Universal care cheaper and better than private insurance.

[JAD_333]

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.

Not necessarily so. Government can create policies and incentives to improve burocratic performance. You saw the TIME article about the VA system. The performace bonuses for medical personnel works. The Goldwater-Nichols bill shook up the burocracy. I was at DoD when it took effect. Useless divisions and branches went into the dumpster. Performace appraisals went to a bell curve-like process--only one "outstanding" could be dealt out in a division; merit pay was tied to ratings. I am sure there are some backwaters in the US gov't that are a total waste of taxpayer money, but we have to look at the whole, and from my experience in 2 federal departments and 2 agencies, the whole is pretty well run, nothwithstanding popular opinion. The problem is that people outside the gov't don't realize that when you have 4 million civilians in DoD alone, there's bound to be some waste, abuse and poor management somewhere.

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.

That's true, but it doesn't follow that government can't be efficient. At the division and branch level you have staffers and managers trying to move up the ladder; higher pay, merit bonuses and more responsibility are incentives at that level.

It's nearly impossible for the government to lay off anyone.

Laying off is easy-it' called RIFing. Firing is excruciatingly hard because civil service rules are so suffocating; I was assigned once to focus on getting rid of a senior employee, a GS-14, who had become a total liability, filing complaints about air quality in the office, etc., and taking long medical absenses; the file they handed me was 12 inches thick; one report on his behavior was rejected by the personnel office because it had a notation in pencil. He was put in a small room with air filters and assigned menial work, hoping he would quit. I was reassigned 3 months later; he was still there. Later, I inherited had a secretary, a GS-7, who was late constantly, had an attitude, was rude to the public, and couldn't spell. I knew better than try to fire her, so we simply stopped giving her any sit down work,
work, assigned her to filing and took her off the phones. She finally left for another gov't job... I rated her as low as she could be rated...no bonus for her.

Politicians have votes to worry...

The biggest impediment to good government is the lack of political will to do the right thing.:)

[glyn]

[QUOTE=JAD_333;484628]Thinking out loud.:)

I'm glad you did and I applaud your open-mindedness. Having a government run national health service will not turn the USA into a communist society! :)

[gunnut]

I am not sure I am right.

Sorry sir, my questions were directed to z. I think you posted when I was composing my questions.

[Bigfella]

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 :)).

No offence intended Shek. :)

Any discipline is only as valuable as the imagination of its practitioners allow it to be. Any discipline can fall into the hands of people whose obsession with theory constructs a shield against inconvenient facts. It has happened to my own discipline at times, and it has most certainly happened to yours.

In any case, I have you pegged at the 'sophisticated' end of the spectrum in these matters. You ask too many questions (and usually the right ones) to be a good acolyte. Sadly not all posters on WAB can say the same.

So you think Sports economics will be less contriversial? I dunno, those SABREmetricians are a pretty hardcore crowd. You may need all your military training to emerge alive. :))

[zraver]

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.

not quote sure what your trying to say here. First you implied that people only did things for money. Now are you saying if they don't want to do things for money they should do charity? What has this got to do with the discussion? No one here as far as I know is saying doctors and medical professionals do not deserve thier pay for profit or for charity employment. The debate so far has been cutting profit out of the equation for secondary providers like insurers and drug companies.

There is a lot that can be done to reduce costs. For example why don't we have the research universities focus on what I will call lifesavers- drugs that treat life threatening illnesses and then put the finished product out to competitive bidding on 3 year contracts. Low bidder wins the right to sell the drug for 3 years. The companies can spend thier money thier own money on cosmetic drugs like treatments for ED and then sell that stuff for what ever they want. Since the government develops the drugs, the FDA assumes a capped liability for failed drugs- say life time earning potential divided by number of years left in an average life or X amount which ever is greater. Yes testing will slow down the process but given the spate of recalls recently that might not be a bad thing.

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?

I never said that. I implied that the number of non-workers as in wont works is so low as to not matter.

[Gun Grape]

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

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

Have you ever had the pleasure of using the VA health care system?

I wouldn't take a leak on a VA Doc/Health care worker if they were on fire

They use threats, make things inconvenient and give veterans the run around until many simply drop out of using VA health care.

[zraver]

Have you ever had the pleasure of using the VA health care system?

