According to the Senator who provided the info...From the pie chart it appears more than 60% of "uninsureds" are doing so by choice or are illegally in the country. Am I reading that correctly?
I see your logic. The differences between list and negotiated price are so great I can't imagine getting a better deal with cash. The fact that cash upfront is such a better deal for the provider yet they can't even make that deal just shows how dysfunctional this whole thing is.
If you read Kenneth Arrow's paper (not an easy chore) he points out that price discrimination is a key impediment to free market functionality.True. And to Youbet's point, I think this dysfunction also impacts "access." I know that I've skipped routine tests because nobody could tell me how much they cost. I'd certainly be less inclined to visit the doctor if I knew I was going to get charged multiples of what other people pay. I imagine many people of more limited means simply avoid the whole system until they no longer have a choice. And yet we can still plausibly claim they have "access."
Good read. It doesn't appear one could compare the Kaiser data to the Senators chart directly, which speaks to your "creative ways" point. Bias is always a challenge...Here is Kaiser Foundation data on the uninsured in the US The Uninsured: A Primer - Kaiser Family Foundation, with lots of data for those interested. While this data has been used extensively, much of it has been interpreted and framed in many different and creative ways.
True. And to Youbet's point, I think this dysfunction also impacts "access." I know that I've skipped routine tests because nobody could tell me how much they cost. I'd certainly be less inclined to visit the doctor if I knew I was going to get charged multiples of what other people pay. I imagine many people of more limited means simply avoid the whole system until they no longer have a choice. And yet we can still plausibly claim they have "access."
I believe this also, and I prefer "my" healthcare to be based on employment status and income, not prioritization. I choose to pay a high premium for low deductible Preferred PPO and be able to get seen by the best doctors at the best facilities.Our convoluted health care system goes back to the wage and price controls initiated during WWII. The single payer system used by most of Western Europe and Canada goes back to the end of WWII and was made possible to a large extent by the Marshall Plan. Both approaches effectively ration care. The US does it by employment status and income. The single payer systems have prioritization policies. Of course, the rich from these countries have ways around the rationing aspect.
US health care is already rationed/prioritized. You can't have any and all procedures done, nor can you be charged an unlimited amount for the services provided.I believe this also, and I prefer "my" healthcare to be based on employment status and income, not prioritization. I choose to pay a high premium for low deductible Preferred PPO and be able to get seen by the best doctors at the best facilities.
I doubt the majority of Americans would stand for prioritization as a means of rationing healthcare.
Healthcare rationing in the United States exists in various forms. Access to private health insurance is rationed based on price and ability to pay. Those not able to afford a health insurance policy are unable to acquire one, and sometimes insurance companies pre-screen applicants for pre-existing medical conditions and either decline to cover the applicant or apply additional price and medical coverage conditions. Access to state Medicaid programs is restricted by income and asset limits via a means-test, and to other federal and state eligibility regulations. Health maintenance organizations (HMOs) that commonly cover the bulk of the population, restrict access to treatment via financial and clinical access limits.
Some in the media and academia have advocated rationing of care to limit the overall costs in the U.S. Medicare and Medicaid programs, arguing that a proper rationing mechanism is more equitable and cost-effective. The Congressional Budget Office (CBO) has argued that healthcare costs are the primary driver of government spending over the long-term.
Our convoluted health care system goes back to the wage and price controls initiated during WWII. The single payer system used by most of Western Europe and Canada goes back to the end of WWII and was made possible to a large extent by the Marshall Plan. Both approaches effectively ration care. The US does it by employment status and income. The single payer systems have prioritization policies. Of course, the rich from these countries have ways around the rationing aspect.
I believe this also, and I prefer "my" healthcare to be based on employment status and income, not prioritization. I choose to pay a high premium for low deductible Preferred PPO and be able to get seen by the best doctors at the best facilities.
I doubt the majority of Americans would stand for prioritization as a means of rationing healthcare.
