BF2S Forums Why Healthcare is already Socialized for the Uninsured

FEOS wrote:

Turquoise wrote:

FEOS wrote:

Size = more cost to field, sustain, etc.

There's only one truth to that I can see.  We do have a lot of land area to cover, and our population is more rural than those of more socialized countries, like Norway and France.

Still, when you figure in the fact that we have a better medical infrastructure than any other country in the world, I don't see how it would be that much more to administer to the needs of our people with socialization.  Bureaucratically speaking, it would be much cheaper.

The government doesn't own the infrastructure of which you speak...it is majority privately owned.

True, however, one of the possible options for socializing healthcare involves socializing insurance, which would leave actual facilities and treatment in the hands of the private sector.

This is a compromise position that both sides might actually be willing to agree to.

FEOS wrote:

Bertster7 wrote:

FEOS wrote:

Size = more cost to field, sustain, etc.

Another way of looking at it is size = greater purchasing power, lower costs for equipment/drugs.....

Even with economies of scale due to volume, the actual expenditure is still higher. And as has been pointed out before, the costs are not linear.

Then why hasn't that been seen to be the case everywhere else in the world?

Back up your assertion.

FEOS wrote:

PureFodder wrote:

As size increses, fixed costs (that aren't proportional to the size of the system) become a smaller cost per person than in smaller systems.

True. But absolute costs still increase. That is the problem.

Why? The absolute costs are shared amongst more people so, for example, if 1 person buys one pizza for $10 or 10 people buy 10 pizzas for $100, everyone gets a pizza for $10.

FEOS wrote:

PureFodder wrote:

When talking about economies of scale you say that despite incresed purchasing power the costs still go up, but the costs per person is the only relavent issue as incresing the size of the system increses the number of people paying for it.

We've increased similar programs and seen a net deficit. How will this be any different?

Chances are that some have gone up, some have gone down, but remember that the US system costs twice per person what it costs other rich western countries, so there would have to be some amazing increases in inefficiency when increasing the size of the system from 80 million to 300 million for public system not to end up much cheaper and cover more people than the current US system.

FEOS wrote:

PureFodder wrote:

You still haven't presented and sensible mechanism as to how the costs for the US will be significantly higher than for anywhere else and why this isn't seen when comparing countries ranging from <1 million people to 80 million people, but will suddenly kick in when going to 300 million people. Plus the entire issue can presumably be avoided even if it does occur by copying the EU system of having each EU country pay for the healthcare of it's own citizens and when they get sick in another country, country they get sick in treats them and sends the bill back to the country from whch the sick bloke came from. A similar system could be put in place in the US, with the state you pay taxes in being the one that pays your medical bills. This way no individual state breaks the 80 million populace mark at which point maths and economics supposedly collape avoiding the issue in the first place at the costs of some increase expendature. It also has the whole states rights thing inherent in it which lots of Americans want too.

Where did you come up with 80 million? That's your number, not mine. What you are talking about is an expansion of Medicaid (the state program for Medicare). And again offering a public option for insurance is fine. But that should be a last resort. A better solution is legal: tort reform and mandating coverage for pre-existing conditions. The first lowers operating expenses, the second increases availability. For those who can't afford coverage even under those changes, a public option is already there: it's called Medicaid.

80 million is the populace of Germeny who has a successful socialised healthcare system which we know isn't being effected by some huge inefficiency of scale that you believe will occur in the case of the US. All US states are smaller than this so there's no reason that a state by state public healthcare system should be any more costly than what is seen in Europe. This completely sidesteps the whole "US is too big" argument altogether even if it did make sense (which it doesn't).

Tort reform has the problems of not involving enough money to make a truely useful change to costs, and having the secondary effect of decreasing the quality of medical care as companies and doctors get a reduced punishment for causing harm, increasing their likelyhood of doing it (we know for a fact that companies have made financial decisions that they knew would cause harm to people even under the current US tort system). Other countries with relatively similar tort systems have nowhere near the same medical costs and predicted increases in medical costs as the US indicating that the tort system is not a primary cause of the huge US healthcare budget.

FEOS wrote:

PureFodder wrote:

FEOS wrote:

True. But absolute costs still increase. That is the problem.

Why? The absolute costs are shared amongst more people so, for example, if 1 person buys one pizza for $10 or 10 people buy 10 pizzas for $100, everyone gets a pizza for $10.

Not at all the same. Right now, people have a choice to not buy pizza.