I wouldn't take a leak on a VA Doc/Health care worker if they were on fire

They use threats, make things inconvenient and give veterans the run around until many simply drop out of using VA health care.

Gun Grape, that was sure true years ago, but the VA was reformed and now ranks highest in the nation.

[Gun Grape]

Gun Grape, that was sure true years ago, but the VA was reformed and now ranks highest in the nation.

Then god help the rest of the health care in this country. Because I was at a VA facility in March. I didn't see the "best in the nation"

I'm still waiting for them to "Evaluate" X-rays took in June and to schedule an MRI. And I'm a priority group 2 enrollee.


As contrast against my private insurance and private hospital

I injured myself 3 weeks ago. On a Monday, Called the Doctor, had an appointment the next day. He diagnosed, decided I needed surgery, referred me to a surgeon with an appointment that thursday. Dr scheduled me for surgery two weeks later. My insurance company called me with the approval the next day

Went in for a "Walk-in" pre-op Wed. Took about 1 1/2 hours. Went to the out patient surgery ward this morning at 7:30AM. Fixed and back up about 2:00PM this afternoon.

Posting on the WAB the same day:)) And since I won't be going to work for a few days next week, I can see my post count going up.

[JAD_333]

Sorry sir, my questions were directed to z. I think you posted when I was composing my questions.

No problem, but they did inspire me.:))

[JAD_333]

[QUOTE=glyn;484655]

Thinking out loud.:)

I'm glad you did and I applaud your open-mindedness. Having a government run national health service will not turn the USA into a communist society! :)

Thank you, sir. And would you be giving us a snapshot of how your health care stacks up to your needs?:)

[JAD_333]

Have you ever had the pleasure of using the VA health care system?

I wouldn't take a leak on a VA Doc/Health care worker if they were on fire

They use threats, make things inconvenient and give veterans the run around until many simply drop out of using VA health care.

I beg to differ. :P I have been in the system for 5 years now and I have never had a run around or been threatened. In fact, the people from techs to docs have been cordial, accommodating and professional. My only complaint is that the damn prostate biopsy they gave me was a pain in the arse.:))

I hasten to add that my clinic is the only one I know and the VA hospital in Martinsburg, WV, is only one of two I've been treated at. But I know other vets using other clinics who say they're happy with them.

[Roosveltrepub]

[QUOTE=gunnut;484013]



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







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



QUOTE]

the VA is the largest so by far the best example. It is the only one that is single payer. the inefficent other ones have a large private component

it's atheory and if you have been paying attention all things being equal our system which treats Human beings is in the bottom Industrialized world for overall performance and costs twice as much as the best run govt systems. Either you believe we can set something up more efficent than the French or you don't. I use them as an example since their govt is NOTORIUS for corruption and inefficency. After all a "tip" is what you used to pay every french civil servant to do his job


I wont even get into any big ideas like a theory proved wrong might not be right. What you are experiencing is cognitive dissonance. it's when the mind must eother adjust it's belief to the facts or reject the facts. Your choice you can be like the Pope or be like Galileo. The numbers all say the earth is round on this one.

[Gun Grape]

I beg to differ. :P I have been in the system for 5 years now and I have never had a run around or been threatened. In fact, the people from techs to docs have been cordial, accommodating and professional. My only complaint is that the damn prostate biopsy they gave me was a pain in the arse.:))

I hasten to add that my clinic is the only one I know and the VA hospital in Martinsburg, WV, is only one of two I've been treated at. But I know other vets using other clinics who say they're happy with them.

Call me jaded. I have used the VA in NC and 2 regions in Fl. I live right on the dividing line.

The clinic and evaluation clinic in NC "went through the motions" and looked for reasons to deny claims.

I went in , With a combat related documented in my health record knee injury. I was wearing a "Robo Knee Brace" (the big metal/polycarbonate contraptions) and a history of 2 operations and over a year of Phy Therapy. All this on active duty Camp Lejeune.

My claim was denied because I had only been to a Dr complaining of knee pain twice. Follow up visits do not count and neither did the time at physical therapy.

My claim for hearing loss was also denied. Even though I came in wearing DoD issued hearing aids and 14 years worth of hearing test noting progressive HFHL.

I appealed and lost because I did not provide any additional evidence. Although I started to mail them my hearing aids and knee brace.

