What is the best way to fix once-and-for-all our national health care system?

The biggest cause of rising US health care costs is that a system has evolved in which there is little ability of those who pay for health care to control the spending of providers. As a result health care providers can increase their own expenses at will and then pass the cost on to the payers. The only limit is what the market can bear, which has yet to be reached.

For example where I live there are over 50 MRI machines within 20 miles. Each time a new one is installed the average price of an MRI in the area goes up, not down. The utilization rate has declined to the single digits and providers have raised rates for other services because even the higher MRI fees are grossly inadequate to pay for all these barely being used machines. Now they are building new Cat scan and PET scan machines even though the existing ones are highly underutilized.

The major hospital groups around here are also embarked on a $6Billion round of completely unnecessary expansion. This is in an area with about 1.5million people and a declining population. Some are talking about this being only round one. This round will cost $4,000 per person.

None of this is not about expanding to meet increasing demand, it is about maximizing expenses in a cost plus health care system. In many areas there is only one or two dominant health care providers. These are in the position of taking take it or leave it positions when negotiating with insurers and other payers, even the government.

Insurance companies can become helpless victims in this. In areas where they have large numbers of subscribers they can negotiate lower prices for themselves but the providers then shift the expense to less dominant insurers. As a result the prices that different insurers can negotiate for the same procedure at the same hospital can vary by an order of magnitude or more. Similarly, an insurer can pay over ten times more for the same procedure in an area where it is a minor player than in one where it is dominant.

As I see it there are some choices to bring this system under control.

1.Allow insurers, including the government, to form a cartel to negotiate long term price structures with providers. This would require a change in anti trust law.

2.Institute price controls and regulate provider capital expenditures to prevent cost shifting and preclude the reckless spending that results in the gross underutilization of resources that must be paid for.

3. Do both.

4. Nationalize US health care.

 

In my opinion, that is the type of system our Founders largely envisioned. One in which goods and services were provided in a free market but where States and localities had the ability to supplement private markets with targeted subsidies and the like. In my ideal society, those types of local services would be financed with land taxes as opposed to "income" taxes or sales taxes.

I must disagree. First of all, communication and information are very important aspects of the modern economy. Without the ability to effectively communicate and obtain information, prospective employees are at a disadvantage in the modern job market, so in that regard, cellphones are more than just a trendy novelty, they are a modern necessity.

Secondly, there is nothing in my study of economics which would lead me to believe that the economics of cellphones wouldn't translate to healthcare. Ultimately, they are based upon the same principle, i.e., supply and demand as predicated upon mutually voluntary exchange, and this allocative mechanism has consistently demonstrated its ability to increase access and quality while driving down prices. Like I said, we've observed this phenomenon in unsubsidized, uninsured, relatively unregulated elective procedures such as plastic surgery and LASIK eye surgery. Freedom creates choices, and choices creates competition. If government were the solution, our healthcare system would have been fixed a long time ago!

For one thing, I do not believe the Federal government has the Constitutional authority to intervene in matters relating to healthcare, but as a practical matter, it is a suboptimal solution because of the uniformity that Federal involvement usually creates. A one-sized-fits-all standard imposed on a diverse society can serve to marginalize individuals, communities, and States with unique wants and needs. What works for the "average" person (statistically speaking) won't work for everyone, so it behooves us to devolve the responsibility to the people as much as possible. That way, we can allow our fifty democratic laboratories of innovation to work towards an optimal model for healthcare provision instead of imposing a patchwork system on people that requires an endless amount of ad hoc calibrations.

I'm not sure about that one.

 

My politically impossible ideal plan:

Abolish Medicare, Medicare, SCHIP, and ObamaCare. Require that every state provide affordable health care but let the states implement it however they see fit. If they refuse, the federal government will administer health insurance for the state. It's possible that most states will choose to let the federal government run it. Regardless of whether it's a state or federal program, here's what my ideal would look like:

1. Prohibit discrimination based on pre-existing conditions.
2. Mandate catastrophic insurance.

That's it. No birth control coverage or even coverage for routine doctor's visits.

 

In my opinion, simply solving official poverty should solve most of our health care issues since more money will be circulating after health care dollars.

 

And at a premium cost....

 

I try to be compassionate but the money I'm spending is EVERYONE'S and EVERYONE will benefit. A national health care system that views patients as people to be made healthy rather than revenue sources will reduce our national spending on health care by several trillion dollars annually.

 

The city I live in has one hospital. The nearest hospital beyond that is about 22 miles away. Think she'll make it? Ready to take your chances?

Supply and demand. My government intervention to manage care or costs. Buyer beware on results. You're on your own


Fire Department? Seriously? No more private fire department. Only supply and demand. The government does nothing. You could buy insurance but it will cost you since there's no taxes to support this public service.

There are some services that are too bigf and too important to trust to the private sector. Police, fire, roads, and health care are just a few.

 

So the government builds 2 more grossly underutilized hospitals in the area and that will lower COSTS?

Half our Police and military costs go to the private sector. Many rural, and not so rural areas have an extremely efficient volunteer fire dept. And you don't EVER want to denigrate a volunteer fireman. Roads are primarily built by the private sector submitting the lowest bid and then maintained that way as well.

And our health care??? We have more people NOW on govt health care than many countries with UHC, and we've had them on govt health care for longer than any other nation has had UHC. The result is that our govt health care costs 31% more than our private health care which is overpriced due to govt intrusion.

 

I think Ron Paul is pretty dead on with healthcare issues.

I don't see how you can control cost of things if it is perceived nobody pays for it. As Paul stated, we already spend more than three times in medical cost per person than they pay in for Medicare. We all know what happens when you spend more than you make!

