The health-care debate in the Senate has, thankfully, returned to the paramount issue of cost. Unfortunately, the most obvious, time-tested and feasible approach to providing high-quality care at reasonable cost remains excluded from consideration.
The irony is that President Obama and a number of legislators have lauded the work of approximately 30 health-care organizations, caring for about 6 percent of the population, that for decades have provided care reliably better than average at lower cost. These are the “group employed models,” or GEMs, such as Geisinger Health System, the Marshfield Clinic, Kaiser Permanente, the Mayo Clinic and the Cleveland Clinic. Two of these GEMs — the Cleveland Clinic and the Mayo Clinic — have been ranked among U.S. News and World Report’s top five hospitals in the country. And shouldn’t all Americans have access to such better and cheaper care?
Most health-care organizations are run on a “fee-for-service” model. GEM organizations are different in that their physicians are employed, they are physician-led, and they work closely together and share information.
Kiss them good-by, they will be federalized within 10 years and all will be government employees. You think standing in post office lines is bad, try a government hospital waiting room.
paul
Sounds like a very reasonable idea. That means Congress will never go for it. Actual cost reduction and improvement of service is not the goal of the “reform” bills. Government control is their goal, to the detriment of cost and service.
I’m not sure if doctors would go for it, as they are salaried in many of these organizations.
#1 – that’s a pretty severe fantasy. But I suppose for some, getting in a line is better than not being able to enter a line unless in an emergency.
#2 – Given the number of lobbyists in Washington, what would you expect to happen? It’s still better than no change at all.
I emphatically do not think that any bill currently under consideration is “better than no change at all.” It’s not a good change if it raises taxes, raises costs, and reduces service.
RE: “It’s still better than no change at all.”
No it’s not — or rather, only for the collectivists among us.
Essentially the bill passed by the House and before the Senate were written by the insurance lobby. It means more people will be insured by the companies, most likely at higher premiums partly subsidized by the government for low income, unemployed, and/or high risk individuals. All of which will significantly improve their bottom line. That is why they have spent billions lobbying this year–all of which they expect to make back many fold. It probably won’t lower health costs for most individuals; it might moderate the soaring costs we have been experiencing and would continue to experience even if Congress were to do nothing.
P.S. I have had to sit in line in private emergency rooms. And I have had insurance company bureacrats tell my doctors what procedures they could perform and what drugs they could prescribe.
For all those screaming “socialism”, what we have in the name of Health Care Reform is nothing more than another Corporate Profit Maintenance and Enhancement bill. If you don’t believe me, stick around and read the annual reports of Aetna, HealthAmerican, the Blues, etc. for the next five years. You might want to check the same reports from the Pharmaceuticals, too. The bill contains no effective restraints on health care costs, and continues to allow the big boys to gouge hard-working Americans. It’s a joke. Sadly, the Republicans and their allies believe there really is no problem and what “reform” they offer is an even more dramatic profit maintenance and enhancement income redistribution program for their corporate buddies.
By the way, GEMs are will continue to be rare in America as long as the medical professions and insurance companies are aligned against them. I live in SW PA where the health insurance industry consists of two main players, Highmark BC/BS and UPMC, neither of which ranks very high in the latest US News and World Report survey of health insurers. They shouldn’t. Yet Pittsburgh has several world class medical institutions. You won’t get world class care, though, if you don’t have the insurance, and even if you do have insurance, you may still be in for a shock.
Heh – Sarah: this bill is a lot like what Republicans wanted in the 60’s and 70’s. Remember that liberal Democrats generally wanted single payer.
Well, it won’t raise my taxes or change my plan, so this “collectivist” isn’t that worried. And insurance company stocks went up, so all the “collectivists” that have stock in the stock market seem pretty pleased as well. As well as the collectivists who work in the pharmaceutical industry. And the AMA, that collectivist organization of doctors.
It is interesting that all the free-marketeers aren’t exactly clamoring to force the insurance companies to compete. But most of them seem to prefer corporate monopolies to the free market, in any case.
