gunnut

But why do I see articles talking about how private companies responded faster and better to the disaster than FEMA? Shek started a thread and I posted an article in it.

So VA is like one organization among many different health care organizations. You're picking the best run and comparing that to the average.

Sure they are the same.

You used the term "kills" as if it's intentional.

It is theoretically impossible for a government bureaucracy to charge less in administrative cost than a private institution, all else being equal.

So they are being run in the best way they can be, with no improvement possible? Who's to say they cannot be improved upon with a private institution?

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Shek

This is slightly over three years old, so I'm sure that more has developed on it. Given glyn's comment about Britain's healthcare system, I find the thought that it would become politicized in the US to be a fair assessment.

Marginal Revolution: Taiwanese national health insurance

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zraver

private companies responded faster.... care to cite any examples as regards to health care. Despite the market prices have gone up faster than inflation, benefits have gone down, and the number of un/under insured is to large when compared to the industrialized nations standard.



No it is the closest thing we have to an integrated national health care system and it out performs all the private systems.



How so?



as if it was preventable- double checking prescriptions, cleanliness issues, proper staffing etc.



really whats the formula that proves that?



They meet the need of the nation and thats the big difference between the them and the current health care system- its not meeting the need.

ba1025

We pay twice as much per capita as the next highest cost Western nation
We are 5th in waiting time to see a Dr.
We are abysmal in infant mortality even a healthcare system run 3/4 as efficent as the French one would save us $1500.00 per capita. The only arguments against this are sniper attacks or misdirections like comparing it to FEMA...HELLO it wouldnt be run by someone who raised show horses. You just cant defend a system taht costs 6000.00 per person when the next most spent is 3000.00. Our sytem is so inefficent. It is far worse than Motor Vehicle at this point

zraver

The Triumph of Socialized MedicineRight here in the USA.
By Timothy Noah
Posted Tuesday, March 8, 2005, at 9:00 PM ET

The English language desperately needs a word to describe something that is objectively true but unrecognized as such because nobody wants to believe it. I hereby coin one: "flakt." Henceforth, a flakt will be defined as a measurable, demonstrable reality that the great majority of people refuse to acknowledge. It is a flakt that, even though the American public is convinced that foreign aid makes up a huge proportion of the federal budget—in one 2001 poll, respondents put it at 24 percent of total spending—foreign aid makes up less than 1 percent of the federal budget. It is a flakt that the war in Iraq has impeded the international manhunt for Osama Bin Laden. It is a flakt that Million Dollar Baby was nowhere near the best picture released during 2004.

Phillip Longman published an article in the January/February Washington Monthly ("The Best Care Anywhere") that states a very important flakt: Socialized medicine has been tried in the United States, and it has proven superior to health care supplied by the private sector. This is a case the Monthly has made at least once before, in an article published by Phil Keisling in 1982, and possibly before that. But Longman's article should leave absolutely no room for doubt. (I should note here in the interest of full disclosure that Longman is a friend of mine; that 20 years ago I was an editor at the Monthly; and that today I'm a contributing editor.)

The socialized medicine to which I refer is the complex of hospitals managed by the Veterans Administration. Longman cites a study published in the New England Journal of Medicine in 2003 comparing veterans' hospitals with fee-for-service health care funded by Medicare. Both, of course, constitute socialized medicine in the sense that both are paid for by the federal government; but the hospitals treating elderly patients on Medicare are not government-run institutions. By every criterion, the New England Journal found the veterans' hospitals to be superior. This is especially striking when one considers, as the New England Journal noted, that patients in VA hospitals
Click Here!

are more likely to be in poor health; to have a low level of education, disability, or a low income; to be black; and to have higher rates of psychiatric illness. These characteristics are associated with receiving poorer quality care.

Surveys by the National Committee for Quality Assurance and other organizations, have reached the same conclusion. The superiority of VA hospitals is so obvious that by now it ought to be common knowledge. But it isn't, because an insane political consensus that firmly opposes turning health care over to the government—because the government is presumed incapable of doing anything well—doesn't want to hear that government hospitals are outperforming private hospitals.

There are many reasons why this is so. One reason, Longman explains, is that people don't shuffle in and out of the VA system the way they shuffle in and out of private health care plans, either because they change jobs or because their employer decides to do business with a different insurance company. Another reason is that the doctors are salaried, and therefore lack any conceivable financial interest in subjecting a patient to avoidable medical procedures. But the main reason the VA hospitals are doing especially well these days is that they have adopted the same modern information technologies that have been embraced by every other sector of the economy.

As the husband of a recently deceased terminal patient, I can attest that doctors frequently make medical decisions without having all the relevant data in front of them. My wife and I energetically collected this information ourselves and brought it to doctor's appointments, because we knew that on any given day there was perhaps a 50 percent chance that, say, the results of a very expensive blood test had been misplaced under a pile of faxes on somebody's desk and therefore never made their way into my wife's medical chart. Staying on top of the data was practically a full-time job. Even so, there were times when we ourselves couldn't make the missing data point appear—films of CT scans were particularly elusive after they were filed away in the hospital's film library—and the doctor had to make a decision without it. The nature of my wife's illness was such that any wrong calls the doctors may have made as a result wouldn't have made much difference, but that isn't true for most hospital patients.

