Thread: Universal care cheaper and better than private insurance.

Originally Posted by ba1025

About 20 million French people smoke - more than one-third of the population - as do 50 percent of youths aged 15 to 24, the highest rate in the European Union.

Survey reports that 20.9 percent of adults aged 18 years and over were current smokers in 2004, down from 24.7 percent in 1997. The percentage of adults who engaged in regular leisure-time physical activity declined from 32.8 percent in 2003 to 30.2 in 2004. Leisure-time physical activity had increased in the late 1990s, but then remained at about the same level before dropping in 2004.

There is no way being fat is worse than smoking and certainly it doesn't double our costs.

BA,

You'd have to control for a lot different risk factors as cesm stated earlier. In thinking through smoking vs. obesity, the interaction of both is going to be the worst combination. However, obesity is something where you'll see issues much faster, whereas with smoking, in most cases, while the problems will be large, they don't manifest themselves until later in life.

Thus, we won't see the effects on healthcosts for the faster downward smoking trend in the US for decades. I don't have the data, but I suspect that smoking participation rates in the US vs. Europe were probably very similar for the older generation that is suffering the high cost health care effects (e.g., cancers, emphysema, etc.) now, but would posit that the consumption of cigarettes by the smoking Americans was greater than the Europeans because of higher average incomes over their lives due to Europe having to play catch up post-WW2 for some decades.



http://www.who.int/tobacco/en/atlas40.pdf

Originally Posted by ba1025

yes we need millions spend researching male pattern baldness treatments and erectile dysfunction drugs and advertisement urging us to get our Dr's to prescribe the latest and greatest drug pharma is pushing from Levitra to Lipitor! Drug companies are in the profit business. If there is money to be made researching a drug to cure cancer they do it and they do. They also pour millions into what really are pretty minor issues when looking at the medical problems of the world

ED drugs represent less than 1% of pharmaceutical revenues, and less than a 0.02% share of GDP. Given that this class of drugs is a small player, both in terms of the pharma industry and in terms of GDP share, you're not looking at a big cost savings. I suspect that a fair number of insurance plans don't provide much coverage for these drugs, and so I suspect that it's not contributing to insurance issues much. However, as a profitable drug, while the absolute amount is small, it does provide a known source of "seed" money for further R&D in other classes of drugs.

Besides, what do you have against grandpa having a little fun

Originally Posted by ba1025

the whole problem with this argument is when social services relied on charity they failed so miserably the demand for government intervention became great enough a majority of the people were for the social programs. The same thing is happening now. if our private health care system were working we wouldn't be seeing an increasing number of people favoring national health care in spite of huge campaigns by Insurance/Pharma against it. You don't deny more people look favorably on the idea than 10-20-20 years ago do you?

Who's telling us our health care system is not working? Who's creating the demand for a universal health care system? Don't you think it's kinda weird that those people telling us our system is not working are the same politicians who want a universal system?

I use private system. I think it's just fine. I do not demand a change.

On the other hand, I think our universal retirement system is broken and needs change. Lots of other people think the same too. Can we get it changed? No. Why? Because once a government program begins, it does not stop. You can only add ever increasing rules and regulations to decrease its effectiveness.

The end result of our universal health care system will be the same as our universal retirement system.

Originally Posted by ba1025

yes we need millions spend researching male pattern baldness treatments and erectile dysfunction drugs and advertisement urging us to get our Dr's to prescribe the latest and greatest drug pharma is pushing from Levitra to Lipitor! Drug companies are in the profit business. If there is money to be made researching a drug to cure cancer they do it and they do. They also pour millions into what really are pretty minor issues when looking at the medical problems of the world

So when people want government intervention we should listen, but when people vote with their pocket books we should ignore them?

I don't know the specifics of Medicaid, but I'm fine with extending care to those who may not be able to afford it. But why do we have Medicare? Medicare accounts for 1/5th of our annual spending. If we cut this and forced people to make choices about health care with their own money, I suspect that we'd cut a lot of costs since people would forego some of the treatments that Medicare may have provided.

There's much more at the link.

Cato Unbound » Blog Archive » Insulation vs. Insurance

Question: How many American families have proper health insurance?

a) over 90 percent.
b) between 80 and 90 percent.
c) between 10 and 80 percent.
d) less than 10 percent.

Given that about 15 percent of American families do not have health insurance, the correct answer would appear to be (b). However, in my opinion, the correct answer is (d).

The health coverage most Americans have is what I call “insulation,” not insurance. Rather than insuring them against risk, most families’ health plans insulate them from paying for most health care bills, large and small.