RE: “For all those screaming “socialismâ€, what we have in the name of Health Care Reform is nothing more than another Corporate Profit Maintenance and Enhancement bill. If you don’t believe me, stick around and read the annual reports of Aetna, HealthAmerican, the Blues, etc. for the next five years. You might want to check the same reports from the Pharmaceuticals, too. The bill contains no effective restraints on health care costs, and continues to allow the big boys to gouge hard-working Americans.”
Sure — government enabled monopolies along with a massive takeover of much of the rest of the pie by the State, causing even less of a free-market solution than before. Not certain why free-market people wouldn’t acknowledge that — I certainly do.
RE: “Sadly, the Republicans and their allies believe there really is no problem and what “reform†they offer is an even more dramatic profit maintenance and enhancement income redistribution program for their corporate buddies.”
Nonsense — DeMint’s plan was real reform and nothing of the sort. But of course, it won’t receive interest by the Collecticrats.
RE: “. . . this bill is a lot like what Republicans wanted in the 60’s and 70’s.”
Why that would interest me I don’t know.
RE: “so this “collectivist†isn’t that worried.”
Well of course not.
RE: “And insurance company stocks went up, so all the “collectivists†that have stock in the stock market seem pretty pleased as well.”
I do — and I’m never pleased at government enabled and enforced monopolies, along with massive takeovers of a huge chunk of the industry.
RE: “As well as the collectivists who work in the pharmaceutical industry. And the AMA, that collectivist organization of doctors.”
Well yes — the AMA is an organization of collectivist physicians — as the free-market physicians leave it in droves. They’ve plummeted to a mere 15% of physicians now — and spiraling downward every day from that. Heh.
RE: “It is interesting that all the free-marketeers aren’t exactly clamoring to force the insurance companies to compete.”
While lying is pretty much the only option, it’s still unbecoming. Of course, there have been screams from free-marketers for insurance companies to compete — to name just one, the desire to allow insurance companies to compete across state lines.
RE: “But most of them seem to prefer corporate monopolies to the free market, in any case.”
Again — I can understand the need to lie at this point.
Allowing insurance companies to compete over state lines is one thing we would agree on, Sarah. But the people actually doing capitalism – the insurance companies – might disagree.
I’m amused, of course, that you think that Republicans would suddenly agree to Demint’s plan of deregulating the insurance industry. A nice dream. Hey – I’d support it if it weren’t fantasy. I think you underestimate the “capitalists” you seem to idolize.
Granted, regarding the AMA – I always thought they were the conservative branch. They aren’t exactly the PHNP.
“Well, it won’t raise my taxes or change my plan, so this “collectivist†isn’t that worried.”
What it will do, is to change most specialists into generalists who will say (sadly) that “you are too complex” for them to take care of. A Cardiologist is an internist who works 100 hours a week, and comes in in the middle of the night either every other night or every 3rd night, to keep you from dying when you have a heart attack. He is currently reimbursed for this. With the passage of this bill, that Cardiologist will do better to drop back to being an internist working 80 hours a week and taking ER call in a group of 15. He will be sued less often, be on call less often, and make just as much money. Nobody will put in a stent into your coronary arteries when you have an acute MI, because nobody will be available in the time necessary. You will be given a referral to a tertiary hospital 6 hours away as an outpatient. This will result (if you are in need of specialty care, as opposed to routine care) in you driving long distances (or flying to a different country) in order to get the care you feel you need (a couple of stents, a pacemaker, or a new knee) or simply doing without and saving your government and insurers a great deal of money.
Sanitation increased our life spans to about 50. Medicine, (Antibiotics, insulin and BP meds) and common surgeries (appendectomies and fracture management) increased our life span to about 66. The increase to 78 is due to the ICU and specialty care. Take it away, and the Social Security and Medicare problems will have been solved.
So I’m glad you’re not worried John. Neither am I worried. I just got back from a 2 day stay in an excellent for profit hospital in Mexico where a young relative of mine had a medical device successfully placed, in immaculate surroundings, to my complete satisfaction. (Her US insurance company would not pay for it as she needed to be “sicker” to “qualify”).
I am perfectly willing to pay cash on the barrel and to fly to foreign countries for those things I feel my family needs, and I am not interested in prolonging my life much beyond 65 anyway, when both my kids should be on their feet. (Why would any Christian fear death?)
