The Indy Star has another installment on the precarious state of our health care system. Turns out, being uninsured isn’t just for poor people any more. Folks at around the median family income level — about $46,000 per year — are joining the ranks of the uninsured at a pretty fast clip. The Lafayette Journal and Courier has a similar article in today’s edition discussing, among other things, how insurance rates go up for the insured as the numbers of uninsured and Medicaid recipients grow. Medical providers end up treating many of these folks with some level of care provided at a loss and need to make up the costs elsewhere.
Money can stand up to populism in this country for a long, long time; but I get the feeling that a huge number of people are getting really, really angry about the state of health insurance in this country and I think politicians will eventually get the sense that Something Must Be Done. That’s a cause for hope and fear. Something actually does need to be done, but politicians simply reacting to populist fears usually doesn’t end well.
In any event, I’ve been over this before, but I take the position that, as a nation, we’re already paying for national health care coverage, we’re simply not getting it. There is massive amounts of waste in the system, with health insurer’s administrative costs — processing claims — representing something like 30% of the total, if I recall correctly. Meanwhile, similar costs for Medicare, if I recall correctly, represent less than 10% of the total. We are, apparently, subsidizing the advertising and R&D for pharmaceuticals — paying full (or more) freight on drugs while the drug companies sell the same drugs to other countries that are more hard-nosed in their negotiations with these companies.
It’s definitely true that Americans could do a better job on their own of keeping themselves healthy. But, just saying that as an excuse for doing nothing with our health care system doesn’t work. Perhaps, for starters, we could divert some of the corn subsidies that encourage production of high fructose corn syrup and use them to pay for parks, trails, green spaces, gym memberships, credits for healthy living, whatever. Just a random idea.
At the end of the day, we need to rationalize health care financing. We have a ton of money going to pay for opaque insurance policies used, in turn, to pay for services that are not on a transparent pricing schedule; assuming that coverage is not denied properly or improperly by the insurer. We also have a lot of money going to treat illnesses at emergency rooms that could have been better and more cheaply treated earlier or elsewhere had the patient had insurance or at least known what the actual cost was as opposed to the retail sticker price. And I wonder how many people keep themselves unemployed or underemployed so that they can maintain their public health care coverage.
[tags]healthcare[/tags]
Then there are the people who are insured, but can’t afford to use it (co-pays, minimum deductibles, etc.) and/or have policies which cover serious dieases but not innoculations.
Nothing is going to happen on this issue, except that I predict family genetic history will mean that coverage amounts to less and less.
I try to avoid sweeping generalizations, but legislators and advocates have health insurance. They have never faced down the choice between an $800 test and the life of a loved one.
Appreciate your post and reference to the lead article in the Indianapolis Star. I wonder how much of an impact health care costs have on innovation and entrepreneurial aspirations? I know of several people that have ideas to start their own enterprise but have to stay with the corporate America career path because of the health care coverage they do have.
Here’s the great thing in the health insurance debate. We already have very clear evidence of our alternative, and that’s socialized medicine. Talk to any Canadian or Brit if you want to know how well that works (or look at their teeth, as most routine dental care isn’t provided since it isn’t a necessity).
I’m not fan of the health insurance industry, and I work in it. But the alternative surely isn’t more government involvement. Frankly, more government involvement in anything hasn’t fixed anything in recent memory, and it could be reasonably argued that much of the problem in the first place is connected with too much government interference.
I disagree with the notion that the government can’t do anything well. And, as an aside, I think folks should think twice about electing to office anyone who thinks that government can’t do well — that’s pretty much a self-fulfilling prophecy. Our military is a pretty damned effective government undertaking. I find our highways to pretty effective as well. I’m biased, but I find that our government run legal system has done an excellent job in keeping violence and corruption in our society below a dull roar. Another bias, but I’m also pretty grateful to our government for creating the Internet.