Real insurance, such as fire insurance, provides protection against rare, severe risk. Real insurance is characterized by:

– low premiums
– infrequent claims
– large claims

American health insurance—including employer-provided insurance and Medicare—is the opposite. Families typically are paid claims several times per year, often for small amounts. Premiums are high—the cost of providing insulation often exceeds $10,000 per year per family. However, most families pay these premiums only indirectly, through taxes and reduced take-home pay from employers.

Real insurance would pay for treatments that are unavoidable, prohibitively expensive, or for illnesses that occur relatively rarely. Instead, insulation reimburses even relatively low-cost services, such as a test for strep throat or a new pair of eyeglasses. Insulation pays for treatment even if it is commonplace or discretionary.

Another look at the issue from Cato:

The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World

Critics of the U.S. health care system frequently point to other countries as models for reform. They point out that many countries spend far less on health care than the United States yet seem to enjoy better health outcomes. The United States should follow the lead of those countries, the critics say, and adopt a government- run, national health care system.

However, a closer look shows that nearly all health care systems worldwide are wrestling with problems of rising costs and lack of access to care. There is no single international model for national health care, of course. Countries vary dramatically in the degree of central control, regulation, and cost sharing they impose, and in the role of private insurance. Still, overall trends from national health care systems around the world suggest the following:

Health insurance does not mean universal access to health care. In practice, many countries promise universal coverage but ration care or have long waiting lists for treatment.

Rising health care costs are not a uniquely American phenomenon. Although other countries spend considerably less than the United States on health care, both as a percentage of GDP and per capita, costs are rising almost everywhere, leading to budget deficits, tax increases, and benefit reductions.

In countries weighted heavily toward government control, people are most likely to face waiting lists, rationing, restrictions on physician choice, and other obstacles to care.

Countries with more effective national health care systems are successful to the degree that they incorporate market mechanisms such as competition, cost sharing, market prices, and consumer choice, and eschew centralized government control.

Although no country with a national health care system is contemplating abandoning universal coverage, the broad and growing trend is to move away from centralized government control and to introduce more market-oriented features.

The answer then to America’s health care problems lies not in heading down the road to national health care but in learning from the experiences of other countries, which demonstrate the failure of centralized command and control and the benefits of increasing consumer incentives and choice.

Michael Tanner is director of health and welfare studies at the Cato Institute and coauthor of Healthy Competition: What's Holding Back Health Care and How to Free It (second edition, 2007).

This is something that I have been thinking about. And I know its an unpopular line of thought based on discussions I've had with my friends.

Why should your health insurance pay for things like your childs' physical for school sports?

Why should it pay for BS visits to the emergency room because you have a sore throat, runny nose, cold?

There is no other type of insurance that we have that we demand provide cheap preventative and sometimes wasteful maintenance. Our car insurance doesn't pay for a new set of rims to dress our ride up, but we want our health insurance to help pay for a new set of B00bs for the wife.

Another unpopular idea, is an old one. If you wish to work for me, and expect me to provide XX level of insurance, then I should have the right to hire healthy, in shape, nonsmoking employees so that I can afford to provide that insurance. Or I should be able to deduct the difference in the premium that I pay for you being unhealthy (in relation to the standard cost of the rest of the employees) out of YOUR paycheck. That was everyone has the same level of compensation.

I liked Klings article

Originally Posted by ba1025

yes we need millions spend researching male pattern baldness treatments and erectile dysfunction drugs and advertisement urging us to get our Dr's to prescribe the latest and greatest drug pharma is pushing from Levitra to Lipitor! Drug companies are in the profit business. If there is money to be made researching a drug to cure cancer they do it and they do. They also pour millions into what really are pretty minor issues when looking at the medical problems of the world

I think you will find that those drugs were originally developed to treat angina.
The ED stuff were noted side effects that were then studied after the drugs failed to be a marked improvement on current oral angina treatments.

The mail Pattern baldness drugs came from research in high blood pressure meds.

Originally Posted by Shek

Another look at the issue from Cato:

This is the key statement in the Cato report you posted.

Countries with more effective national health care systems are successful to the degree that they incorporate market mechanisms such as competition, cost sharing, market prices, and consumer choice, and eschew centralized government control.

But I still wonder whether these think tank guys ever actually go to countries that have successful national systems and see for themselves.

It's interesting how a simple concept like making health care accessible to all our neighbors and countrymen/women becomes a battle of statistics. You would think our starting point would be 'how do we get everyone health care' -- the unemployed, the destitute, the struggling family with an average income, etc.

Originally Posted by gunnut

Who's telling us our health care system is not working? Who's creating the demand for a universal health care system? Don't you think it's kinda weird that those people telling us our system is not working are the same politicians who want a universal system?