If, John, those are your reasons for not being worried, then we agree with one another.
RE: “But the people actually doing capitalism – the insurance companies – might disagree.”
I’m doing capitalism. And I don’t disagree one bit. Neither do the other free-marketers I know disagree. In short you’re dead-wrong about free-marketers.
RE: “I’m amused, of course, that you think that Republicans would suddenly agree to Demint’s plan of deregulating the insurance industry.”
When did I say that? Answer — I didn’t. You just made it up out of whole cloth. You started out making silly claims about free-marketers like me. Now you’ve switched to using the word Republicans, which I am not. And you’re not amused, John. Whenever you say that, I know you’re just angry and pettish.
; > )
RE: “Granted, regarding the AMA – I always thought they were the conservative branch.”
Heh — another display of ignorance here too. There are 18 medical organizations that have denounced the collectivist health care bill, and just one of them is larger than the AMA, which is the collectivist branch of physicians. Maybe you should join.
Hi Sarah,
Well, one thing is certain: blogging doesn’t convey emotions very well. I will gladly admit to some frustration and bewilderment when you go ad hominem, but I recognize it’s part of the game. Anger and pettiness? Whatever.
I don’t think I was referring to you personally, but it seems I touched a nerve. I was simply pointing out that plenty of people who claim to support the free market (say, global bankers) are hypocrites, especially when there are other stakeholders or issues in play. You’ve certainly been far more consistent than most elected officials. Of course, I’m sure that your discussion group is able to think exactly as it pleases. I’m also a willing participant in the free market, but I’m more of a skeptic when it comes to applying its wisdom universally.
Clearly I do need to be reminded you aren’t a Republican. But I will repeat that many of those Republicans who say they defend the free market haven’t been that eager to challenge corporate interests or monopolies. I’m sure your friends find those Republicans disagreeable. I’m glad you can uphold your principles.
I simply did not know that the AMA was as irrelevant as you insinuate. I had always heard that it was fairly conservative (at least, the liberal doctors I know thought so). There have to be many more than 18 medical organizations. Do you mean The American Nurses association? The National League for Nursing? The College of Surgeons? Are they of a greater percentage of doctors? What percentage of the AMA will now leave? You clearly have the facts at your fingertips. What’s the organization the doctors will now join? Does that mean I shouldn’t look for things approved by the AMA? Pardon my ignorance, Sarah.
#12 – well – thank you for playing out some of what may happen. I will have to bow to your expertise, but I’m not sure how to compare it to what would happen without any reform. Expenses will continue to increase, and things will still get worse. At least, that is what I hear. I do think the internationalization of health care is a fascinating issue. I’ve thought of getting dental work next time I go to India. A friend of mine got her hip replaced for $5,000, and now she’s dancing salsa.
Clueless, I’ve always wondered what you thought of Arrow’s essay “Uncertainty and the Welfare Economics of Medical Care.” I think your insight would be fascinating.
“I will have to bow to your expertise, but I’m not sure how to compare it to what would happen without any reform. Expenses will continue to increase, and things will still get worse. At least, that is what I hear. I do think the internationalization of health care is a fascinating issue. I’ve thought of getting dental work next time I go to India. A friend of mine got her hip replaced for $5,000, and now she’s dancing salsa”
John. WHY do you think that hip replacements in India “only” cost $5,000? It is true. It does. And it might easily cost 20-50,000 in the US. Why is that John?
In India, that 5,000 will be split as 2,000 to hospital, 1,000 to anesthesiologist, 2,000 to surgeon. There is no malpractice and very little overhead for both the anesthesiologist and for the surgeon, and there are no cross subsidies of the uninsured in India. The uninsured in India who need a new hip will simply not get care.
In The US, the (conservative figure) 20,000 will be divied up as follows: 300 to anesthesiologist, 800 dollars to the surgeon (both of whom pay over 30,000 a year in malpractice insurance alone), 18,000 to cover Medicaid, Medicare, and the uninsured of the hospital, and 900 (maybe) “profit” to the hospital.