Government isn’t a thing, it’s just us. Given a large enough population, people are pretty much the same — it’s the incentive structures of the organizations in which they work change. Different tasks call for different incentive structures. If you want commodities produced and distributed, business will beat government just about every time. If you have a huge undertaking which is necessary but not necessarily profitable, business isn’t the right incentive structure.
I see two primary problems with health care under a business model. First, you can’t negotiate with a gun to your head. That’s essentially what is happening when you’re forced to contract for an urgent life saving procedure. Second, an utter lack of informational transparency. The second one can be improved to some extent, but the first one never will. Even the second one, however, will remain a huge problem in that, even if the medical providers were willing to be completely up front about pricing structures, they can’t say for sure, prior to the transaction being agreed to, what you’ll need to get better.
I’m sure government can do a bad job. But, even so, I’m not certain that government *will* do a bad job. I do know that the current situation is pretty bad and it looks to be getting worse quickly.
My mom took a trip to Australia the year before she passed away. She took her trip in 1994, that was several years ago and not long after the controversy over Hillary’s plan for universal coverage, but I remember my mom mentioning that the Australians were able to handle it without rationing or long lines. (Mom got to talk with a lot of Australians while she was there, and there seemed to be a consensus, at least among she talked to, that government health insurance isn’t necessarily a bad thing). As has been pointed out here and on some other blogs, there is much too $ being spent on paperwork. As has been pointed out, we all pay for the uninsured anyway, not a good thing, but when folks don’t have insurance and get sick, where do they go? The emergency room, and we all know hospitals as well as other places make it up through the premiums we pay.
Lets try ‘socialized’ medicine.We know private doesnt work.( that is, the system doesnt work for those who dont have insurance).. Too much money is simply pre-diverted to private coffers… Bush administration has continually campaigned that health care is as good as it gets in this country now ,so we already know there will not be improvements under the current system.
Scribe, I can’t say I’ve taken a scientific poll of Canadians but those I have talked to geenrally shake their heads in amazement that we lack a true national health care system. And if Canadians & Brits didn’t like “socialized” medicine I imagine there would be political movements to get rid of it…I don’t see that happening either but I could be wrong. As for dentistry, well, we can keep that purely in the private field for now if you’re worried that “socializing” it would lead to bad American teeth…
We spend 25% more per person than any country in the world for healthcare and, in general, we have terrible results.
Our lifespan is below average, infant mortality rate is double that of other developed countries, our obesity rate is 20% higher than any other developed country, we have few doctors and nurses per capita than every other developed country.
But yea, I guess we’re not doing too bad.
And go ahead and ask the 20% of Americans that don’t have ANY health covereage if they would prefer the Canadian system.
I bet we all know the answer to that…
Maybe just an aside, but I read something today that suggests poor communities in the deep south had been making great strides in terms of infant mortality over the past few decades, but more recently their progress has stagnated and, in some cases, started to regress.
I would guess that socialized medicine won’t much change our two tier system except in form. Instead of hospitals fleeing aging neighborhoods we will eventually see health care companies setting up in Bermuda or the Bahamas to cater to relatively wealthy Americans. These folks just won’t want to put up with rationing, and will become health care “tourists” just as many Canadians and British do now. You can see this in the growth of Indian Health Care companies such as Apollo.
I desperately hope that no one on this thread will be instrumental in forming health care policy for anyone other than themselves – that would include me…
There are a lot more ways to make things worse than there are to make things better, and my feeling is that we will be using one (or more) of them, just so politicians and activists can “do something”.
I’d pay money to be wrong about this – but what I expect is that I’ll be right, and still wind up paying the money.
Interesting posts: especially your comments under #4, Doug. (Wish I’d been here first to write that myself!) Government programs don’t have to be bad. They may not always be good, but we shouldn’t assume that they will always be bad, either. Like Doug, I’ve never understood why people who hate government want to run for political office and thus become part of “the government” they claim to despise. Do they hate all of us, including themselves, since we are, “the government”?