We're supposed to find out the truth ourselves. Politicians, especially those in heat, play to the polls for the most part. Ever notice the politicians who push national health care don't lay it out in much detail?

I use private system. I think it's just fine. I do not demand a change.

You're fortunate; a lot of people a little west of me in West Virginia can't afford any insurance worth having. You get out in the hustings and you find people who have all sorts of ailments and every doctors visit is a dollar trauma. They work hard all day, make 70-100 bucks and the doc wants $125 for a 10 minute visit...it hurts me to hear it, and I hear it all the time.

On the other hand, I think our universal retirement system is broken and needs change. Lots of other people think the same too. Can we get it changed? No. Why? Because once a government program begins, it does not stop. You can only add ever increasing rules and regulations to decrease its effectiveness.

What's wrong with it other than the gov't borrows from the trust fund? It isn't enough to live on for city folks. But it helps if you have savings and can keep on working for a few more years. Could it be better? I don't know. Every 100 bucks in pay a worker costs him 7 bucks and change and I match it. Some $14/hundred goes into the trust fund for him. Not a lot in 20 years of work. I say, join the military or work for uncle sam...best insurance you'll get decent retirement pay.

The end result of our universal health care system will be the same as our universal retirement system.

How do you know? It depends on how it is structured. How would you do it to protect it from political meddling? Congress is capable of creating arms length agencies--Fed Reverve, Mitre Corp, Fannie Mae, Base closure mechanism...as long as no party has to take the heat for changing Soc Security, etc., bipartisan compromise works.

Originally Posted by JAD_333

This is the key statement in the Cato report you posted.

But I still wonder whether these think tank guys ever actually go to countries that have successful national systems and see for themselves.

It's interesting how a simple concept like making health care accessible to all our neighbors and countrymen/women becomes a battle of statistics. You would think our starting point would be 'how do we get everyone health care' -- the unemployed, the destitute, the struggling family with an average income, etc.

JAD,

If you note from the statement, he doesn't state that the other national health care systems are successful per se, but only to the extent that they harness the market instead of having an all knowing bureaucrat make decisions.

Here's an excerpt from the body of the paper. There's some cherry-picking that is going on that probably makes the differential seem a little bit greater, but I doubt that the excluded data points from national health care system countries on some of these metrics would yield a vastly different result.

When you compare the outcomes for specific diseases, the United States clearly outperforms the rest of the world. Whether the disease is cancer, pneumonia, heart disease, or AIDS, the chances of a patient surviving are far higher in the United States than in other countries.

For example, according to a study published in the British medical journal The Lancet, the United States is at the top of the charts when it comes to surviving cancer. Among men, roughly 62.9 percent of those diagnosed with cancer survive for at least five years. The news is even better for women: the five year-survival rate is 66.3 percent, or two-thirds. The countries with the next best results are Iceland for men (61.8 percent) and Sweden for women (60.3 percent). Most countries with national health care fare far worse. For example, in Italy, 59.7 percent of men and 49.8 percent of women survive five years. In Spain, just 59 percent of men and 49.5 percent of women do. And in Great Britain, a dismal 44.8 percent of men and only a slightly better 52.7 percent of women live for five years after diagnosis.26

Notably, when former Italian prime minister Silvio Berlusconi needed heart surgery last year, he didn’t go to a French, Canadian, Cuban, or even Italian hospital—he went to the Cleveland Clinic in Ohio.27 Likewise, Canadian MP Belinda Stronach had surgery for her breast cancer at a California hospital.28 Berlusconi and Stronach were following in the footsteps of tens of thousands of patients from around the world who come to the United States for treatment every year.29 One U.S. hospital alone, the Mayo Clinic, treats roughly 7,200 foreigners every year. Johns Hopkins University Medical Center treats more than 6,000, and the Cleveland Clinic more than 5,000. One out of every three Canadian physicians sends a patient to the United States for treatment each year,30 and those patients along with the Canadian government spend more than $1 billion annually on health care in this country.31

Moreover, the United States drives much of the innovation and research on health care worldwide. Eighteen of the last 25 winners of the Nobel Prize in Medicine are either U.S. citizens or individuals working here.32 U.S. companies have developed half of all new major medicines introduced worldwide over the past 20 years.33 In fact, Americans played a key role in 80 percent of the most important medical advances of the past 30 years.34 As shown in Figure 2, advanced medical technology is far more available in the United States than in nearly any other country.35