A surgeon in India makes a killing compared to those in the US. I envy my Indian friends lifestyles. They take naps in the afternoon. NAPS! NAPS! (Elves is there a way of making even larger capitals on this thing?). American surgeons learn to simply do without sleep.
I think that medicine will go global, but what that means is that our physicians will go elsewhere. Our 30% foreign medical graduates will likely go home. Many other US physicians will go overseas (just as Indian physicians came here 40 years ago). I get ads from Australia and New Zealand boasting their sunny beaches and lack of law suits all the time.
The cure for health care charges is to reduce what it costs. Initiate a loser pays the malpractice lawsuit, and costs for malpractice and defensive medicine drop. Take away the “no hospital can turn away anybody EMTALA law” and hospital and physician charges drop. Create a single charge for any procedure with the PATIENT being responsible, (CASH up front, the hospital will not deal with your insurance company or Medicare) and the billing department and collections department vanish as does about 20% of the physicians time. Then we will likely have even LOWER costs than INDIA because as you might notice above American physicians are paid less per procedure in the US than Indian physicians are paid for the same procedure in US dollars in India.
As for Arrow’s essay, do you have a url? I have not read it.
As to the AMA, yes it is some 16% of docs (a year ago and dropping like a stone). The other medical organizations, all of whom have denounced the bill are medical organizations, including every medical specialty organization, the American college of physicians and surgeons (which is larger than the AMA) etc.
The AMA is the politicians tool. Doctors don’t trust it, and don’t feel that it represents them, with the exception of the academic physicins who are both on a salary and are hand in hand with the government. It is a corrupt organization, and I never joined it, not even back when I was in academic medicine and I was strongly counselled to join it for the benefit of my academic career.
http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf
Enjoy!
Hi Clueless – I’m fairly aware why medical care is cheaper. Of course, it’s not universally available to Indians. It’s available to people who are rich(er). I’m willing to take advantage of it myself, of course.
I admit, I’m a bit skeptical of medical specialty organizations – might they also not be motivated by money first? What of nurses? How do they feel about it? We’ll see what happens. I don’t blame them, of course.
http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf
Well, I’ve read it, and while I agree with much that is in it, the author appears to think that the medical monopoly originated with physicians. It did not. It originated with Congress. Congress insisted on passing the Flexner act (over the overwhelming protests of physicians who pointed out that it would lead to fewer physicians, less access to health care, and more expensive fees). The Flexner act prevented physicians from educating their younger colleges in an apprenticeship fashion (for nothing) that had worked well right through WWI, and insisted on giving a monopoly on medical education to the universities (thus placing academic medicine on their payroll, and subverting the AMA).
As to the idea that physicians should not be businessmen I agree. It would be fine by me to have physicians all be civil servants paid civil servant wages, with no malpractice concerns, federal benefits and paid overtime. That is what similar occupations (police, fire) receive. If physicians were paid in this fashion, then their pay would be a little lower and their free time and lack of headaches would be vastly improved. I traded private practice for government service and I feel like I’m on vacation working only 50 hours a week with no worries. Unfortunately, this would not lower costs. I see far fewer patients than I saw previously, and I am paid only slightly less.
I do agree that it would be fairer to the physicians, and I have no trouble with going to a French style system, where the government pays for medical school, gives you a stipend while you train, and then pays you a fat salary with benefits, and time and one half for overtime. Unfortunately, the French system is going bancrupt even faster than our system. But it is going bancrupt with better rested docs, so that I guess is a good way to go
“Expenses will continue to increase, and things will still get worse. . . I’ve thought of getting dental work next time I go to India.”
That is an interesting comment. You (like myself) have no objection to going overseas to get better care for yourself and for your family. However, unlike me, you have a philosophical belief that medicine should be provided by the Government, even though you realize that quality and access will drop like a stone when this happens, resulting in those with resources fleeing to unregulated markets.
Actually it is not necessary to go to India, you could drive accross the border to Juarez (or park in El Paso and walk accross -since it is faster). There are several gleaming dental offices just below the international line, for people just like you, John.
You are aware, I presume that many people in the US don’t have the priviledge of going to Mexico for their dental or medical care?
