What's Scary About Health Care Reform?

The system may be in need of repair. But ObamaCare will only make things worse.

Steve Chapman | August 17, 2009

A hammer is a marvelous tool, but only for the right job. If you took an expensive watch to a repairman and he pulled out a hammer, you would be extremely nervous, if not aghast. Maybe he could find a way to do some good with that implement, but you would be more focused on the damage he could cause.

A similar scenario is playing out in the public anxiety over health care reform. Plenty of people think the existing system is in need of repair. But when they hear about expensive plans that require a more powerful and intrusive federal government, they fear that what is best in our approach to medicine may get smashed in the process.

What is best in our approach is the exceptional quality it provides. Americans grasp that: A 2006 poll found that 89 percent were happy with the medical care they get. But President Obama and his allies in Congress don't seem to realize how good we have it.

He says though the United States spends more per person on medical care than any other nation, "the quality of our care is often lower, and we aren't any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do."

That's one of the favorite rationales for a government-led overhaul. But it gives about as realistic a picture of American medicine as an episode of Scrubs.

It's true that the United States spends more on health care than anyone else, and it's true that we rank below a lot of other advanced countries in life expectancy. The juxtaposition of the two facts, however, doesn't prove we are wasting our money or doing the wrong things.

It only proves that lots of things affect mortality besides medical treatment. Heath Ledger didn't die at age 28 because the American health care system failed him.

One big reason our life expectancy lags is that Americans have an unusual tendency to perish in homicides or accidents. We are 12 times more likely than the Japanese to be murdered and nearly twice as likely to be killed in auto wrecks.

In their 2006 book, The Business of Health, economists Robert L. Ohsfeldt and John E. Schneider set out to determine where the U.S. would rank in life span among developed nations if homicides and accidents are factored out. Their answer? First place.

That discovery indicates our health care system is doing a poor job of preventing shootouts and drunk driving but a good job of healing the sick. All those universal-care systems in Canada and Europe may sound like Health Heaven, but they fall short of our model when it comes to combating life-threatening diseases.

Some of those foreign systems are great, as long as you don't get sick. Samuel Preston and Jessica Ho of the Population Studies Center at the University of Pennsylvania examined survival rates for lung, breast, prostate, colon, and rectum cancers in 18 countries and found that Americans fared best.

The U.S. also excelled on other measures, such as surviving heart attacks for more than a year. Why? Because our doctors and patients don't take no for an answer. The researchers attribute the results to "wider screening and more aggressive treatment." Another factor is that we get quicker access to new cancer drugs than anyone else.

Critics say all those great medicines and therapies are cold comfort to Americans who lack insurance—which by any standard is our greatest shortcoming. People without coverage are more likely to do without needed treatment or preventive care and more likely to die from disease or accidents.

But they have it better than you might think. Some 62 percent of uninsured Americans are satisfied with their medical care. That is probably because they get a lot of uncompensated treatment from the most advanced, ambitious, and capable medical system in the world.

In Britain, by contrast, having guaranteed access to care doesn't mean you'll actually get it. Twenty percent of British cancer patients who might be cured become incurable while awaiting the treatment they need.

The challenge in this country is to extend coverage to the uninsured without degrading quality for everyone. With a little caution and humility, the president and Congress can find ways to achieve that goal. But first, they need to put down the hammer.

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Fist of Etiquette|8.17.09 @ 7:13AM|#

We are 12 times more likely than the Japanese to be murdered and nearly twice as likely to be killed in auto wrecks.

For the love of God, Chapman, don't put in their heads the idea they need to write stricter gun control and automobile safety regulations into their healthcare bill!

Art-P.O.G.|8.17.09 @ 7:26AM|#

Yeah, but what about our suicide rank? Where does the US rank (I remember reading somewhere that Japan has a higher suicide rate than the US, but I don't remember who else did, other than a bunch of former Soviet satellite states)?

Kyle Jordan|8.17.09 @ 7:29AM|#

Here's the suicide rankings on the Wiki via WHO.

http://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate

I'm surprised on where we're (USA) at on the list.

Perhaps if we were higher, we would be having less problems...

Suki|8.17.09 @ 7:33AM|#

What Fist said!

Next we will be getting told this is for our own good because we don't make the right decisions. Or was that three things ago?

Kyle Jordan|8.17.09 @ 7:35AM|#

Woah! You know what else is cool? Our gun ownership numbers from Wiki.

http://en.wikipedia.org/wiki/List_of_countries_by_gun_ownership

90 per every 100. That's fucking great! Now if we could just get 90 people for every 100 people, we'd be doing good.

Art-P.O.G.|8.17.09 @ 7:41AM|#

Apparently China's the only country in the world where the suicide rate is higher for women than men. Just sayin'.

Suki|8.17.09 @ 7:41AM|#

KJ,

I am trying to pick out my first shotgun. Any suggestions?

Art-P.O.G.|8.17.09 @ 7:43AM|#

Seeexist.

Art-P.O.G.|8.17.09 @ 7:44AM|#

Not you, Suki. China.

Kyle Jordan|8.17.09 @ 7:45AM|#

What's the purpose of it going to be Suki? Are you a man or a woman? Physical characteristics?

If it's for home/self defense, Remington 870 Express 12 gauge with an 18" barrel and 7-shot extended tube magazine. They can be had for about $350 and are THE shotgun when most people think of a shotgun. If you want to go nicer with the quality to match, a Remington 870P Police model with ghost ring sights, 18" barrel, and 7-shot extended tube magazine for about $600 is a great shotgun.

That being said, these suggestions are VERY general. I can give you a better recommendation with better info.

Suki|8.17.09 @ 7:48AM|#

LOL APOG

For a shotgun I am thinking black.

Suki|8.17.09 @ 7:52AM|#

KJ,

Mostly for home. I am female, 5' 6" 120ish (NOT as hot as the book character Suki) early 30s, good fitness.

Is the 870P black? I really want a black one!

Kyle Jordan|8.17.09 @ 7:54AM|#

Well, I meant YOUR physical characteristics.:D

Ok, if you're a female of average build and strength, I'd honestly recommend taking a good hard look at a rifle. Shotguns kick and have low ammo capacity. Also, firing one off in an enclosed space with no hearing protection is very likely to lead to hearing loss. Possibly severe. They're also SLOW to reload.