True, they can either not get treatment (bad and likely only covering a small percentage of potential healthcare costs and has cascading increses in costs such as development of minor to major medical issues, incresed spreading of infectious dieases and lowering of productivity as ill/injured workers go to work as opposed to getting treatment), get treated on medicaid (same effect as in socialised medicine) or pay for their treatment directly (approximately the same overall costs as buying insurance). Again, no particular differences are evident.

FEOS wrote:

PF wrote:

FEOS wrote:

We've increased similar programs and seen a net deficit. How will this be any different?

Chances are that some have gone up, some have gone down, but remember that the US system costs twice per person what it costs other rich western countries, so there would have to be some amazing increases in inefficiency when increasing the size of the system from 80 million to 300 million for public system not to end up much cheaper and cover more people than the current US system.

There are amazing increases in inefficiencies...particularly with our government.

Americans are just crappier at running countries that the people of other rich countries? If so, are Americans in the private sector also crappier, thusly explaining the huge differences in healthcare costs between the US and other countries?

FEOS wrote:

PF wrote:

FEOS wrote:

Where did you come up with 80 million? That's your number, not mine. What you are talking about is an expansion of Medicaid (the state program for Medicare). And again offering a public option for insurance is fine. But that should be a last resort. A better solution is legal: tort reform and mandating coverage for pre-existing conditions. The first lowers operating expenses, the second increases availability. For those who can't afford coverage even under those changes, a public option is already there: it's called Medicaid.

80 million is the populace of Germeny who has a successful socialised healthcare system which we know isn't being effected by some huge inefficiency of scale that you believe will occur in the case of the US. All US states are smaller than this so there's no reason that a state by state public healthcare system should be any more costly than what is seen in Europe. This completely sidesteps the whole "US is too big" argument altogether even if it did make sense (which it doesn't).

As posted in another thread re this topic: US Constitution does not allow the federal government to intervene in intrastate commerce...which is what you are getting at.

Why does the Federal government have to get involved, can the states not chose to sort out the system co-operatively themselves?

FEOS wrote:

PF wrote:

Tort reform has the problems of not involving enough money to make a truely useful change to costs, and having the secondary effect of decreasing the quality of medical care as companies and doctors get a reduced punishment for causing harm, increasing their likelyhood of doing it (we know for a fact that companies have made financial decisions that they knew would cause harm to people even under the current US tort system). Other countries with relatively similar tort systems have nowhere near the same medical costs and predicted increases in medical costs as the US indicating that the tort system is not a primary cause of the huge US healthcare budget.

Then explain the extravagant costs associated with malpractice insurance--a direct result of the threat posed by current tort laws. It's not the actual cost of the legal proceedings...it is the recurring cost of malpractice insurance and the recovery of those costs through increased fees for services rendered by doctors, hospitals, companies, etc. You're looking at it from the wrong perspective.

In 2002 the entire insurance industry had a $1.4 trillion dollar turnover.
http://www.forrester.com/Research/Docum … 73,00.html
In 2009 it is still likely to be well below $2 trillion. In order for tort insurance to be a leading cause of the incresed costs of the US healthcare system vs. European systems, insurance taken out against being sued within the healthcare system would have to represent something on the order of 25-40% of the entire insurance market. This is a market that includes auto insurance, home, life, health insurance, financial insurances, a vast array of business and fincancial insurance policies. Those at risk of being sued in the medical sector simply don't put out anywhere near that much money for their insurance, so the financial impact cannot be that significant.

I still don't understand how the US has the highest per capita spending on healthcare when it doesn't even have a real national healthcare system (whereas other countries on that list do, and yet the per capita spending is so much lower).

My explanation is, they're subsidising the private companies, whilst the private companies still screw everyone over regardless.

Flaming_Maniac wrote:

"37th best" kind of numbers are bullshit, because they factor in how much the care costs, not directly the quality of care. The fact is the U.S. is still way, way up there in medical tech, and if you have serious medical issues you are better off coming to the U.S. over anywhere else so long as you have the money to justify the immense resources going in to prolonging your life. People in the U.S. spend the most on healthcare because they can - as a whole we are a rich people, and we are willing to pay for procedures that probably wouldn't be done in most other places.

There is always a premium for cutting edge quality, that's all there is to it. Your system is not better, it is different.

...except for the fact that we also pay more for treatments that aren't cutting edge.  We pay more for basic medications and basic operations -- neither of which would cost nearly as much with socialization.

PureFodder wrote:

FEOS wrote:

PureFodder wrote:

Why? The absolute costs are shared amongst more people so, for example, if 1 person buys one pizza for $10 or 10 people buy 10 pizzas for $100, everyone gets a pizza for $10.

Not at all the same. Right now, people have a choice to not buy pizza.