They count on the medical system to function. That medical system is already on life support thanks to the amount of government regulation and litigation, but you wish to increase that regulation, even though you apparently realize on some level that this will make quality and access much worse. So it is not simply ignorance with you, John. It seems to be more like, principle? religion? what is it, since it is apparently not lack of insight?
Why John? Just to satisfy a sense of what is “fitting” in an “ideal society”? I am beginning to think that liberals actually secretly despise the poor. For they will be the ones who suffer most from Government health. They are the ones who have suffered the most in Government schools.
#18 It may lower costs if the fee-for-service system is replaced. Doctors who are hired on a salaried basis seem to be able to work cooperatively with other doctors on one patient. You may have seen Gawande’s article in the New Yorker? the one Obama required his staff to read?
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
#20. Even Mayo clinic (lauded by Gawande) has said that it cannot lower costs. Mayo now refuses to accept primary care of new Medicare patients despite having the lowest percentage (only something like 5% IIRC). The Florida place DOES accept Medicare and indeed it has far more Medicare than its share, since it has the burden of dealing with snowbirds. Mayo does not.
Fee for service lowers costs in Mexico and in India because there is no cross shifting to cover government patients who don’t pay costs. And it is clear you must understand that Medicaid and Medicare do not cover costs, and are therefore subsidized by private pay insurance and by self pay (who are not permitted to receive a discount under medicaid/medicare rules). Why then would there be lower costs if the only part that is paying for everybody else suddenly stops paying? The only thing that would happen with goverment medicine, which I presume liberals want to happen is that physicians would stop offering the service (and yes, then costs to the government will have come down, since they will have been shifted to patients who will not only pay their government health care premiums, but will pay to go accross the border to get their surgeries done in Mexico at their own expense.
And you must know this, John. Otherwise you would not be talking about going to India.
Clueless, I oculd respond several different ways, but I do not have the answer, nor do I have a comprehensive understanding of medical economics. You mention “However, unlike me, you have a philosophical belief that medicine should be provided by the Government, even though you realize that quality and access will drop like a stone when this happens, resulting in those with resources fleeing to unregulated markets.”
Actually, I’m an agnostic about how the government should be involved. I do think that there are reasonable laws that the public can impose upon insurance companies, private companies, and doctors because I do not think patients should be treated like profit centers. I’m not adverse to public regulation because I think it could be less expensive than private bureaucracies. Of course, I’m fully aware that some laws are quite onerous. I do not believe in regulation for its own sake, but because people often act irrationally and even counter to their own interests, and the interests of the public. Broadly, I have “institutionalist” and “behaviorist” views of human nature.
I am inclined, as you assume, toward single payer with some management of fees, but I’m still unsure if quality and access will really “drop like a stone.” People seem to be overtreated, and their health is not particularly be better. It may improve for some, who previously did not get health care. I’m willing to be convinced it’s a bad idea. I actually don’t have any religious convictions for or against the market. I tend to think a “mixed” economy with multiple institutions ensures for the greatest freedom and peace. But this seems empirically verifiable.
Social insurance – even if run as a national not-for-profit – makes some sense. I think it is justified, as a citizen, that we have expectations to care for one another in a minimum fashion. Medicine falls under that category for the reasons Arrow notes.
I’m less of an ideologue than others on the blog make me seem. I think a fully free market system would be better than what we have now. I also think a single payer would be better than what we have now. I also think that any change will be rough for some.
I tend to trust the numbers of Jonathan Gruber (the MIT economist) and Nate Silver (of fivethirtyeight.com) in terms of reducing costs. both are careful and thoughtful, and a little less ideological (albeit liberal). Both are professional number crunchers and have integrity enough to change their minds and resist moralizing from the rest of the left.
I admit, your last comment has me a little confused. I’m not sure what “the service” is – do you mean all services? Particular services? You begin the sentence with “fee for service lowers costs im Mexico and India” but – you mean in the US – it lowers costs in Mexico? I presumed it was simply lower expenses. I could retire in India on the pension I could get and live far better than I do in the US.