If you want to stay with a shotgun, a 20 gauge Remington 870 Express set up like I mentioned above would work pretty well too.

If you're a male of average build and strength, all the same from above goes. Even the 20 gauge idea.

Art-P.O.G.|8.17.09 @ 7:56AM|#

The US' suicide rate is pretty average, but the suicide rate in Belarus, Lithuania and Russia is odd, to say the least.

Kyle Jordan|8.17.09 @ 7:56AM|#

So, gents, we know Suki like 'em big and black...

Sorry Suki, I wrote the above post before you had posted your stats. (rrrrooooww!)

The 870's come mostly in black.:)

Suki|8.17.09 @ 8:00AM|#

I can shoot 12 gauge but never owned one.

Will let beloved boyfriend know about my taste for big and black the next time he shows up without a bag of groceries ;)

Kyle Jordan|8.17.09 @ 8:06AM|#

Well then, a Remington 870 set up like I mentioned above would serve you very well. What I would also look to doing is making sure that the gun has good night sights and a white light. You can pick up an 870 Express and have many places install some good night sights on it ofr not too much money. I like XS "Big Dot" sights. And Surefire flashlights makes a white light that attaches to the fore end of the 870s. It's actually a replacement fore end.

Above all, whatever you go with, the BEST thing you can do is take a good class and get some quality training with your firearm. It's ALL about mindset. If you have any other questions, go ahead and ask. I'll answer as best I can.

PS.
I still prefer rifles though...

Art-P.O.G.|8.17.09 @ 8:07AM|#

I'm blushing over here ;)

Back on topic, Americans don't seem more likely to off ourselves more than most other nationalities, but I wonder if our higher rates of death by car accident has more to do with some sort of culturally intrinsic recklessness or our road system.

ransom147|8.17.09 @ 8:07AM|#

Art: seems i heard that japan skews their suicide/homicide numbers by listing murder-suicide victims as all being suicides.

of course that should only have a minor effect on actual rankings (unless they have a ton of murder-suicides, which in itself would be an interesting phenomenon...)

ransom147|8.17.09 @ 8:17AM|#

i would bet we rank high in miles of roadway and per capita automobile ownership as well

not the real jb|8.17.09 @ 8:21AM|#

"In Britain, by contrast, having guaranteed access to care doesn't mean you'll actually get it. Twenty percent of British cancer patients who might be cured become incurable while awaiting the treatment they need."

Can I get a reference for that?

Hollywood|8.17.09 @ 8:49AM|#

Heath Ledger didn't die at age 28 just because the American health care system failed him.

FTFY.

Phil|8.17.09 @ 9:00AM|#

I would love to see the reference for these stats so I can use them in my arguments.

Rich|8.17.09 @ 9:11AM|#

With a little caution and humility, the president and Congress can find ways to achieve that goal.

They're being cautioned at the townhells.

Humility -- don't hold your breath.

T|8.17.09 @ 9:46AM|#

I'm going to have to disagree with Kyle on the shotgun. Get a Mossberg 935 Tactical, Remington 1100 Tac-2, a Stoeger 2000 Tactical, or a Benelli M2 or M4.

Pump action shotguns are great if you're going to train obsessively. If you're not going to train religiously and compulsively, get a semi-auto. The price runs from about $450 for the Stoeger on up to about $1200 for the Benellis.

stuartl|8.17.09 @ 9:48AM|#

Phil,

According to Chapman's article, the data comes from the "... 2006 book, The Business of Health, economists Robert L. Ohsfeldt and John E. Schneider...." It looks like you can get the complete book in pdf form at AEI.

|8.17.09 @ 10:23AM|#

Don't forget how we calculate infant mortality compared to other countries. That also skews our health care stats and not in our favor.

|8.17.09 @ 10:28AM|#

I missed the part where spending twice as much for poorer health care is a good thing.

Rhywun|8.17.09 @ 10:29AM|#

Interesting that France and Germany have 5x the ratio of guns as the UK, but a lower homicide rate. Not trying to make a point--I just find it interesting, as a gun-agnostic.

|8.17.09 @ 10:48AM|#

I missed the part where spending twice as much for poorer health care is a good thing.

No, you missed the part where we don't have poorer health.

T|8.17.09 @ 11:09AM|#

Interesting that France and Germany have 5x the ratio of guns as the UK, but a lower homicide rate. Not trying to make a point--I just find it interesting, as a gun-agnostic.

The gun ownership rates don't really seem to tie in to homicide rates at all from the times I've looked at the data. Plus, they're using the Small Arms Survey for ownership rates, which in my opinion seriously undercounts actual rates.

|8.17.09 @ 11:18AM|#

T--#1 on the semi auto suggestion. Less kick and no danger of short stroking.

"There is one gun for every 13 people on the planet. My question is, how do we arm the other 12?"

Rich|8.17.09 @ 11:22AM|#

I missed the part where spending twice as much for poorer health care is a good thing.

You'll have less to spend on emitting carbon.

Sean W. Malone|8.17.09 @ 11:22AM|#

Tony's dumbassery strikes already, huh?

Awesome. Yeah... Has anyone reminded him yet today that our government already spends more on health care than any other government in the world too - so if more government spending were the key, then we'd have costs down by now already. Cept... strangely, the more government spends on it, the more expensive it gets. Funny how that works...

Funnier how it works like that in *every* case.

|8.17.09 @ 11:22AM|#

Another reason our ratio of life expectancy to money spent is thrown off is that we try to save everyone. We spend tons of $ on premature infants that would be written off as stillborn in other countries, and more $ trying to save old people in their last months of life. So duh--of course the ratio will be less than other countries.

|8.17.09 @ 11:35AM|#

I'm getting dizzy from all the fact twisting going on here to defend a system nearly everyone thinks is in a shambles.

Just because the health care provided in this country is decent, even top-notch, that doesn't mean everyone has a reasonable level of access to it. Yes, Sean, health care costs are an enormous burden both on individuals and the federal government. But the cost increases are coming from the private sector due to mini-monopolies, and where competition does exist it's competition to deny the most coverage.