Instead of trying to define basic level of care, I'd start with what the 30+ developed countries with universal care provide. If they can provide more access and (more) effective basic care (including catastrophic) than the US at on average half what we spend per capita, it would seem we could learn a lot. I don't think anyone seriously considering universal health care in the US expects everyone should have Cadillac health care, I certainly don't. Again, those who can afford more or better care than the universal standard, are entitled to whatever care they choose...I'd be curios as to your vision of "basic level of care" is and I'm not being snarky, just cannot imagine a healthcare structure that could provide universal cradle to grave healthcare for 300,000,000 Americans.
Oh, I only said I want to keep mine as is, I didn't say the government was trying to take it away. My point was having exactly the option you mentioned in your surgery, i.e., avoiding waiting lists. And I'm very skeptical that I would be able to find surgery as quickly if/when a single payer system comes into existence.I've said this many times here, and I'll say it again, a single payer system does not have to exclude private insurance, through employement or otherwise.
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I don't think a single payer system will be accepted in the USA because of the great distrust Americans have of their government. (Note that in the UK the recent documentary on CNN stated that overhead costs of the NHS Trusts running the healthcare is 5%). However, the argument that single payer excludes private insurers is a scare tactic that works very well to ensure it won't happen. (except when you get to Medicare age).
The concept is fine, the details of implementing it are many and I don't see anyone with a plan. Just lots of folks jostling to keep their piece of the pie.Instead of trying to define basic level of care, I'd start with what the 30+ developed countries with universal care provide. If they can provide (more) effective basic care (including catastrophic) than the US at on average half what we spend per capita, it would seem we could learn a lot. I don't think anyone seriously considering universal health care in the US expects everyone should have Cadillac health care, I certainly don't. Again, those who can afford more or better care than the universal standard, are entitled to whatever care they choose...
Oh, I only said I want to keep mine as is, I didn't say the government was trying to take it away. My point was having exactly the option you mentioned in your surgery, i.e., avoiding waiting lists. And I'm very skeptical that I would be able to find surgery as quickly if/when a single payer system comes into existence.
For instance, your example of foot surgery. Currently let's say foot surgeons in the US do 20 per month and on 01 May 2012 the single payer system is implemented. I cannot imagine that would not impact my waiting time.
Oh gosh yeah, you are absolutely correct, it's not a "belief", it's a "knowledge". We know for a fact they could not do it. Every congress person would want some benefit for his state.I think you make my point quite nicely. Americans don't trust their government to do big programs like this well. (I'm not saying that you are wrong or right in this belief).
You may see this as heavy handed (or out of date), but there was a time when 'folks jostled to keep their piece of the pie' regarding slavery, women's rights, etc. Hope springs eternal.The concept is fine, the details of implementing it are many and I don't see anyone with a plan. Just lots of folks jostling to keep their piece of the pie.
Make Medicare totally funded by taxes and no cost to users.
The private sector without real competition has brought us the very high health care prices we have now. While free markets work well for most goods & services that face competition and elastic demand, they haven't worked for health care with controlled competition (or worse) and patients who have little to no (short term) control over demand. But there are countries that have managed to provide cost effective universal care with government intervention (Switzerland comes to mind first), and many have combinations of public and private.In a perfect world, they should negotiate with someone in the private sector, give them the Medicare funds and say, "here, run it as a service to the government". Then tax current workers, retirees, and corporations to pay for the service. Make Medicare totally funded by taxes and no cost to users.
The unfettered private sector has brought us the very high prices we have now. ...
While we agree there are problems, and changes are needed, I hardly think we can call our present system 'unfettered'. Govt has done things like meddled with the pricing of insurance (by giving it tax breaks for employers), which has also led to the crazy tie of employment to HI, and not allowed comp across state lines, etc. That has had a lot to do with the high prices we have now.
-ERD50
While we agree there are problems, and changes are needed, I hardly think we can call our present system 'unfettered'. Govt has done things like meddled with the pricing of insurance (by giving it tax breaks for employers), which has also led to the crazy tie of employment to HI, and not allowed comp across state lines, etc. That has had a lot to do with the high prices we have now.
You may see this as heavy handed (or out of date), but there was a time when 'folks jostled to keep their piece of the pie' regarding slavery, women's rights, etc. Hope springs eternal.
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... plus the exemption HI companies enjoy from the Anti-Trust regulations which fetter the rest of the business world.