and frustration on too many fronts to make the discussion worth what little is learned.

Krugman knows whereof he speaks.

Having dealt with the first issue, here's the second.  I'm not so sure of his credibility-- I wonder how much time he's spent attempting to work his way through the VA system as a customer.  If he doesn't know squat about the one point in the article I happen to have some experience in, then how can I trust the rest of his claims that I know nothing about?

Anyone recommending the VA as a model for nationwide healthcare must be carrying their own personal insurance.  Or else they're planning to use Bumrungrad for the big stuff.

 

[Eagle43]

I saw that 60 minutes segment.  We have always wondered why our hospital bill would say, for example, the procedure cost $2195, but TRICARE paid $575.  Now, we know.  The insurance companies only pay what they have bargained for, but if you're uninsured and not indigent, you get hounded for full-price.

I just read Krugman's article and it seems logical.  Why wouldn't the Democrats nominate a candidate that uses his proposals?  I think that many corporations would love to unload all of the medical insurance problems on the feds.  They're already doing it to some retirees.  

 

[maddythebeagle]

I'm not so sure of his credibility

I might agree with some of the article, but when you drone on about democrats being saints and republican's being in the pocket of special interest, you lose me. :

 

[ERD50]

It also brought up the fact that about 1/2 of the bankruptcies in the US are from medical related bills.

That statement has been discredited. The authors of the study admitted it.

Some googling provided this:
"The study with the “50 percent” claim is based on a survey of debtors that sets the bar so low that any filer with medical bills exceeding $1,000 counts as a medical bankruptcy. By this logic, anyone with a car payment over $100 a month who goes bankrupt would count as a “car bankruptcy"."

Makes a good headline or sound bite, but the truth is less sinister. And these twists don't help to solve the real problems.

-ERD50

 

[Martha]

I might agree with some of the article, but when you drone on about democrats being saints and republican's being in the pocket of special interest, you lose me. :

I didn't get that out of the article at all. In fact the author says a shift of power from republicans to democrats would not be enough to give us sensible health care reform.

 

[Martha]

That statement has been discredited. The authors of the study admitted it.

Some googling provided this:
"The study with the “50 percent” claim is based on a survey of debtors that sets the bar so low that any filer with medical bills exceeding $1,000 counts as a medical bankruptcy. By this logic, anyone with a car payment over $100 a month who goes bankrupt would count as a “car bankruptcy"."

Makes a good headline or sound bite, but the truth is less sinister. And these twists don't help to solve the real problems.

-ERD50

There was a Harvard study about medical issues and bankruptcy. The study abstract says:

"In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9-2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs average $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick."

The conservatives say that it is a myth that bankruptcies are often caused by medical problems and site their own review through the US Trustee's office of bankruptcy petitions which showed 78% of bankruptcy petitions show medical debt of less that $5000.

My experience tells me that the US Trustee's review tells only part of the story. First of all, there are plenty of people that have so little that garnishment of wages resulting from a $5000 medical bill can send them into bankruptcy. Also, even if medical bills are paid by insurance, the medical problems can mean loss of time from work that might not be paid or even the loss of a job. Also, people live on such tight budgets that the slightest little slip can mean a bankruptcy.

 

[Martha]

Sorry for the third post in a row. Micheal Moore (oh my) is working on a documentary about the US healthcare system. His office has contacted people I know who are working on healthcare access issues. Will be interesting. Unfortunately, Moore likely will alienate a large number of people. Though I don't much care if he alienates insurance companies and drug companies.

 

[ERD50]

...subsequently completed in-depth interviews with 931 of them. About half cited medical causes, ...

Of course they would site 'medical causes' - do you think most people would admit that they blew the money on (fill-in-the-blank)?

To be fair, it is probably impossible to summarize the reasons for bankruptcy in a single number (they shouldn't try). There are some very real problems, some are going to be related to medical issues - those are very real problems that can grow beyond ones means very easily. I just get aggravated with these sound bites that attempt to present 'all you need to know'. Things are not that simple, and pretending they are gets in the way of solving the problem.

-ERD50

 

[MasterBlaster]

Right now we have great medical care and can get it on demand but at very high prices and without access for everyone in the country.

My take on government run (or single payer) medical care is that there will be high medical access for everyone but at a cost of quality and on demand service.

So those other countries trade quality and timeliness for widespread access. Maybe that's a choice we should make. But at least let everyone know the trade-offs we will be making and have an even-handed debate.

Think US Post Office like service when you think of government run or single payer medical care. It gets the job done but you may wish the service and the timeliness was better.

 

[Martha]

You know, I never have had a problem with the post office. But I have had problems with insurance companies.

 

[REWahoo]

You know, I never have had a problem with the post office. But I have had problems with insurance companies.

Me too. No, come to think of it, I've had trouble with both:

On March 2 I got a 1099 from a small savings account I had forgotten about. It was postmarked January 16 and only took 44 days to travel 26 miles!

 

[cute fuzzy bunny]

We dont have health care. We have sick care.

And I think the health care providers ratchet up the 'standard price' so that they can offer a good discount to the insurance company negotiators when they both show up at the table.

 

[Martha]

We dont have health care. We have sick care.

And I think the health care providers ratchet up the 'standard price' so that they can offer a good discount to the insurance company negotiators when they both show up at the table.

Of course. Everyone wants a discount, with Medicare/Medicaid wanting the biggest discount of all.

Read an article a bit ago about Amish communities negotiating with their local hospitals for lower prices. They couldn't get the cash price lower than the medicare price because that may be viewed as medicare fraud.

At least the feds have now told hospitals that they can offer some discounts off the full price to the uninsured without violating medicare rules.

 

[cute fuzzy bunny]

Somewhat on topic, has anyone tried out any of those 'health care cards' for medical, pharmacy and dental that appear to offer the insurance company price for the uninsured? Do they really work? The cynical slice is telling me that they have a list of doctors you have to use, all of which are like one of the two doctors on the simpsons...

 

[Rich_by_the_Bay]

Right now we have great medical care and can get it on demand but at very high pricescare...

It's not that easy to measure the quality of health care. We have great technology (if you have $) but after stripping away the health-consequences of a good societal infrastructure (e.g. water, sanitation, food inspection, etc.) our outcomes are probably no better than most developed countries, and maybe a bit worse.

Everyone has stories, but the life expectancy, neonatal mortality, disease outcome evidence etc. are available. Is it bad to wait 6 months for a hip replacement in Canada v. 2 weeks here? Yes, of course, but at the risk of breaking the economy, disrupting retirement plans, or making otherwise able workers postpone retirement due to obscene health insurance costs, I don't know.

Believe me, I am no radical in such matters. Our system has kernels of brilliance, but a whole lot of mud.

 

[Martha]

Good post Rich.

 

[maddythebeagle]

Somewhat on topic, has anyone tried out any of those 'health care cards' for medical, pharmacy and dental that appear to offer the insurance company price for the uninsured?  Do they really work?  The cynical slice is telling me that they have a list of doctors you have to use, all of which are like one of the two doctors on the simpsons...

http://www.simpsons-crazy.co.uk/DrNick.html

you must be thinking of dr. nick.