T|8.17.09 @ 11:41AM|#

But the cost increases are coming from the private sector due to mini-monopolies

And how, exactly, are these mini-monopolies maintained, Tony?

Tomcat1066|8.17.09 @ 11:42AM|#

But the cost increases are coming from the private sector due to mini-monopolies, and where competition does exist it's competition to deny the most coverage.

Which are because of regulations that restrict access to the market and therefore prevent competition.

A "public option" that will increase demand on resources without permitting greater resources won't do a damn thing to control costs.

|8.17.09 @ 11:43AM|#

I'd vote against the rifle for home defense due to the risk of overpenetration.

|8.17.09 @ 11:45AM|#

"that doesn't mean everyone has a reasonable level of access to it."

Then make it more accessable for them, but don't put us all on a national health plan which will bring about rationing.

|8.17.09 @ 11:47AM|#

It's amazing to me that anyone can think that an organization that spends roughly 90% of it's income on overhead can lower costs when compared to any other organization. Even if you just think about the costs involved in gathering it's funds, the waste is astronomical. Yet somehow the President still insists that government involvement will reduce costs, at least most of the time. The other times, he blatantly says we can't pretend that insuring more people is going to not cost more. Leaving out the obvious, more government involvement automatically means higher costs.

|8.17.09 @ 11:48AM|#

"A "public option" that will increase demand on resources without permitting greater resources won't do a damn thing to control costs."

It will increase costs by increasing demand.

Rhywun|8.17.09 @ 11:49AM|#

I work in property & casualty insurance, where there's lots of competition between private carriers. Believe me, you can find someone to cover any sort of risk. You just have to pay more for it. There's no reason to believe the same wouldn't be true of health insurance were it done the same way.

What it really boils down to is whether you believe everyone is entitled to the same coverage, no worse and no better.

|8.17.09 @ 12:02PM|#

don't put us all on a national health plan which will bring about rationing.

It won't bring about any more rationing than already exists.

All the arguments here against public healthcare come down to antigovernment boilerplate nonsense that is contradicted by the evidence.

|8.17.09 @ 12:03PM|#

that doesn't mean everyone has a reasonable level of access to it.

Many have completely unreasonable access to it. Access that is free, subsidized by higher costs and increased hassles to those who follow the protocols and pay their bills.

I personally believe that communities should support graduated cost clinics. We as neighbors should do our best to reach out and care for those less fortunate around us, of our own free will. But I also firmly believe that if I can't afford to pay for something, I shouldn't expect to have it, and that includes things like expensive life saving treatments or drugs. Just because something is out there doesn't make me entitled to have it. I don't see anyone handing over the keys to a Veyron to me. I don't see any reason that I should feel entitled to expensive procedures that I can't afford.

Tomcat1066|8.17.09 @ 12:03PM|#

It will increase costs by increasing demand.

My point exactly. Nothing in this plan increases resources. Nadda.

Of course, I guess you could call the increase in prices as "controlling costs"...just in the wrong direction.

Opposed to Obamacare!!!|8.17.09 @ 12:09PM|#

"The challenge in this country is to extend coverage to the uninsured without degrading quality for everyone."

I want to keep up the present prohibitions to buying health insurance. Every society must have its haves and its have nots.

I know just about every low-life dirt-bag in America can some how scratch together a few hundred dollars for car insurance, rent, food, and a pack-a-day, but i DO NOT want them to be able to buy a catastrophic policy for $100 OR $200 a month.

Let's keep the legal restrictions in place that forbid people from buying health insurance, particularly from those menacing out-of-state insurance companies.

|8.17.09 @ 12:13PM|#

Sure it's anti-government, but not opposed to the evidence as you claim. And at least we have the constitution on our side. The doesn't mean that you can't lobby to have a public option in your state (if you could tell me which that is so I can avoid it, I'd be appreciative).

In fact one of the great things about having 50 sovereign states, trying different things to solve the same issue is, we get to choose where we live, and states can look around for plans that are working and adopt them. If California wants to have completely free to use healthcare for all, great! Just leave me out of it, and don't come crying to the rest o us when your state is completely broke as all serious earners move away from the ridiculously high taxes and regulation.

Tomcat1066|8.17.09 @ 12:14PM|#

"All the arguments here against public healthcare come down to antigovernment boilerplate nonsense that is contradicted by the evidence."

Bullshit.

Explain how healthcare costs will decrease when the demand is increased through more insured people (not a bad thing in and of itself)? There is nothing in this bill that increases the resources for doctors, MRIs, labs, hospitals, anything. With a finite amount of resources, costs will go up. Period. The only competition that the so-called "public option" will give is in the insurance industry itself. That's only a small part of the healthcare cost equation.

Unfortunately for everyone, the left has forgotten all about the rest of that equation.

|8.17.09 @ 12:16PM|#

Any plan that's worth passing has a goal of reducing the financial burden on people. Money is money, whether it comes from taxes or healthcare costs. I really don't get the argument that it's better to have more expensive healthcare based on a fringe and dubious claim that the constitution forbids making it cheaper.

Tomcat1066|8.17.09 @ 12:24PM|#

And I've written more than once on this thread that none of these plans increase the amount of resources available to patients. Without that, demand will increase on the remaining resources and costs will go up.

Or is that irrelevant to you?

Sean W. Malone|8.17.09 @ 12:31PM|#

Cute how Tony can simultaneously see how mini-monopolies can contribute to increased cost of medicine and coyly avoids figuring out how those monopolies can exist.

"I'm getting dizzy from all the fact twisting going on here to defend a system nearly everyone thinks is in a shambles.

Just because the health care provided in this country is decent, even top-notch, that doesn't mean everyone has a reasonable level of access to it."

Is it in "shambles", or is it decent, even top-notch?

Do you realize how much you paint yourself into a corner with your hysterical assessment of this stuff Tony? American health care is phenomenal overall - the main problems are A. High cost (and subsequently limited access for some people), and B. Insurance coverage/portability.

Problem A will only be made way worse a government mandate - which, as noted above basically encourages a massive increase in demand while doing dick-all to increase the supply of doctors & medicine.

And while government "can" solve problem B by guaranteeing universal coverage, if the cost is astronomical and the resources available keep getting more scarce - the reality of actually getting treatment will be a different matter entirely.