Surely we could learn from the mistakes of other countries and include dental care under any national health care plan, if one ever comes to pass.
I read the article Doug refers to in comment #9. It was in the dreaded New York Times.
We also need to realize that health care issues are more complex than simply giving people money and/or insurance. Lack of transportation, attitudes about illness, previous bad experiences, ingrained habits and cultural norms, inflexible job situations, focusing on getting health care coverage for children and the elderly while ignoring middle-aged people, M-F 8-5 clinic and doctor office hours, lack of leisure time, failure to connect bad habits with chronic disease, and lack of access to healthy foods, are part of the problem, also.
We’ve talked about this before – in this country the relationships among patients, payers, providers, insurers, and insureds have become wildly disconnected and hugely complex.
[This situation gives me the chance to use the word ‘disintermediation’ (getting middlemen out of transactions), but other than that it doesn’t seem to be providing much benefit.]
I’m amazed that our system works as well as it does, as often as it does – my fear remains that it is much easier to make it worse than it is to make it better, even with the best of intentions.
Hardly anyone ever talks about the growing burden all the lawsuits, and settlements, place on our health care system. This is a massive growth industry and takes an increasing share of our health care dollar every year.
Part of any health care “solution” needs to involve fixing the runaway tort system.
Current estimates put the total cost of litigation to Americans around $865 billion per year. While that’s not entirely health care-related, it’s certainly the lion’s share. These settlements drive up the cost of insurance, both ours and the providers’, and result in higher prices for health care.
I’m not trying to claim lawsuits are the only reason health care costs go up, but they’re a significant contributor.
Every time you see one of those ads that say Car Wreck? Call Me!, just think about how that’s raising your health care costs.
I don’t have the stats handy, but what I’ve seen suggests that lawsuits aren’t the problem. Payouts from lawsuits have essentially remained flat over the last 10 or 15 years while premiums have skyrocketed; suggesting that the tort system isn’t a primary culprit. Plaintiffs lawyers do, however, give a lot of money to Democrats. So, you’ll hear a lot about how bad they are (not saying that’s your reason, Byron) when health care solutions are discussed.
If you’re correct that lawsuits have remained flat, then I’d agree with you. But every mention of the subject I ever see says 2-5% growth annually. I don’t know where you’d get an unbiased accounting (the bar association wouldn’t count), nor if solid numbers are even possible with all the out-of-court settlements.
Still, I doubt the number was even close to $865 billion 15 years ago so I’m really inclined to believe there has been a lot of lawsuit/settlement growth.
As far as democrats being in bed ($$$) with plaintiffs lawyers, an equally likely scenario is the the dems get pressured to NOT change anything with regard to the health care system, or tort reform, because it could undercut the windfall earnings the p-lawyers are currently enjoying.
The Canadian system is so wonderful that building/owning a hotel next to a hospital in Buffalo, Detroit or Minneapolis is an incredible investment.
Why?
Because they’re chock full of Canadians fleeing from their glorious health-care system to be treated in our broken-down system in need of government takeover.
A few years ago, David Asman of dreaded Fox News had a column in Opinion Journal that brilliantly compared the British and American systems after his wife had a stroke on vacation in London. I don’t have it, but remember it did a better job of bursting the socialists’ bubble than anything else I’d read.
You people really want the government to “take care of you”? I mean, they do such a wonderful job with Social Security, and our government school system is just an absolute model for educational development. I really want some bureaucrat deciding what care I should have.
The Scribe: the opposite thing happened to my sister’s in-laws, who are from Scotland. Her father-in-law had a stoke while here in the states. His “insurance” paid for everything over here and will continue to do so now that he has returned to Scotland. The UK health system even paid for a return flight with health care provided en route. From all reports, he received excellent care in both the U.S. and in the UK. This man and his wife are retired and on a fixed income, so it was nice that they didn’t have to worry about money along with everything else they were going through.
That’s supposed to say “stroke” not “stoke.”