 

Can't happen. The US health care system is about $2.5 trillion per year. Our government is broke and cannot afford a public program this size and the citizenry obviously are not going to pay higher taxes.

Now what...

 

This is the age-old problem of government meddling in the private sector; it never works!

This is so simple; if government wants any program, the government goes to the people to collect enough tax revenues to pay for the program. If the people refuse, or the tax burden is too great, then the government cannot do the program. When government ignores this logic, government fails and so does the private sector...

 

But "catastrophic" coverage is just another word for "basic" coverage that everyone has, right? So... it's Obamacare. Obamacare doesn't give everybody coverage for every possible medical procedure they could want. The argument then becomes what qualifies for "basic" care (i.e., the mandates on insurance providers) and what should be optional. So correct me if I'm wrong, but it seems like you agree with the structure of Obamacare, but perhaps you take issue with what health insurers are required to cover in their "basic care?"

 

So do you wish to abolish the current private health care system?

Are you wanting to nationalize the private health care industry?

The federal government already has veterans medical treatment centers, Medicare, and Medicaid; why not just expand what is in place and just increase taxes to pay for it?

 

The USA has had MORE people on govt health care for longer than any other nation. And our govt health care is FAR more expensive than our private health care.
b.o.'s 2013 budget proposal revealed a bit about obamacare.

Previously the estimated cost to subsidize people that could not afford to buy insurance under obamacare when it kicks in was $over $300 billion dollars. Quietly the new proposal has that amount increased by $111 billion dollars and obamacare hasn't even started yet. That will be the continuing and increasing story of govt ANYTHING. IT ALWAYS IS.

Fannie and Freddie, on "sound financial footing" according to liberal Congresspeople. How is sound footing and $200 billion in bailouts compatible.
USPS, a wonderful service that only loses $2 to $8 billion per year.

The military. Deadly, powerful, capable. But neither cheap nor efficient.

Would govt health care be BAD health care? Not necessarily. But to entertain any thought that it would not be much more expensive is just downright denial of the costs of every govt program so far.

 

We spend about $8k per person for health care in this country.

About 1/3 more than the average for countries with fully socialized systems for worse outcomes.

The fee per service model that Medicare uses generates about 50 billion in actual fraud per year plus who knows how much unnecessary services provided but not needed.

Remove the profit motive from the system and you eliminate 20% to 30% of the costs.

Pay for it with an 8% medicare tax along with a 4% employer match.

The insurance companies and large providers will not be happy but since when is the purpose of health care to make then happy?

 

Obama went about helping the people with rising health cost completely wrong. His mandate of requiring health insurance has and will continue to drive the cost of that insurance up.

If he was sincere about reducing the costs to the consumer, he would have regulated medical costs instead. Paying $200 for an aspirin is ridiculous. Yes, $200...that is what a lot of hospitals will charge if you are given an aspirin while admitted.

The problem is that the Medical Association is one of the biggest lobbyist organization. They have most of the politicians from both sides of the political aisle in their pocket. It would be political suicide for Obama if he went after the AMA.

 

I think we agree here, though I'm not ready to write off national-level supplements.

This is somewhat of a rabbit trail. My real point is that the psychology is very different between paying for a service you will use all the time, even if you could get by without it, and that of paying for a service that you hope you won't have to use.

I've had little formal instruction in economics, but I remember a difference between someone in the you have cancer now what are you willing to pay to treat it? dilemma and someone in the you don't have a cell phone now what are you willing to pay for it situation. I think you're right when it comes to optional health services; but when you enter the realm of do-or-die the normal laws of supply and demand don't work.

I still think a one-sized-fits-all standard for basic care is feasible; anything beyond that becomes free market fair game.

 

You are correct, Nunya.

Especially when you say, "Obama went about helping the people with rising health cost completely wrong. His mandate of requiring health insurance has and will continue to drive the cost of that insurance up."

The health care system in our country has to change.

But ObamaCare is not the way to do it.

All we have to do is allow people to buy insurance across state lines and set up a special pool for people who are unable to buy insurance like the rest of us.

Buy requiring EVERYONE to have insurance and then using taxpayer money to pay for most of the cost of their policies is not the way to go. This only breeds dependency.

Also, by requiring very low or, in many cases, no co-pays we are encouraging people to overuse and abuse the health care system. When people do this, as they will, there will not be enough doctors or hospital beds available for the people who really need the care.

Also, with more and more people entering the health care system, our problems with access to care will now be magnified many times over in many more cities.

These problems will only get worse with ObamaCare, not better. The Democrats were very foolish when they passed this legislation by only one vote in 2009.

 

The $8000 per person is in the ball park of being correct. But that is for ALL persons. The breakout is near $11,000 per person for govt health care and well under $8000 for private health care.

$8000 per person is like saying that if you have one foot in ice water and one foot in boiling water, on average, you're comfortable.

Govt health care, EXACTLY as EVERY OTHER govt program of any kind, is more expensive than the private sector. What Europe experiences with fewer people on UHC for a shorter period of time means absolutely nothing to how things work in the USA.

 

Plenty of systems with MORE gouv control in healt care work betetr then in the USA.

The mantra "everything private is better" is getting very old now.

Of course its quite possible to do it right, against a very reduced costs of now with the same quality.

But of course those big coorporation will have less profit, how sad for them.

 

Collectivize it and continue to ignore our borders, continue funding a perpetual welfare state, and collapse.

 

Amen to that!

 

You hit the nail on the head. You are absolutely correct!

 

uhhh, a private market functions privately. A government market functions on destroying the wealth of the nation.

Run faster, try to keep up.

 

You make a proclamation that you have in no way proven, and likely cannot. What you are saying here is ludicrous.

You do what YOU need to do; you've got a lot more work ahead of you, IMO.

We need a single payer healthcare system in this nation TODAY.