"It won't bring about any more rationing than already exists.

All the arguments here against public healthcare come down to antigovernment boilerplate nonsense that is contradicted by the evidence."

Tony, when you understand the difference between actual rationing (non-price rationing) and price allocation, that will be a lovely day.

And... Umm... What evidence are you talking about? Is it the stuff you've pulled out of your ass the last few months? Cause you know we don't accept that around here.

Ruby|8.17.09 @ 12:37PM|#

I had low expectations when I saw this headline in my newsfeed this morning, especially considering the publication:

How American Health Care Killed My Father

But the article is an impressively organized summary of what ails us. Highly recommended read.

All of the actors in health care-from doctors to insurers to pharmaceutical companies-work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing. And that-most important-remove consumers from our irreplaceable role as the ultimate ensurer of value.

and

The most important single step we can take toward truly reforming our system is to move away from comprehensive health insurance as the single model for financing care. And a guiding principle of any reform should be to put the consumer, not the insurer or the government, at the center of the system. I believe if the government took on the goal of better supporting consumers-by bringing greater transparency and competition to the health-care industry, and by directly subsidizing those who can't afford care-we'd find that consumers could buy much more of their care directly than we might initially think, and that over time we'd see better care and better service, at lower cost, as a result.

A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care-with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.

Sean W. Malone|8.17.09 @ 12:40PM|#

"I really don't get the argument that it's better to have more expensive healthcare"

I think I may have already reached my "Tony, you retard" point for the day.

None of us are arguing that it's better to have more expensive care! We're trying to tell you that with a government plan that is what you'll get!

I've offered about 10 ways to make health insurance cheaper on this blog dozens of times.

Increasing demand by 30-40% and continuing to hamstring the development & production of medical supplies and the limiting the number of licensed doctors by AMA fiat is what we're talking about right now... Just on the surface - without getting into why you need a price-system to allocate resources across a dispersed population - that will only increase costs.

|8.17.09 @ 12:41PM|#

dubious claim that the constitution forbids making it cheaper.

Who made that claim? The only thing the constitution says about it is that it is not within the mandate, and is to be left to the states and the people. The only way the Feds can make healthcare cheaper is by reducing taxes and regulation, and reasonable tort reform. Everything else needs to be handled more locally.

mark|8.17.09 @ 12:41PM|#

Correct me if I'm wrong, but if Medicare runs out of money, the only two choices are 1) Cut payments, causing shortages and lines, or 2) Deny service, basically rationing.

Please, I'm confused as to how the government plans on cutting costs. With a brand new business model based on what? Not fee-for-service? Couldn't be any unintended consequences of that, could there be?

|8.17.09 @ 12:44PM|#

Damn, screwed up the close italics tab. Bad aelhues, bad!

|8.17.09 @ 12:49PM|#

So, at some point I saw the claim that the US spends about 16% of GDP on health care, while France spends about 8%.

US GDP is $13.84 trillion. 16% of that is $2.21 trillion. 8% is $1.12 trillion. So getting down to France's yearly costs would save us $1.12 trillion. Getting half that savings would be $550 billion or so.

That's a lot of money ($550 billion is about $1,800 for each of us), and honestly, I'd be willing to accept a slightly lower standard of care if it meant an extra thousand or two for everyone in the US. That's a quantifiable good.

But I'd want to hear exactly where that money is going to come from. Vague talk about waste and excess profits are not going to cut it. We're talking multiple percentage points of our GDP. That doesn't get lost in paperwork. It's half a trillion dollars, people: if you can't point to it, I don't think that you're going to produce it.

And I haven't seen anyone point to it so far. Maybe I'm wrong? Tony?

mark|8.17.09 @ 12:58PM|#

We're talking multiple percentage points of our GDP. That doesn't get lost in paperwork.

Well it does, but that's besides the point, because government never does a good job of reducing paperwork. No, I think the answer you were looking for is "rationing" but maybe I'm mistaken. President Obama mentioned two things at his town hall: 1) Wash you hands, nurses and doctors! and 2) Penalize/incentivize hospitals that get it right the "first time". No way that could have any unintended consequences.

Sean W. Malone|8.17.09 @ 12:59PM|#

"That's a lot of money ($550 billion is about $1,800 for each of us), and honestly, I'd be willing to accept a slightly lower standard of care"

Why would you settle for poorer quality care for more money in your pocket when you could get both higher quality of care at a cheaper cost with an actual market?

|8.17.09 @ 1:17PM|#

Michael,

Excess health costs in America (based on what the GDP predicts per capita spending on health care should be compared to other advanced countries) come from:

Higher prices paid for healthcare-related goods and services than other countries pay for the same.

Much higher 'administrative' overhead costs than are present in countries with simpler systems.

More widespread use of high-tech costly equipment, which, along with perhaps an element of defensive care due to our tort laws, amounts to a lot of unnecessary care.

Sean W. Malone|8.17.09 @ 1:27PM|#

"Higher prices paid for healthcare-related goods and services than other countries pay for the same."

A result of foreign countries "controlling costs" by dictating prices that they will pay which are below what our providers need to charge to cover costs - which then get passed on to us in the United States.

You've just figured out that we're subsidizing many other countries' health care.

"Much higher 'administrative' overhead costs than are present in countries with simpler systems."

We also have the most massive government involvement in health care by spending of any country and... You know... Five times larger a population than the UK. Other than a fully private system - which would eliminate redundancy and have mechanisms built in to encourage efficiency as much as possible - how exactly do you propose to reduce or eliminate administrative costs for a system covering 300,000,000 people?

"More widespread use of high-tech costly equipment, which, along with perhaps an element of defensive care due to our tort laws, amounts to a lot of unnecessary care."

Some of it's unnecessary and is employed by doctors who don't want to get sued - but a lot of it is also why we have much higher cancer survival rates, and in general more success with diagnosing & treating serious illnesses than any other country. And why we are able to save more premature infants than anywhere else in the world... But yes... We could "control costs" if we were only operating a fraction of the MRI machines & such like Canada or the other nationalized systems.