You said “You begin the sentence with “fee for service lowers costs im Mexico and India†but – you mean in the US – it lowers costs in Mexico? I presumed it was simply lower expenses. I could retire in India on the pension I could get and live far better than I do in the US”
Paying cash on the barrel for medical procedures in Mexico (as I did last weekend) lowers the price of the _medical_ service. The device implanted has the same price in the US and in Mexico. Some products like IVs would have been cheaper. I do not believe that the nurses were paid less, (I’m told that that hospital paid nurses and other attendants more than the US hospital in El Paso).
What the hospital/physician saves by insisting on cash on the barrel is:
1. No need for billing or collection staff.
2. No accountants or lawyers to ensure that one is not running afoul of any of the JCAHO or Medicare/Medicaid regulations.
3. No cross subsidy of folks with poor insurance, or folks with Medicare (typically paying less than expenses) or Medicaid (basically giving it away for free).
4. No need to keep an ER open and staffed (they did have an urgent care – also cash on the barrel)
5. No need for malpractice insurance, there is no possibility of lawsuits.
6. No need for medical records. (If there is no billing and no lawsuits, and no follow up, there is no reason for a hospital or doctor to keep medical records). After the procedure were were handed our records and we are responsible for maintaining them, not the hospital (who will shred them) or the physician who will likely destroy them in a year or so.
If a US hospital did not have those expenses, then we could easily out compete Mexico on price because private practice US physician (and nurses) are paid less on an hour for hour basis (after expenses) than are for profit physicians in Mexico.
The reason costs in the US are so high is the complex liberal created system of cross subsidies and secret pay offs.
1. There is the bureacrat/white collar jobs program that requires everything to go through layers of insurance and regulation to root out “fraud and abuse”. (Ya think there’s none in Mexico?)
2. There is the lawyers and accountants full employment program that forbids me (unlike wall street bankers or lawyers) from saying “I will charge you 20 dollars/hour over my expenses if you sign here saying that you will submit all claims of malpractice to binding arbitration. (I’m not permitted to do this).
3. There is the social support network for the elderly (medicare does not pay costs so these are subsidized by private insurance or self pay, using physicans and hospitals as tax collectors to support that elder care network.
4. There is the social support network for the poor and the disabled or the simply reckless who either have no insurance or have Medicaid (which does not even cover the cost of medications, let alone nursing/physician/er costs). These also are paid for as what amounts to a tax on those with private insurance or who are self pay (Medicaid considers giving the “self pay” a discount, medicaid fraud).
5. There is the public emergency services (the open ER, the EMTALA laws that say that every hospital (and all specialists who practice there) must see all patients who come to the ER whether or not they are abusive, obviously maligering, obviously dangerous etc. This also is paid for using what amounts to a tax on private pay/self pay patients (the cross subsidy).
Now I am not necessarily against paying for items 3-5. I simply think that if we are going to tax the responsible middle class who pay for private insurance and the working class who can’t afford private insurance and aren’t eligible for Medicaid we should call it a tax, and debate it in Congress and decide whether to place the burden’s of this tax on the shoulders of the above mentioned middle and working classes, or whether to place that burden in some other fashion (a sales tax, a VAT, whatever).
However Congress and liberals do not wish to acknowledge that they have placed high taxes on the responsible few (and getting fewer) folks who pay for medical insurance. Thus, the cries of “fraud and abuse” and the constant denunciations of “greedy physicians” and the cries that the “health care system is broken and needs even more regulation and hidden taxes which the high minded and pure souled Democrats will administer since only politicians can be trusted to look after the interests of patients.
Clueless, I haven’t heard the term “greedy physicians” very often. I’m sure there are a few, but doctors are more often the victims, I suspect, in these cases. There is some literature about doctors who would rather work for industry than in the trenches, but that’s how the incentives work, I suppose.
The problems you mention are quite broad. Firstly, I’m a bit confused by the conflation of your institutionalist critique with liberal. As I understand it you read “liberal” as interventionist or statist. Is that right? I ask because a liberal can be both critical of state institutions but also supportive of regulation. In my world “liberal” is a very broad term (the curse of being a philosophy major). Liberal economics is generally market oriented, for example, but has a wide range within it. It is also, however, critical of other institutions as well.