This is a problem computer technology can easily solve, but hospitals have been resistant to computerizing medical records, for the simple reason that it's difficult for them to benefit financially from such an investment. "Suppose a private managed-care plan follows the VHA example and invests in a computer program to identify diabetics and keep track of whether they are getting appropriate follow-up care," Longman explains.

The costs are all up-front, but the benefits may take 20 years to materialize. And by then, unlike in the VHA system, the patient will likely have moved on to some new health-care plan. As the chief financial officer of one health plan told [the University of Chicago's Lawrence] Casalino: "Why should I spend our money to save money for our competitors?"

Or suppose an HMO decides to invest in improving the quality of its diabetic care anyway. Then not only will it risk seeing the return on that investment go to a competitor, but it will also face another danger as well. What happens if word gets out that this HMO is the best place to go if you have diabetes? Then more and more costly diabetic patients will enroll there, requiring more premium increases, while its competitors enjoy a comparatively large supply of low-cost, healthier patients. … An idealistic commitment to best practices in medicine doesn't pay the bills.

The Bush administration is pushing energetically to provide more information technology in hospitals, but its commitment to making health care more competitive and market-driven is undermining that effort, Longman says. "Health savings accounts" are a case in point. These are new tax-free accounts that can be used only to pay medical expenses. But, as Arnold Relman, former editor of the New England Journal, noted in the March 1 New Republic,

Healthy, young families would choose the least expensive plans with the highest allowable deductible, and those with health problems would be forced to choose plans with the lowest allowable deductibles but higher premiums. The premiums or the required co-payments of the latter plans would spiral upward because of the greater use of services by sicker beneficiaries, so it would become even harder for those with the greatest need for insurance to afford coverage. In this way, one of the most important values of insurance—the sharing of risks over a broad population base—would be lost.

To whatever extent hospitals absorbed these costs themselves, they'd have even less money left over than they do now to pay for computerization. What's really needed is to make private hospitals more like VA hospitals. Even Bush has recognized that "the VA has got an advantage because the—all the administrators work for the same—same outfit, the same organization." But he doesn't want to think about what that says about the virtues of socialized medicine. He doesn't want to face flakts.

The triumph of socialized medicine - By Timothy Noah - Slate Magazine

JAD_333

I am wondering what you mean here. No one is charged per se for administrative costs, although in a for-profit system, they are considered overhead and find their way into cost of services. But I don't see why the government can't have a lower cost than private care facilities. To begin with, government has no profit motive whereas private medical providers mark up their services to make a profit. That means everything, from asperin to administrative costs.

Do away with the profit angle and the cost of health care comes down. That won't be enough to make a successful nat'l system. The VA example is a case in point; government funds the bulk of its cost. Although a mandatory insurance system would reduce government funding requirements for a VA-like national system, just getting Congress to think about it is hard enough.

The TIME article hit the nail on the head:

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gunnut

OK, let's just say you are right, a single payer, nationalized, universal health care system is better than private care and more efficient. How "universal" is this care? Does it provide free care for the unemployed?

gunnut

It is true a government system doesn't have a profit motive and therefore no need to raise the cost. However, without the profit motive, there's no need to contain cost. People won't strive to be efficient because there's no profit. In fact, people (workers in the system) would do the opposite. They would do the bare minimum specified in the doctrine and collect maximum pay possible.

A private system is merit based. People need to perform to keep their jobs. If the company doesn't do well, the fat goes. If it's not fixed, the meat goes. One more chance and the bone goes. That's when the inefficient competitor leaves the market and replaced by the more competant. I know. I've been through 12 quarters of layoffs and laid off twice by the same company.

A government agency is anything but merit based. It's nearly impossible for the government to lay off anyone. When it does, it's not the fat, but equal across the board. California is cutting 10% of the services across the board because otherwise it would anger too many people in a concentrated area. Politicians have votes to worry about.

Bigfella

you would be correct if you weren't completely wrong. Australia has a universal healthcare system and a large parallel private system, allowing for comparisons.

The public system is markedly more efficient. Put simply, it delivers a lot more service for your dollar, even in Emergency Rooms. Devotees of neo-liberal economics know that this isn't true because....it can't be. Well guess what...it is.

Private providers seek to provide treatments that will ensure profits. This certainly can be efficient, but it can also lead to over-servicing - notably the provision of expensive tests & procedures that may be of marginal clinical value.

The notion that the profit motive is the ONLY possible way to motivate people in a positive way is not just crude, it borders on stupid. The slavish devotion of some of the dismal science's less sophisticated true believers to this idea looks a good deal more like faith than science. There are a world of facts out there to show that the world is a good deal more complex than that.