But Tony, you still haven't explained how this is an improvement, or how it will increase supply of medicine - in fact, your technology comment seems like a further reduction in supply.

|8.17.09 @ 1:35PM|#

I'd be willing to accept a slightly lower standard of care if it meant an extra thousand or two for everyone in the US. That's a quantifiable good.

But why should you be able to make this decision for everyone else?

|8.17.09 @ 1:39PM|#

Why can't you let the individuals and their doctors decide if the procedure or technology is unnecessary? Let them decide if it's too expensive? If you want less procedures, tests, and tech, talk to your doctor.

Tomcat1066|8.17.09 @ 1:51PM|#

Tony: You've been asked multiple times for an answer as to how costs can be controlled when the demand is increased for a resource without increasing the resource. You can talk about percentage of GDP that's healthcare, but you can't tell us how costs will be controlled (which means kept affordable after all) when the demand increases. After, demand will increase, right? I mean, if people don't have access to healthcare before, then them suddenly having it will increase demand.

Or, do you not have a clue. It's OK to say so after all ;)

Sean W. Malone|8.17.09 @ 2:13PM|#

Tomcat,

I have given up ever expecting a complete argument from Tony, much less citations.

The disturbing thing is that he scrupulously avoids questions like this. If there are really 46,000,000 "uninsured" right now who Obama wants to add to the government rolls - and let's say another 20,000,000 or so who, like me, are paying for their insurance by themselves and would benefit financially from stopping all that and leaving it up to a government system instead... That would be around 20% of the population of the US right there...

Without factoring in additional changes in behavior, like people using the system even more than they already do for minor health problems (colds, etc.) on the belief that it is "free", that's still a MASSIVE increase in demand.

Simultaneously, we have Tony complaining that we're spending too much on machinery.

So what? Sell off or scrap a few thousand MRI or CT machines. Run fewer tests... Anyway you slice that, you're reducing the supply of medical care.

Plus there's never any mention of the cost of the FDA or the AMA restrictions, and a constant barrage of attacks - both socially & legally - against pharmaceutical & insurance companies. Not that the big-boys can't fend for themselves (Obama + PhRMA = Deals!), but obviously that destroys the ability for any competition to arise.... so yeah...

If the plan is to crush supply and massively boost demand - how's that going to save money? And how's that not a fast-lane to rationing?

Tomcat1066|8.17.09 @ 2:25PM|#

Sean,

All that is true. And really, there is no answer he can give. You and I both know it. The Law of Supply and Demand is what it is. The costs will increase astronomically, and there's not a single mechanism in place that will prevent that.

What will that leave? Price controls and/or rationing. Price controls won't actually decrease the costs, since it's most likely to only apply to public option patients. Instead, that cost will be shifted onto folks like you and me.

That leaves rationing as the only way to control costs, be artificially controlling demand. However, we've been told that there won't be rationing. If that were 100% true, and there was a mechanism in place to prevent it, then what? But there isn't anything to prevent it. Just the vague promise of a politician.

Demand will increase. I honestly don't think it can be successfully argued that it won't...by anyone. And after that, we're really screwed.

|8.17.09 @ 2:34PM|#

"All the arguments here against public healthcare come down to antigovernment boilerplate nonsense that is contradicted by the evidence."

Is there evidence that socialized medicine doesn't lead to rationing?

Tomcat1066|8.17.09 @ 2:46PM|#

No, but Obama's plan will be different because it'll be funded with pixy dust and unicorn farts, so there won't be rationing.

Sean W. Malone|8.17.09 @ 2:48PM|#

If only there was some standardized denomination of value that we could use to figure out what individuals want... That might help us figure out what things we need to produce more of, or less of, or which might give us a clue as to which professions are needed in which places......

If only I could think of a way to allocate resources in a way that took individuals' needs & preferences into account. Gosh, this one is so hard.

|8.17.09 @ 2:48PM|#

Higher prices paid for healthcare-related goods and services than other countries pay for the same.

That seems rather like restating the question. What I want to know is how you think that the present option on the table is going to reduce those goods and services by hundreds of billions of dollars. We aren't talking "we'll shave a percentage point off here and there," and so there should be concrete things that you can point to and say, "We can reduce the cost of this good by 25% and it will save us, say, $10 billion a year."

If there's not that kind of concreteness, then I just don't believe that the magic of a public option is going to make radical changes.

Much higher 'administrative' overhead costs than are present in countries with simpler systems.

Again, the idea that "administrative" costs are eating up multiple percentage points of our GDP is kind of ludicrous. This imagines that something like one person in fifty to a hundred is employed an an entirely valueless healthcare administrative job. It's an extraordinary claim, and would require extraordinary evidence.

But, that aside, what I want to know is how the present suggestion will deal with it. It's not a single-payer system, it won't prevent hospitals from having to deal with multiple different claims systems. In fact, it will add another. How does the Obama proposal reduce administrative costs? And, again, we're talking big deals here. Not a few hundred million dollars here or there -- a thousand times that. You can't wave away tens or hundreds of billions with, "I'm sure we'll have some process improvements."

More widespread use of high-tech costly equipment, which, along with perhaps an element of defensive care due to our tort laws, amounts to a lot of unnecessary care.

So, where's a reasonable $50 billion worth of high-tech equipment that you plan to get rid of? What tort reform are you planning?

Not to sound like a broken record, but: little incremental "we'll cut bits here and there, we'll save on some paperwork" stuff will absolutely not cut hundreds of billions from the healthcare industry. I don't accept "we'll have nationalized healthcare, and France has nationalized healthcare, and France is cheap" as evidence that our version will be cheap.

Tomcat1066|8.17.09 @ 3:01PM|#

Sean,

You stop that crazy talk about people's wants and needs right now! You know that ain't right!

Tom

|8.17.09 @ 3:17PM|#

Ooh, ooh, I know. Pick me, pick me! Survey's!
We can put all our hopes and dreams in Rasmussen!

Well, it couldn't be money, I mean that would be mean...

|8.17.09 @ 3:24PM|#

Sean W. Malone|8.17.09 @ 3:36PM|#

France is also going bankrupt. So's Canada. The UK is already bankrupt... Sweden is on par with France.