True, they can either not get treatment (bad and likely only covering a small percentage of potential healthcare costs and has cascading increses in costs such as development of minor to major medical issues, incresed spreading of infectious dieases and lowering of productivity as ill/injured workers go to work as opposed to getting treatment), get treated on medicaid (same effect as in socialised medicine) or pay for their treatment directly (approximately the same overall costs as buying insurance). Again, no particular differences are evident.

Then--more accurately--people have a choice about which pizza shop they buy from, which toppings they get, which crust to go with, what size pizza to buy, how much to pay for it, and whether or not to have it delivered.

Right now, in the US, people have a similar spectrum of choice when it comes to medical care. That is, except for those of us who use government-run medical care.

PF wrote:

FEOS wrote:

PF wrote:

Chances are that some have gone up, some have gone down, but remember that the US system costs twice per person what it costs other rich western countries, so there would have to be some amazing increases in inefficiency when increasing the size of the system from 80 million to 300 million for public system not to end up much cheaper and cover more people than the current US system.

There are amazing increases in inefficiencies...particularly with our government.

Americans are just crappier at running countries that the people of other rich countries? If so, are Americans in the private sector also crappier, thusly explaining the huge differences in healthcare costs between the US and other countries?

That's a huge leap. The answer is no.

What causes the huge cost differentials is multi-fold: different laws, different levels of disposable income, different priorities, longer life spans...most of the cost drivers aren't medical in nature and aren't related to method of payment.

PF wrote:

FEOS wrote:

PF wrote:

80 million is the populace of Germeny who has a successful socialised healthcare system which we know isn't being effected by some huge inefficiency of scale that you believe will occur in the case of the US. All US states are smaller than this so there's no reason that a state by state public healthcare system should be any more costly than what is seen in Europe. This completely sidesteps the whole "US is too big" argument altogether even if it did make sense (which it doesn't).

As posted in another thread re this topic: US Constitution does not allow the federal government to intervene in intrastate commerce...which is what you are getting at.

Why does the Federal government have to get involved, can the states not chose to sort out the system co-operatively themselves?

If you go to a "single-payer system", which is what you have been championing, then yes. The federal government would have to be involved. We already have 50 different single-payer options in the states, along with a single single-payer option from the feds. They are options if you have a sufficiently low income level or sufficiently complex medical problem...and "sufficiently" varies widely from state to state.

That's one of the cost drivers: varying standards and laws from state to state that limit portability. That's something the Fed could do to help reduce costs--make a standard that is portable between states. Related to that cost driver are the ridiculously low payment levels from the government, which drive up costs for everyone else due to the government's payment levels not even touching the actual cost of services rendered.

PF wrote:

FEOS wrote:

PF wrote:

Tort reform has the problems of not involving enough money to make a truely useful change to costs, and having the secondary effect of decreasing the quality of medical care as companies and doctors get a reduced punishment for causing harm, increasing their likelyhood of doing it (we know for a fact that companies have made financial decisions that they knew would cause harm to people even under the current US tort system). Other countries with relatively similar tort systems have nowhere near the same medical costs and predicted increases in medical costs as the US indicating that the tort system is not a primary cause of the huge US healthcare budget.

Then explain the extravagant costs associated with malpractice insurance--a direct result of the threat posed by current tort laws. It's not the actual cost of the legal proceedings...it is the recurring cost of malpractice insurance and the recovery of those costs through increased fees for services rendered by doctors, hospitals, companies, etc. You're looking at it from the wrong perspective.

In 2002 the entire insurance industry had a $1.4 trillion dollar turnover.
http://www.forrester.com/Research/Docum … 73,00.html
In 2009 it is still likely to be well below $2 trillion. In order for tort insurance to be a leading cause of the incresed costs of the US healthcare system vs. European systems, insurance taken out against being sued within the healthcare system would have to represent something on the order of 25-40% of the entire insurance market. This is a market that includes auto insurance, home, life, health insurance, financial insurances, a vast array of business and fincancial insurance policies. Those at risk of being sued in the medical sector simply don't put out anywhere near that much money for their insurance, so the financial impact cannot be that significant.