It seems to me that there is a relationship between the private companies and government that is alternately confrontational and cooperative. It doesn’t take a rocket scientist to see that there are multiple interests (pharmaceutical companies, insurers, the government, tort reformers and trial lawyers, doctors and … patients) who have their own issues and manipulate policy makers for their own benefit.
I think the idea of “paying cash on the barrel” makes some sense. At the Divinity School coffee shop in Chicago we had no cash register – everything was computed in the server’s head. We made more of a profit than the Business School coffee shop for exactly the reasons you mention – we had relationships with local restaurants who offered us take out packages of food – much better than what was offered at any of the other larger, institutionally run coffee shops. The freedom we had allowed for greater creativity and our profits were enormous. After a while, however, the business school and the University started doing what we did (better coffee and food), but had a greater scalability. Our profits dropped. They still make a profit, of course, but it wasn’t quite sustainable at the level it was once.
As far as malpractice, there should be some way to hold doctors, Hospitals and other institutions accountable when they are irresponsible (is that wrong?). “Let the buyer beware” is difficult as long as there is asymmetrical information. And since the outcome isn’t just about shoes, but life and death, the “exchange” usually offends the public’s imagination about the medical profession. There must be some way to distinguish, of course, the honest mistake from the negligent. Negligence should be punished severely. No?
The purpose of insurance, that is subsidized with a tax upon the prosperous (to whom much is given much is expected), and the irresponsible (say, smoking, sugar, and alcohol taxes), would be to create a general pool so that the viccissitudes of life do not send the responsible (or even less responsible) into poverty due to inescapable randomness of illness, which is what the current system of arrangements often do. It need not be run by the government, but could be more like a health care alliance (like the Ithaca Health Care Alliance, which is run by volunteers).
If insurance companies were not-for-profit and staff of such companies were paid more like bureaucrats rather than corporate executives perhaps they could serve more people. But it’s also difficult when big pharma tries to get insurance companies to pay for expensive medication which may not be effective.
I’m skeptical that all of our problems can be laid at the foot of big government. The reason why we need comprehensive reform is the number of competing interests. Our legislators are often responding (perhaps not effectively) to moral intuitions that the public has about health care, and then listening to how for-profit institutions would run things. I’m not sure who else, except the government, can coerce all the different competing interests to change the rules. It reminds me of what needed to happen in the early part of the 20th century for the airline industry to take off.
“As I understand it you read “liberal†as interventionist or statist. Is that right? ”
Yes. Liberal used to have a different meaning in politics (just as “gay” used to have a very different meaning. Currently the word “liberal” means just about the opposite of the original idea regarding tolerance, broad mindedness etc. The word has been stolen by folks who realize that the word socialist (used to replace communist) was no longer working.
Most folks find that when you need to keep changing the name in order to get people to swallow the garbage sold, there is something wrong with the stuff you’re selling.
I ask because a liberal can be both
“As far as malpractice, there should be some way to hold doctors, Hospitals and other institutions accountable when they are irresponsible (is that wrong?). ”
Since more than 95% of such suits are found to be baseless, there also needs to be a way to hold lawyers and patients responsible for bringing baseless suits as a way of generating revenues. This is FRAUD, plain and simple. The European method (which I favor) is that the loser pays all legal fees of both parties. Where a lawyer takes the case on a contingency method, the lawyer pays the legal fees of both parties
“Let the buyer beware†is difficult as long as there is asymmetrical information. And since the outcome isn’t just about shoes, but life and death, the “exchange†usually offends the public’s imagination about the medical profession. ”
Buyer beware is expected in Law and finance. Medicine is no different. The cure for ignorance is study. If politicians have governmental immunity for the dreadful laws they inflict on us, physicians should have governmental immunity for seeing train wrecks who come into the ER (whom they are required by law to see regardless of compensation) who cannot give informed consent.
“I’m skeptical that all of our problems can be laid at the foot of big government. ”
I am not.
“I’m not sure who else, except the government, can coerce all the different competing interests to change the rules. ”
That is exactly it, isn’t it, John? It is all about coercion with you liberals.