Tomcat1066|8.17.09 @ 3:43PM|#

|8.17.09 @ 4:00PM|#

To address some points above, much of the problem is too much health care. Incentives are structured in such a way as to provide overcare to people with insurance and undercare to people without.

This doesn't actually address any of the points above, it stipulates a new potential cost saving: reducing total amount of care.

But let's work with that. Is this the source of our hypothetical future savings? If so, you should be able to easily point to about 20% of all care currently given in the United States as unnecessary. Can you identify some?

|8.17.09 @ 4:25PM|#

It won't bring about any more rationing than already exists.

Where is there rationing in America now?

All the arguments here against public healthcare come down to antigovernment boilerplate nonsense that is contradicted by the evidence.

Like the cost of healthcare before government intervened in the market.. like all that evidence?

Any plan that's worth passing has a goal of reducing the financial burden on people. Money is money, whether it comes from taxes or healthcare costs. I really don't get the argument that it's better to have more expensive healthcare based on a fringe and dubious claim that the constitution forbids making it cheaper.

To decrease costs you have to increase supply or lower demand. Nothing in the current bill does anything about this, it will just make things more expensive. What do you propose that will accomplish this?

|8.17.09 @ 4:37PM|#

Where is there rationing in America now?

It's rationed based on who can afford it.

|8.17.09 @ 4:42PM|#

To address some points above, much of the problem is too much health care. Incentives are structured in such a way as to provide overcare to people with insurance and undercare to people without. True reform will balance some of that out, yes. Whatever form it takes, however, you will still be able to purchase all the unnecessary care your heart desires.

So close.. makes me think you might have a brain in there somewhere.

The problem is indeed too much 'overcare' because there is too much demand.

Incentives are not structured in place to cause this, anymore than 'incentives are structured' for car salesman to sell you more car than you need or 'incentives are structured' for travel agents to sell you more vacation than you wanted. That's asinine.

The problem isn't that people like to sell things. The problem is that people are insulated from perceiving the the costs through all sorts of mechanisms which government has put in place. Subsidies, tax breaks, regulation, mandates, etc. After all, if you don't pay for something why not take it? If you don't pay for all of it why not take more? If you are forced to pay for something you didn't want but since you paid anyway why not use it? If you get a tax break for buying something why not buy more.

All this increases demand. Which in turn, necessarily increases price. It's just that simple.

The answer is for business providing health care (Insurance companies, AMA, tort lawyers, et, hospitals, et al) to take their damned fingers out of the pie and for people who can afford it to pay their own freight. Remove all subsidies, tax breaks, mandates, regulations. If you're not poor you pay full price, period.

Then the price will rapidly approach par as people stop buying crap they don't need.. because they are paying for it. And then the people that DO need subsidies get more with the subsidy their receive.

stuartl|8.17.09 @ 4:44PM|#

It's rationed based on who can afford it.

"When I use a word,' Humpty Dumpty said in rather a scornful tone, 'it means just what I choose it to mean - neither more nor less."

"The question is," said Alice, "whether you can make words mean so many different things."

"The question is," said Humpty Dumpty, "which is to be master- that's all."

Tomcat1066|8.17.09 @ 4:54PM|#

And yet he fails to answer the question of how overcare will be prevented when more people are now being treated. After all, the original article was able to demonstrate how we're doing pretty damn well with our care as it is, so perhaps that "overcare" isn't such a problem?

Seriously, how hard is it to give us estimated numbers for how much "overcare" is being provided, and how "true reform" will correct this without getting involved in health care decisions that should be between a patient and a doctor?

|8.17.09 @ 4:56PM|#

It's rationed based on who can afford it.

That's not rationing.

You don't go to McDonalds to get your 'ration' of hamburgers or go the the Hummer dealership to get your 'ration' of SUV or go to the Apple store to get your 'ration' of Iphone.

People decide whether they want an Iphone or a SUV or a hamburger.. or medical insurance. That's not rationing. That's personal choice. We call it freedom and many people are fond of it, especially Americans.

You can't have a 'ration' unless you have a monopoly. IE 'single payer'

You can't have a sustainable monopoly ('single payer') without government enforcement.

Sean W. Malone|8.17.09 @ 5:10PM|#

I suppose it's time for me to repeat myself with Tony, yet again:

"Tony, when you understand the difference between actual rationing (non-price rationing) and price allocation, that will be a lovely day."

- Me

|8.17.09 @ 5:44PM|#

Sean, hypothetical.

Hypothetical because it assumes we could get real market reform. ie remove subsidies, tax breaks, regulations, mandates, the whole shebang. Really make health care a free market.

Would you be willing to go along with a health care subsidy for the genuinely poor along the following lines?

If you are at poverty level you have two options. Funding for this follows individual choice between the options, and funding may not be allocated to either option independently. Eligible individuals are free to choose at will between the options.

Option 1) Medical health care stipend. Any funds unspent after 5 years may be used as the recipient wishes. Also not subject to estate tax. Thus there are resources available to those who need it, but there is not pressure to use it if they don't need it.

Option 2) A national health care bureaucracy. NHS or Canada Care style. This is your progressive managed care sandbox. HMO writ large, but it has to compete with the option 1 health care stipend.

mark|8.17.09 @ 5:57PM|#

If you haven't seen the President's town hall in Grand Junction, CO, it was pretty good. He got a lot of tough questions and handled a somewhat hostile crowd. In the end I think he talked himself out of the public option. It was pretty sweet overall.

I'm posting his comments on "reducing cost" to see if anyone can make sense of them:

Q: Good afternoon, Mr. President. My name is Polly. I work at Rocky Mountain Orthopedics here in Grand Junction. On behalf of our CEO, I would like to extend an invitation for you to visit our successful practice to see how we provide excellent health care at a lower average cost to our patients.

My question is, the original health care House bill included funding for federally qualified health centers whose future budget would be based on expenses plus inflation. If private physicians, hospitals, and other providers are going to be given incentives to reduce waste and cost, what will be done to ensure the government programs will do the same?