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ba1025

Dude it's free now only they have to wait till they are real sick and then go to the ER. Afterwards they get a bill for 40 or 50k for their 4 day hospital stay that those with private insurance end up paying for. I'd rather He get to see a DR. at a practice free than wait till He is deathly ill and costs me HUGE dollars. I am paying for his health care now just VERY inefficiently. Just having a universal set of forms would save some money. Every medical practice/hospital/pharmacy has people employed solely to navigate those waters and it adds cost not quality to health care. Does anyone really think Big Insurance spends big every time this come up because it will cost you money???? I'd bet it's because they know the gouging of Americans would end.

zraver

Of course some people are only motivated by money. And for many money is a major consideration. But if it was the only consideration why would anyone teach, do plumbing, wrench on a car? Calling and job satisfaction are just as important as money. I think the VA system will salaried employees proves this point. Despite being unable to profit past thier government pay and incentives they still manage to lead the nation in the quality of care delivered.

Please define unemployed? Do you mean kids, elderly, workers between jobs becuase of lay offs, the mentally ill or physically disabled, or that tiny percentage that won't work? I think with the exception of that tiny percentage you would agree that they deserve coverage in a national system. They either can't pay, can't pay yet, or already paid.

The portion of those who won't pay and won't work is so small as to not matter. Our current unemployment rate among working age adults is 4.8% and this includes the disabled and workers between jobs as well as the wont works.

gunnut

Hmmm...never heard this expression before, but OK. Would I be correct if I were only partially, rather than completely wrong?

Major Shek already said that an apples to apples comparison is difficult to say the least because a government system gets tax dollars and a lot of the costs are buried under feet of paper work.

I agree. That is what's happening here in the states when employers pay for most of the health care cost and the people don't see the hard cash coming out of their pockets.

Marx thought that and that experiment didn't work out so well.

gunnut

In a society with private care system, these people can start a non-profit charitable organization without mountains of paper work from the government and be even more efficient. There are no laws saying they have to work in a for-profit organization.

So the system isn't truly a universal system. I have to work to get it. If I were able to work but don't, I won't get care. Is that what you propose?

Shek

Bigfella,

This label actually comes from Malthus, who predicted that we'd all die of food shortages about two centuries ago. His predictions were dismal indeed, although they don't represent the economics of today (or for quite awhile, actually).

Heck, maybe this is why I'm going to teach a sports economics class next year - you can really get at economics without arousing too much furor, although I suspect I'll get some folks riled up when I tell them that steroids and HGH don't matter in baseball .

JAD_333

I am not sure I am right. I was dead set against a national health system based on what I knew of the Canadian and British system. The latter has improved according to some accounts I've read. They use a gatekeeper system where you go to a GP first and he deals you out to a specialist if necessary. Their hospitals now compete for operations money, an odd way of creating the semblance of competition... But it lowered wait times, imporved care and allows choice. Some hospital administrators are complaining. What about, I am not sure...inefficient hospitals being threatened with closure, I think.

Anyway, moving on. I'm still not 100% sold. But I am beginning to be. It started when I saw other systems that were (or seem to be) running better than the Canadian & GB systems. The Japanese model was interesting; you can go to any doctor or hospital you want to; fees are set annually by the national health care admin and they are incredible low. No appointments are needed; the average time with the doc is under 5 min; there is practically no paperwork. Procedures like MRIs are set so low that there is an incentive for companies to make better and less expensive machines and they have--(necessity is the mother of invention) and they are selling them worldwide at a fast clip. One night in a hospital is $20 Some clinics have small hospitals attached--10-20 rooms to handle immediate needs. All health records are centralized...Doctors grouse a bit about pay, but they're making $90K and up.

The German system is the oldest; was started by Bismark, on the theory that a healthy nation is a strong nation; it is also the most liberal, e.g., visits to spas and herbal remedies are covered. It is funded by insurance which everyone is required to have and small co-pays (10 Euros for a doctor visit); lose your job, you still keep your policy.

Switzerland is new to the ballgame; the conservatives fought it tooth and nail, but now extol its virtues...originally only 52% voted for it in a national referemdum. Today, it has a 90%+ approval rating. Everyone is required to have insurance, and it's cheap by US standards. Their gameplan included
doing away with the profit angle. Interestingly, the same insurance companies as before do the insuring, but make no profit. Their incentive at the CEO level is pay for efficiency. You do a better job than the other companies and get more customers, you are rewarded via bonuses and being able to stay in business.

Here's the thing, there is no perfect system and any system will cost the taxpayers something. Plus, users will still have to pay fees, albeit a small fraction what they are now. Higher taxes to pay for government's part is offset by lower medical costs.

But the attraction for me is just one thing: everyone is covered no matter what their circumstance--employed, unemployed, young, old... If you can afford more plush medical attention, ok; opt out.

I think its time we took a close look at this, GOP or Dem... It's appalling to me that we allow so many of our citizens to go without routine medical attention simply because they cannot afford it. Sure, there are laggards who spend on entertainment before med insurance, but exceptions don't justify punishing those in need. And no one in GB, Japan, Germany, Canada etal, goes bankrupt on account of massive medical bills, but many do in this country.

And let's not get bamboozled by terms like "socialized medicine". They're meant to scare us conservatives away from any government-run program the medical lobby is against. Afterall, we have "socialized education", or at least it's fair game to call the public school system that, if we're going to call a public health system, "socialized".