The same is true for prescription drugs. For example, 44 percent of Americans who could benefit from statins, lipid-lowering medication that reduces cholesterol and protects against heart disease, take the drug.
That number seems low until compared with the 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians who could both benefit from the drug and receive it.36 Similarly, 60 percent of Americans taking anti-psychotic medication for the treatment of schizophrenia or other mental illnesses are taking the most recent generation of drugs, which have fewer side effects. But just 20 percent of Spanish patients and 10 percent of Germans receive the most recent drugs.37 Of course, it is a matter of hot debate whether other countries have too little medical technology or the Unites States has too much.38

Some countries, such as Japan, have similar access to technology. Regardless, there is no dispute that more health care technology is invented and produced in the United States than anywhere else.39 Even when the original research is done in other countries, the work necessary to convert the idea into viable commercial products is most often done in the United States.40 By the same token, not only do thousands of foreign-born doctors come to the United States to practice medicine, but foreign pharmaceutical companies fleeing taxes, regulation, and price controls are increasingly relocating to the United States.41 In many ways, the rest of the world piggybacks on the U.S. system.

ABC News: John Stossel: Whose Body Is It, Anyway? Sick in America

American Health Care in Critical Condition
The Case for Putting Individuals, Not Employers or Government, in Control of Health Care
By JOHN STOSSEL and ANDREW SULLIVAN
Sept. 11, 2007 —

Most everyone agrees, America's health-care system is a mess.

Millions of Americans lack health insurance and still our annual health-care costs exceed $2 trillion that's about the size of the entire economy of China. For the country with the world's "best" medical care, a lot of people seem unhappy.

Many hate the insurance industry.

Employers have seen insurance premiums rise 87 percent over the last seven years. General Motors now spends more on its employees' health insurance than on steel. Doctors are fed up, too; the average physician's office spends 14 percent of its income filling out paperwork.

No one seems angrier than the patients who have been denied care. Vicki Readling of North Carolina was diagnosed with breast cancer after she had quit her job and lost her employer's insurance. Readling purchased temporary insurance for herself, but when it expired she was told that because of her pre-existing condition cancer she would now have to pay $27,000 a year for a new policy. With an income of $60,000 and twin sons in college, she couldn't afford it.

Insurance industry spokeswoman Karen Ignani is eager to report that most people aren't like Readling. Polls show that while people dislike the insurance industry in general, 87 percent of people with health insurance are happy with their coverage. Only 3 percent of health insurance claims are denied, she says.

In his hit documentary "Sicko," Michael Moore focuses on tragic stories of people whose insurance claims have been denied. His prognosis? He calls for "the elimination of private profit-making health insurance companies" and suggests turning over all health-care spending to the government to provide "free" health care to everyone. He goes to countries like Canada and Britain and implies that their socialized systems are far better than that of the United States.

'What It Costs When It's Free'
There are many problems with health insurance, but that doesn't mean we should put the government in control. If it's decided that health care should be paid for with tax dollars, then it's up to the government to decide how that money should be spent. There's only so much money to go around, so the inevitable result is rationing.

It's just the law of supply and demand. Lowering prices increases demand. Lowering the price to nothing pushes demand through the roof. Author P.J. O'Rourke said it best: "If you think health care is expensive now, wait until you see what it costs when it's free."

When health care is free, governments deal with all that increased demand by limiting what's available.

The reality of "free" health care is that people wait. In the United Kingdom, one in eight patients waits more than a year for hospital treatment and the British government recently set its goal to keep wait times to less than 18 weeks that's more than four months! In Canada, almost a million citizens are waiting for necessary surgery and more than a million Canadians can't find a regular doctor. In the small town of Norwood, Ontario, a weekly drawing is held in which a townsperson wins the right to access the town's one family doctor.

Governments ratchet down health-care costs in different ways. Doctors went on strike last year in Germany because their government's system pays them less than they thought they deserved and forces them to work thousands of hours of unpaid overtime. In the United Kingdom, one hospital was inspired to save money money by not changing sheets daily. British papers report that instead of washing the linens, nurses were told to just turn the bedsheets over.

Government is less the answer to our health-care crisis than the problem. It was our government that helped to create the absurd system in which two out of three Americans get health insurance through their employer. In a country where four in 10 Americans change their job every year, this system makes little sense; it leaves people like Readling without coverage when they need it most.

The government also makes insurance expensive by mandating the medical services that policies must cover. Required services vary state by state and include massage therapy, pastoral counseling, acupuncture, hair prosthesis and dentures. Such mandates are a reason why an individual policy in New Jersey costs around $4,000 a year while a policy in Iowa costs only a third of that. Yet insurance regulations make it illegal for someone in New Jersey to buy a policy from out of state.