THE PRESIDENT: Well, it's an excellent question. Part of what's so important about reform is that right now the way Medicare and Medicaid operates, if it's starting to go over budget, we basically have two choices. Either we raise taxes and just keep on paying more and more, and health care inflation is going up at least twice as fast as inflation on everything else, or what we do is we just tell the providers, we're going to give you less money -- period. We'll reimburse you 80 cents or 90 cents for every dollar of services that you provide. And then what happens is that the providers, they end up just charging people with private insurance to make up for the difference. So that drives everybody's costs up.

Now what's been done here in Grand Junction, in other outstanding health programs like Mayo, is they started to change the delivery system so that you're actually getting more bang for your health care dollar.

Let me give you an example. Right now if you go to your doctor and you get a test, a lot of times that test won't be forwarded to the next doctor or specialist that you have to see. You have to take another test. You might have to take three or four or five tests by the time your treatment is all completed. That's a waste of money. And if we can incentivize the provider to say, do one test and then e-mail the results to everybody who might be providing treatment, or the patient might be referred to, that right there saves a lot of money.

So what we want to do is to do this in Medicare and Medicaid, which will incentivize a lot of health systems around the country to start using some of the smart practices that you're using. Frankly, Medicare and Medicaid is -- they provide a lot of care for a lot of patients, particularly seniors, and so if they hear from Medicare, can you start doing things smarter, they have an incentive to do it, and once they put a smarter system in place, the benefits spill over to the private insurance market, as well. So we want to do it through Medicare and Medicaid, but we also want to see in the private insurance market that health providers start thinking smarter and providing better care, which often turns out to be lower-cost care.

Now, it's not going to happen overnight, because a lot of these systems have been put in place for a long time. And if you're in Grand Junction or Mayo Clinic or Geisinger or other of these really good health care systems, what they've done is each year they are continually comparing notes, they've got a peer review process where doctors are exchanging ideas, and they're continually making the system better and better, smarter and smarter, and over time what we can do is bend the cost curve so that instead of having inflation go up a lot faster on health care than everything else, it matches everything else.

And if we could do that, if we could just get health care inflation to match the inflation on food and other items, all of our deficit -- long-term deficit problems would be solved. Just that alone. If we could just reduce the amount of health care inflation, our long-term debt and deficit problems would be solved.

So this is the most important thing we can do for deficit reduction. And I want everybody to remember that, because in this debate you've heard a lot of people saying, "We can't afford to do this because our deficit and debt are too high." The biggest driver of our deficit and debt is health care. And if we don't change delivery systems and adapt some of the innovations that are being used where you work and in really good health care systems around the country, then we're going to be in red ink forever.

What's crazy is that he's talking about "incentives" as if there's not already incentives in place that make the health care market the way it is now! I would much rather have a market based on price incentives than government incentives, that's not even a question for me.

mark|8.17.09 @ 5:59PM|#

Then there's this question, about "preventable medical errors", let me tell you those people in Colorado were not fucking around.

Q My name is Jamie and I am a nursing student at Mesa State. (Applause.)

THE PRESIDENT: Outstanding.

Q Being as I am a potential health care provider in the health care system, there are a few things in the plan that I read about that I wanted to understand more --

THE PRESIDENT: Sure.

Q -- as far as providers being required to report -- what was the words -- preventable medical errors in the health care system. Now, as far as health care systems are concerned, we are required to report every error we see. So I kind of want a clarification of how much you're expecting from providers in this system.

THE PRESIDENT: Well, different states have different rules. So we got kind of a patchwork. I don't -- I confess I don't know exactly what the rules are here in Colorado. But about 100,000 people die every year from preventable diseases and illnesses in hospitals. Some of the ways that we could solve this are so simple. There's actually a doctor who's put together a protocol -- washing your hands, a lot of just basic stuff that costs no money -- that has been shown repeatedly to cut these preventable illnesses and deaths down drastically -- by a magnitude of 50 percent, 75 percent reductions in preventable deaths just by applying these things that don't cost any money.

So the question then becomes, how do we get more hospitals, more doctors, more health systems, to adopt these systems. And the best way to do it is to make sure that not only are they reporting these preventable errors, but that they're also available to consumers -- the American people -- so that if they've got too many of them, after a while they start getting embarrassed. Right? I mean, if you found out that there are two hospitals here in this city and one hospital has half the preventable deaths of the other hospital, you'd want to know that, wouldn't you?

The problem is right now oftentimes it's very hard for consumers to get that information directly. So the idea is simply to make sure that that information is packaged in a way where you can comparison shop, and your employer -- if you're getting health insurance from your employer -- could comparison shop. So we're putting some competitive pressure to improve quality across the system. That's what we're talking about. (Applause.)

By the way, thank you for being a nurse, because we need more nurses. That's important. (Applause.)

mark|8.17.09 @ 6:03PM|#

He just assumes that you can change the entire health care market and get better results:

So here's what's going to happen if we don't change the delivery systems and change some of the incentives -- we'll have a choice. We'll either have to cut Medicare, in which case seniors then will bear the brunt of it, or we'll have to raise taxes, which nobody likes. And we still will be paying about $5,000 to $6,000 more than any other advanced country in the world and not get better health care for it. Now that doesn't make sense.

After this quote he talks about the "death panels" comment. So it sounds like he's admitting, when seniors will "bear the brunt of it", he's talking about rationing, right?

mark|8.17.09 @ 6:08PM|#

More talk about incentives, but no real answers. This whole thing sounds very scary.

mark|8.17.09 @ 6:09PM|#

Whoops I meant to post:

So any system we design, there are going to have to be some choices that have to be made in terms of where you go to see your doctor, what's going on, et cetera. That's being done currently in the private marketplace.

All we're trying to do is to make sure that those decisions that are being made in the private marketplace aren't discriminating against people because they're already sick; that they are making sure that people get a good deal from the health care dollars that they are spending.

So let's make sure, for example, that if you go to a hospital, you get one of those operations that you discussed, and it turns out that two weeks later you've got to be readmitted because they didn't do it right the first time, that the hospital has to pay some penalty for that, or at least they're not being reimbursed as much as a hospital who gets it right the first time. That's an example of changing incentives that can save us money.

The more that we make those kinds of changes that improve quality, reduce cost, the more likely it is that more Americans have more options and that they are not being jerked around. It doesn't mean that everything is going to be perfect, but it does mean that consumers will have more choices, better options, more security, more protection.