Moved to Fl and the county Veteran Services Officer worked with me and Lake land VA hospital. Also had to flood the local medical facility with appointments and letters from various doctors, that were worded in s specific way. My county VSO was a former VA rater so he knew the specific phrases that they look for and have to be addressed by a doctor. The raters are non medical workers that sit with a checklist looking at the request and mark off the things that fit. Its a subjective evaluation by people with a 8 hr class on medical terminology.

I had just started my first job and had no sick or vacation time. The VA Hospital would call me in the evening after I would get off work and tell me I had an appointment the next day at the hospital. A 5 1/2 hour trip one way.

When I would ask them if they could reschedule so that I could try to get time off work and not have to leave in the middle of the night to make that appointment, the first thing that would come out of their mouth was "Are you refusing to come to this evaluation?" After saying ""No, I'm trying to keep my job by getting it rescheduled so I can notify my boss". they would say "If your not here at the appointed time, then we will close out your request and you will have to start over again."

I could go on and on. I'm currently assigned to Boloxi Miss VA reason and they are worse. I have actually written my Congressman about them. Prior to Katrina

You should also google the various reports about the inconsistencies in the rating evaluations by different State and rating centers.

I also read that article about VA being the best system and their are a few things that they got wrong. The computer system with patients records does not work over the entire country. It only works within what ever region you are in.

And the "Voting with their feet" veterans moving from the private sector to a more efficent VA system " isn't exactly true either. There was a large influx into the VA system because of the new 7 and 8 priority groups.

And the quote from a former Army captain who lost her right arm in Iraq, says negotiating the bureaucracy to get treatment for all her medical needs has been frustrating at times. She had to wait eight months for an appointment at the Washington hospital to get her teeth cleaned. Even so, she says, the care "is not as bad as I thought it would be."

I think statements like that are also what skew the U of Mich survey. We get so disgusted with the process that once in we breath a sigh of relief and give the old military "It could be worse"

I use the system for my required once a year evaluation. Only because I have to.


"end of rant"

[cesm]

Talking about health care systems, in France a true universal one has been created in 1999 : the CMU (Couverture maladie universelle, Universal health care coverage) and even the AME (Aide médical d'Etat, State medical aid) for the illegal aliens.

Some doctors don't like the CMU, I've heard about some abuses (traffics of drug substitute products) but it seems to work not so bad.

The American health care seems to be a huge waste for the society, a very profitable market for the companies, and a big risk for the poors.
We'll make a revolution before it comes in France. ;)

[FOG3]

Monopolies are generally considered bad as a monopoly now longer is truly subject to market forces forcing it to increase its efficiency. Bureaucracies are notorious for two things: being unaccountable and growing larger, more officious, and inefficient over time.

Given that the law of large numbers would tend to indicate any insurance company of meaningful size would basically just have a scale model of what the whole pie looks like and unlike phone/power/water lines each institution doesn't require dedicated infrastructure, how can a government bureaucracy operated monopoly being more efficient then the existing market force driven institutions? Profit? Profit is not some nebulous treasury box, it either goes back into the economy or towards new initiatives/R&D.

I would say that if one wants to lower the cost of healthcare they should go after the trial lawyers that go after providers for lottery sums and in so doing have driven up the cost of insurance for a doctor to the point they don't make a meaningful profit. As is the lawyers have been allowed to create an artificial environment where market forces do not encourage people to become doctors. Seems as how doctors are a necessity that's not acceptable.

If there are fraudulent business practices are going on that is the field of the judiciary to resolve those issues, and is independent of government monopolies. I'm agree with Gunnut, knock out employer provided health plans and let the market forces properly come into play.

If Capitalism didn't work the US would not be where it is. Why should we not trust it when clearly capitalism and market force do work? Even the Euros implicitly admit that by coming over here for medical care if they can.

From where I'm standing this is more of Socialists showing their inability to see reality. Socialists love groups, they love them so much they create and effectively enforce racist policies under the principle these castes are innately stuck in said castes. So they pity the caste, and try to appease them. Capitalism creates a land of opportunity. Anything someone wants can become a driving force to them to perform and succeed. What the Socialist in their caste mentality forgets is by their actions they deprive people of their reason and thus their will to better their environment, simply creating a bunch of dependents that take their handouts for granted.