Health Care Debate, Part Two

The expected problem with universal healthcare is the same as one of the big problems with healthcare now -- too much money disappearing for things other than the delivery of healthcare.

Now we have insurance companies siphoning off massive amounts of money for shareholders, executive salaries, and so on.

With universal healthcare that money would be siphoned off into some massive bureaucracy.

Other countries manage it. We are paying more for our healthcare and getting less (judging from our infant mortality and lifespan stats) than they are.

How abut "Cato Institute's Dirty Little Secret" and have an article about the magical market fairies.

Greg, have you no idea how large the corporate health insurance bureaucracy is? Every hospital in America has an entire staff that does nothing but paperwork to squeeze money out of the insurance companies.
A recent comparison between major hospitals in Toronto and Boston showed that the Boston hospital had a staff of dozens whose job is to process insurance forms. The Toronto hospital had one person, whose job *included* sending the monthly invoice to the national health service.

Greg and Paul W both have valid points. As for Greg's point, it is true that any time you change the way that large mounts of money move, some people try to position themselves to skim some of it for themselves. And the bureaucracy.would have to expand. But there are reason to think that it still would be much more efficient than the current system.

Paul W is on to something too. The so-called "denial management industry" is a 2 billion-dollar-per-year business. That is, 2,000,000,000 health care dollars go into the process of insurance companies and providers arguing about whether the bill should get paid.

The point I was trying to make is that we are told that the problem is with healthcare delivery. The problem is really that all this money that people pay in insurance premiums is being eaten up by large insurance companies, then peanuts doled out for care.

Believing that our government would set up something efficient to administer national healthcare is a delusion.

I do worry about that; that the creation of the national system would be seen as a target-rich environment for opportunistic persons of various sorts; that it would turn into a hodgepodge of favors to special interests. But if they expanded Medicare for the hospital and office coverage, ditched Plan D, and allowed the States to use their existing Medicaid drug benefits to cover everyone, it would, in theory, be highly efficient.

How likely is that? I am more optimistic than some, perhaps unrealistically so. I do know how much money is involved. What they would have to do is start by adding coverage for everyone 18 and under, then have that coverage follow them as they age. It would take a while to do it that way, but at least you wouldn't toss everyone employed at insurance companies out of work all at once.

but at least you wouldn't toss everyone employed at insurance companies out of work all at once.
______________

And if anyone thinks that the insurance companies will not fight to the bitter end to disallow this... I have a bridge to sell you- LOL!! I think they would just move into government if it did happen, though.

Honestly, after reading things in the last two years about how those companies weaseled their way out of billions in claims for homeowners during Katrina, or reading anecdotes about people who THOUGHT they were covered by their health care insurance for cancer or heart disease, or seeing how health care as a benefit is being chipped away at so that it resembles a shadow of its former self, while insurers are posting insane profits, I am really certain that there is little that can be done without a change in how health care is perceived, and the economic model it is based on is turned on its head.

I do not think that in the current economic system in the States that this will be possible. And yet, there is a struggle to contain health costs in countries with inherently "mixed" economic models.

Here we get into ethics-- when is enough enough, or do we do all that can be done, no matter the cost. Making those decisions is something that involves weighing the cost of one life in relation to the cost to society. That, being done behind the scenes is leads to situations like Andrea Clarke"s:
http://scienceblogs.com/insolence/2006/05/an_update_on_andrea_clarke.ph…

and is something most of us do not want to even think about, let alone be a part of. Look at how many people who do not have advance directives.

In Britain, there is a a new act, called the Mental Capacity Act, which some charge with introducing back door euthanasia. http://catholicactionuk.blogspot.com/2007/04/mental-capacity-act-comes-…
Granted this is a religious viewpoint on the situation, but it highlights how a government can intervene and make health decisions for patients. What is the end result?

The two posts are basically to show that both private and public systems are making those decisions and it is not just "evil" corporations or governments that are responsible for th ills of society. It in fact comes from both sides. It is often phrased in terms such as the cost of doing business or something similar.

What is the right thing to do? The more I read, the less I am sure of. But it is always fascinating to ask the questions.

There's certainly is a degree of political interference in the running of any health-care system, be it public, private or a mix of the two. In the UK, we've has constant attempts by politicians to run the NHS along 'business' lines, which has basically ended up as a more expensive and less efficient way of doing things (although there certainly have been improvements).
Governments always need to have a regard for the healthcare of their citizens, not just in terms of public health (such as basic sanitation, prevention of epidemics, etc), but also through the development of new drugs, the provision of local health services, etc. Even in the US, you, as a taxpayer, pay a significant amount for all those things (tax breaks for drug companies?), but you seldom have any real control over the whole system.
Control is important, not only because of such things as drug buying (GM can buy in bulk, but apparently the US government cannot - that makes sense), but also because where money rules, then short-term financial considerations tend to win over long-term planning. Paul Krugman has a chapter in one of his books about healthcare, and he makes the point that the US hospital industry periodically goes through boom and bust cycles as it over-expands, and then contracts as the extra cash everyone banked on never appears.
Much of the money disappears through the cracks - the perverse incentive of private insurance companies is to cover as little as possible, or to jack up rates as much as they can. And the vast number of different systems within the US healthcare industry has a cost - tranactions within such a system are never zero cost (despite our own politicans vain hope that they are), but while business's, individuals and government pay for it, there will be enormous resistance to change.

This does not mean all is perfect in the UK. Costs continue to rise (although this has as much to do with ageing populations, better treatments, etc, as anything else), and government is constantly worried about it, although importing US style solutions seems to be less than useful. However, costs are lower, there is less friction in the system, and drug costs are more under control, both because of bulk buying and because the NHS has NICE, which carries out cost-benefit analysis on treatments. they may not always get it right, but they do ensure that drug company lobbying is mitigated by a regard for outcomes and cost.

Perhaps a new system would not copy the NHS (which has always been a hybrid), but it is cheaper than the European systems (which are now being scaled back) while overall more effective than much of the US system. Perhaps the Democrats will have have another attempt in 2008, this time with a radical change, rather than a messy exercise in keeping the system much as it is?