That's all we're trying to accomplish here and we're trying to do it in a way that over time reduces costs overall for families, whether you're getting Medicare or you're getting Medicaid or you've got private insurance through your employer or you're a small business owner. That's what we're trying to accomplish.

Still my main takeaway is BE AFRAID.

Sean W. Malone|8.17.09 @ 7:21PM|#

Faithkills.

Ultimately, I'm an anarchist, so anything that is supported by taxes, I'm fundamentally against. That said, in the imperfect world where I might get a large chunk of freedom but can't expect anarchy... then what I might support is this:

1. A real free market in health care. No subsidies, no bureaucracy, no congressionally mandated licensing, competitive options to the AMA and the FDA, etc. All health care = tax free to buy. HSAs & high deductible insurance becomes the norm, innovation & development is encouraged. No wage/price controls causing shortages of medicines & doctors... OK.

2. For the genuinely poor - i.e. bottom 15%, let's say - I could be ok with a program similar to food-stamps for medicine. Everyone gets X dollars per month to spend on health care in whatever way seems best to the participants. Let's say $150.00 - That would mean the entire program gives out $6,750,000,000 per year.

Considering we're talking about a world where everything is much much cheaper, because there isn't the hand of government mucking up supply and encouraging redundancy & waste, this should easily be enough for decent insurance.

This also assumes we make setting up free clinics and medical charities as easy as walking down the street, and allow registered nurses to treat most minor illnesses without doctors needed, etc.

Beyond that, we quit telling everyone to spend all their money, get rid of the Fed, encourage savings and sound finances - and your hypothetical has a deal.

|8.17.09 @ 7:43PM|#

I don't fundamentally disagree Sean, if you would not voluntarily agree to subsidize the needys' healthcare I think it's immoral to force you.

However philosophically I don't think any principle of libertarian philosophy is violated if we could indeed all agree we would like some safety net. (not saying we do all agree, but if we could)

In this case the goal would be to do it in the way which is least disastrous as possible to the economy as a whole.

To me that means a direct no strings subsidy for those that need it and claim it, and if we decide to have a health care bureaucracy it must compete with the direct subsidy for funds.

And yes your figures should be sufficient for normal health care as well as a catastrophic care insurance policy.

In any case I don't, as Rand does, see altruism as an a priori evil. I do see it as the most often used cloak of righteousness of evil people

I don't think it's wrong for government to help people, as long as all the people funding it do so voluntarily. Not likely I know;)

But still. It could be more closely accomplished if, for example, no one who receives any funds from the public treasury were allowed to vote. That would include me, as a state employee. I don't act or vote on it, but I have an intrinsic conflict of interest, and it's immoral, imo, for me to be in a position to vote on policy which will take from others to my personal profit.

So I don't vote that way.. but I can assure you many many people do.

Sean W. Malone|8.17.09 @ 8:19PM|#

"But still. It could be more closely accomplished if, for example, no one who receives any funds from the public treasury were allowed to vote. That would include me, as a state employee."

I actually do generally support this - It's ridiculous that people can vote more money to themselves. There's a massive conflict of interest there.

Chad|8.17.09 @ 9:33PM|#

But they have it better than you might think. Some 62 percent of uninsured Americans are satisfied with their medical care.

That's probably because 62% of Americans have never been seriously ill or cost their insurance company a dime.

Sean W. Malone | August 17, 2009, 7:21pm | #
Faithkills.

1. A real free market in health care.

Sean, you can't have a "real free market" in health care as long as people have strong health insurance. The rights' "solution" to the market failures inherent in health insurance (paid for by anyone) is to neuter the insurance with loads of deductibles and co-pays. Unfortunately, long before you actually get significant market forces to take hold, you gut the insurance.

Health insurance is a massive market failure. It is also a necessity. The "free market" can't solve this problem.

Sean W. Malone|8.17.09 @ 10:43PM|#

A "market failure" that hasn't experienced anything approaching a "market" in 50 years, huh?

Chad. Shut the fuck up you moron.

|8.18.09 @ 12:05PM|#

You know what I find scary? That my seven year old is facing a lifetime of health care uncertainty because of a condition she was born with. She will never be able to purchase a policy on her own ever with our current system. By not supporting Health Care reform you are personnally hurting my child and my family. Please rethink your stance before you allow corporations to define who gets care and who lives and dies in this country.

Tomcat1066|8.18.09 @ 1:12PM|#

Every time I turn around, someone pops up with a sob story, someone who no one has ever heard of before, about how our currently fucked up system is at fault, and that only Obama's plan can save us.

Unleash competition and see who competes for your daughter's health insurance dollars. Will she have to pay more? Probably, but they're taking a risk. But she sure as hell would be able to get it.

|8.18.09 @ 1:31PM|#

By not supporting Health Care reform you are personnally hurting my child and my family.

This is the problem with economic ignorance. The people aren't against 'reform' because they don't want to help people. They are against it because it will reduce the health care pie and it's intent is to set up a monopoly/monopsony (that's 'single payer' by definition) and there will be less health care available for everyone. With this bill more people will die for lack of care. It's that simple. It's economically unavoidable.

And not just in the US, more people will die in Canada and Mexico because there won't be available resources to fill in for the health care systems they have destroyed in their own countries.

If there was real reform on the table we'd be for it.

Health insurance is a massive market failure. It is also a necessity. The "free market" can't solve this problem.

Do tell. What market failed and how?

You don't understand something if you can't explain it. If you try to explain this you will realize how confused you are. You should read this before you make asinine assertions about 'free' health care markets.

Tostitos|8.23.09 @ 1:37PM|#

I'm quite disappointed that this article actually defended the American health care system. The quality is great if you can afford it, but the bottom line is that the socialized aspect of the system is terribly inefficient. Americans pay more for health care and get less coverage for it, ending medicare would be a good start.

|8.28.09 @ 10:03AM|#

Don't forget, too, that Americans are FATTER than most other national populations.
In fact, America is about the ONLY country where the POOR PEOPLE are fat.
Obesity--which is a personal choice--accounts for a large amount of the reduction in life expectancy in the US, and thus is another form of 'slow' suicide.
No amount of juggling the health care payment systems will improve longevity unless we trim up.

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