The Way We Pay
Another problem that raises costs, and keeps individuals from controlling their own health care, is the way we pay for medical care. Out of every dollar that the United States spends on health care, only 12 cents comes out of the pocket of patients, according to the Centers for Medicare and Medicaid Services. Most of us have our medical expenses covered by a third party, either an insurance company or the government.

When we pay for health care with someone else's money, it creates nasty incentives. It's good to be covered in case of a medical catastrophe, like a heart attack or cancer, but when patients pay for almost everything from physicals to acupuncture using third-party money, they have no reason to care about cost. Because the buyers don't care about cost, neither do the health-care providers.

"It's gotten to the point where doctors don't even know how much it costs them to provide this service or that service or how much an office visit should cost. Try asking a doctor how much an office visit costs and watch their face go blank," said Michael Cannon, director of health policy at the Cato Institute.

Our health-care system has become totally removed from the competitive market forces that have improved every other area of the economy. If patients cared about cost, health-care providers would compete to attract patients. They'd do innovative things to keep costs low while increasing quality.

Harvard Business School professor Regina Herzlinger, author of "Who Killed Health Care?", reminds people that "when Henry Ford came around, cars cost more than houses." By competing for profit, Ford revolutionized the auto industry. In eight years, he cut the price of cars in half while improving quality immensely. In nearly every sector of the economy, prices drop over time as technology improves. Not so in health care.

Customer Service, Competition, Control
Can you e-mail or call your doctor to ask quick questions? In the 21st century, when even small children regularly use computers, many doctors and hospitals don't.

"Why would they?" said Dr. David Gratzer, author of "The Cure." E-mail and telephone consultations aren't things most doctors can get paid for. Dr. John Goodman of the National Center for Policy Analysis, said, "The federal government has a list of 7,500 procedures it will pay for the telephone's not on the list [and] neither is e-mail."

But when patients are in control of their health-care spending, things get better. Lasik surgery isn't covered by most insurance policies, so patients pay for this high-tech procedure out of their own pocket. It's for this reason that laser surgeon Brian Bonanni gives out his cell phone number and e-mail address to all of his patients. He knows that he has to attract patients by making himself available.

Competition has also made Lasik cheaper: While in nearly every other field of medicine, prices have gone up faster than consumer prices in general, the price of Lasik has fallen by as much as 30 percent. The quality of the surgery has also improved. The difference is that people care about prices when they spend their own money, so providers compete to offer services that are faster, better and cheaper.

John Mackey, CEO of the supermarket chain Whole Foods, saw his insurance premiums rise through the roof so he changed the way his employees got health care. He proposed a health insurance plan with a high deductible. To help meet that deductible, the company puts money into a "personal wellness account" for each employee and employees use that money to pay for routine care. The money in the account belongs to the employees and puts them more in control of their health-care spending. Employees pay for the small stuff, like sore throats and sprained ankles, but their health insurance covers them in case of a catastrophe. Accounts like these are typically called HSAs, or Health Savings Accounts.

Mackey saw Whole Foods' health-care costs drop by 13 percent the first year the plan was in place. Some employees objected. They wanted the old "full-coverage" plan back. One wanted "pet bereavement services" covered. Whole Foods then held a vote and "77 percent of team members voted for the health plan that we have today," said Mackey. Today he says most of his employees love the plan because it allows them to spend the money how they want to spend it.

'You and Me'
Whole Foods' health-care costs have been creeping back up lately. Mackey says it's because there are so few people with health plans like his. Only 4.5 million people in America have Health Savings Accounts, according to a 2007 census conducted by America's Health Insurance Plans. That's a tiny fraction of the insurance market, but consumer-directed health plans are a step in the right direction toward placing individuals not government or insurance companies in charge of their health-care dollars.

The more people control the money they spend on their own health care, the more people shop around and the more providers compete to attract patients by lowering prices while improving quality. It's putting individuals in control that could turn our health-care sector into the vibrant, competitive marketplace that we see in nearly every other area of our economy.

After all, it's our body and our health. Shouldn't we be in control of how our health-care dollars are spent?

Harvard's Herzlinger said, "Who should decide whether you live or die? Do you want the government to decide? Do you want a health insurer to decide? Who's gonna make that decision? Is it gonna be a government? Is it gonna be an insurer? Or is it gonna be you and me?"

Putting individuals in control of our health rather than our employers or the government is a better way to cure what ails America's health system.

To those who believe our system to be more than twice as good as any other country because it is costs twice as much and the efficiencies of a for profit system increase that value. It's clear I think that idea ludicrous but for the purposes of discussion i will agree with it. That leaves one question.


How long can the current system sustain 15% a yr inflation rates before you consider it in trouble?