Hm – Clueless -“The cure for ignorance is study.” That’s a harsh penalty for someone who is sick and bewildered. Some do study more about their illness. Others simply trust their doctors. In my view, for this reason, medicine is a bit different than law and finance. Law, as Arrow noted, does have some similarities, but it happens with less frequency. Lots of people get sick. Not everyone gets in trouble with the law. perhaps I could study enough to give myself surgery. Or then I could die.
I have no problem with the European method myself. I seem to recall, however, that they are socialists in those countries. It seems to be far more reasonable than tort “reform” in the form of caps.
“it’s all about coercion with you liberals.” That’s quite a statement, clueless. It’s the nature of the state to be the sole proprietor of violence rather than, for example, tribes. I’m sympathetic to anarchy myself, but I’ve seen parents coerce their children for good reason, and I’ve seen states coerce people for good (and bad) reasons. perhaps I have too low an opinion of human rationality (far lower than most progress-oriented liberals).
People are generous if they are taught to be generous are are members of institutions that are generous. They are selfish if they are around other selfish people and are encouraged to be selfish. Some institutions are more free than others. It so happens that being a member of an institution (a church) I obey laws even when it doesn’t suit me.
It is, of course, capitalism and liberalism that have unleashed uncoerced desire and have said that all desires are equal, and there should be no coercion when it comes to the marketplace, aside from affordability. I understand that view. But I also have no problem with the idea of the common good, or that there is a public, or in social mores, all of which can be considered “coercive.” It’s a tough life, perhaps, but generally I obey the rules and think there should be some rules.
Although I’m sure places like Somalia, where there is little central government, are enjoyable for some, there are benefits to larger, faceless institutions – both corporations and states. they can be fairer and more just than tribes, and sometimes more balanced. I wag my fingers and fists against corporations and governments with the best of them, but I must acknowledge that government investment in trains, roads, the internet, NASA, and all sorts of things have benefitted me, and the private sector, through a coercive taxing of my pocketbook. It’s tough, but I’ve managed.
I’m a bit more of an agnostic about government. Sometimes its good, sometimes its bad. It depends on if the person running it wants the government to run well or run poorly. If you hate government, then you probably shouldn’t run it.
Everything is cheaper in India. Maybe it has something or other to do with the price of tea in China. The fact is that every industrialized country spends about half of what the U.S. spends on health care in terms of the countries’ GDP and receives medical care which is at least as good, if not better than that available to most of us in the U.S.
Some of the arguments being advanced from the Party of No are really quite strange. For example, the major players in the health insurance business operate across state lines. They have limited, state regulated near monopolies in those states in which they choose to operate. They do not want competition across state lines, which is why that isn’t in the health bills passed by the Senate and House.
It is also curious to hear “conservatives” argue that (federal) tort reform. The fact is that tort law is state law and tort cases are tried in state, not federal courts. What the Party of No advocates is for Congress to take medical malpractice law out of the hands of state legisatures and state courts and make it controlled by Congress and the federal courts. Curious argument from the right wing. Some states (like Texas) have passed tort reform. The trial lawyers don’t like it; some insurance companies don’t like it (namely those who sell liability insurance to doctors and hospitals). I’ve seen no evidence that it has reduced medical costs in Texas. It has resulted in more “malpractice” because the disciplining of the medical profession has fallen to state boards, who are more interested in protecting bad doctors than in stopping them from practicing.
But merry Christmas anyway. It is the birth of him who calls us to “Heal the sick, raise the dead, cleanse lepers, cast out demons. You received without paying, give without pay.” (Matthew 10:8)
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18. Clueless wrote:
[blockquote]Well, I’ve read it, and while I agree with much that is in it, the author appears to think that the medical monopoly originated with physicians. It did not. It originated with Congress. Congress insisted on passing the Flexner act (over the overwhelming protests of physicians who pointed out that it would lead to fewer physicians, less access to health care, and more expensive fees). The Flexner act prevented physicians from educating their younger colleges in an apprenticeship fashion (for nothing) that had worked well right through WWI, and insisted on giving a monopoly on medical education to the universities (thus placing academic medicine on their payroll, and subverting the AMA).[/blockquote]
Ah, I see. We need to return to the days when the horse doctor was your general practitioners and the barber was your surgeon.