When did I say the insurance was the primary cause? It's a contributing factor. Then you roll in the cost of unnecessary tests, visits, procedures, etc that doctors order to cover their asses from a malpractice perspective. Why? Because they are scared to death of getting sued for missing something when they provide the basic standard of care in a given circumstance. Revision of torts would reduce a significant medical cost driver...and it has nothing to do with who is paying for medical care.

http://www.house.gov/jec/tort/05-06-03.pdf

2003 JEC Report wrote:

The past several years have witnessed a considerable increase in the cost and impact of medical malpractice litigation. The result has been higher malpractice insurance premiums for health care providers, which in turn has led to higher costs for the health care system as well as reduced access to medical services. In 2001, premiums for medical malpractice insurance topped $21 billion, double the amount ten years earlier. This paper presents an analysis of the current medical malpractice system and examines the proposed federal reform legislation. The benefits of reforming of the medical liability system are significant and could:
• Yield significant savings on health care spending;
• Reduce unnecessary tests and treatments motivated out of fear of litigation;
• Encourage systematic reform efforts to identify and reduce medical errors;
• Halt the exodus of doctors from high-litigation states and specialties;
• Improve access to health care, particularly benefiting women, low-income individuals and rural residents;
• Produce $12.1 billion to $19.5 billion in annual savings for the federal government; and
• Increase the number of Americans with health insurance by as many as 3.9 million people.

http://www.detnews.com/article/20090731 … re-changes

In 2007, according to a survey by the consulting firm Towers Perrin, the American civil liability, or tort, system imposed $252 billion in costs on the U.S. economy. The cost of defending and paying medical malpractice claims accounted for about $30 billion of that total.

Consider that the estimated annual cost of ObamaCare is pegged at about $100 billion, and it's easy to see how to find some of the money to pay for it.

http://www.house.gov/jec/publications/109/03-21-05.pdf

JEC Report Conclusion wrote:

In practice, the medical liability system departs dramatically from its two central goals of punishing negligent doctors (i.e., deterrence) and compensating patients with negligently-caused injuries. Given the facts noted above, two conclusions are apparent. First, the existing medical liability system is hamstrung in providing an effective deterrent to negligent injuries for the simple reasons that most negligent acts go unpunished and most doctors who are sued are not guilty of negligence. In the effort to punish the 3 percent of negligent injuries
that actually result in a liability claim, the system ends up penalizing four innocent doctors for every one that is negligent. Second, the medical liability system fails to meet its goal of compensating the negligently injured because the vast majority of negligently-injured patients do not file a
liability claim. If victims of negligence do not file liability claims, then the liability system cannot compensate them for their losses. In sum, the observable facts of the current medical liability system demonstrate that in practice, the system is both inefficient and ineffective at meeting its goals.

https://www.towersperrin.com/tillinghas … 4/Tort.pdf

At nearly $27 billion in 2003, medical malpractice costs translated to $91 per person. This compares to $5 per person in 1975 (not adjusted for inflation). This significant escalation in medical malpractice costs has contributed to the increase in health care costs in the U.S. over the past 30 years.

http://www.aarpmagazine.org/health/heal … costs.html

AARP wrote:

Other doctors insist that malpractice suits are the culprit when it comes to rising costs. Though malpractice-insurance premiums and payouts constitute only a tiny fraction of our national health care bill, the fear of being sued causes physicians to order unnecessary tests, send patients to specialists, and sometimes even do needless procedures.

Why? Because doctors believe patients will be less likely to go to a lawyer if they think the doctor did everything possible—even when doing so doesn’t help the patient or causes harm, as in Susan Urquhart’s case. Statistics back this up. The top reason for malpractice payouts involves the failure on the doctor’s part to diagnose a disease.

FEOS wrote:

PureFodder wrote:

FEOS wrote:

Not at all the same. Right now, people have a choice to not buy pizza.

True, they can either not get treatment (bad and likely only covering a small percentage of potential healthcare costs and has cascading increses in costs such as development of minor to major medical issues, incresed spreading of infectious dieases and lowering of productivity as ill/injured workers go to work as opposed to getting treatment), get treated on medicaid (same effect as in socialised medicine) or pay for their treatment directly (approximately the same overall costs as buying insurance). Again, no particular differences are evident.

Then--more accurately--people have a choice about which pizza shop they buy from, which toppings they get, which crust to go with, what size pizza to buy, how much to pay for it, and whether or not to have it delivered.

Right now, in the US, people have a similar spectrum of choice when it comes to medical care. That is, except for those of us who use government-run medical care.

Apparently according to wiki 27.8% of Americans get public health coverage through the government, 59.3% get their insurance through their employer. That means that a full 87.1% of Americans have at least some restrictions in choice or no choice at all as they aren;t the ones purchasing the insurance, their employer is. To get a sensible look at the amount of choice, you'd need to look at the typical degree of freedom that employers give their employees when chosing healthcare (ie. does the employer say you have a budget of $X per year to get whatever healthcare you want or do they say 'here's the company healthcare policy, that's what you are getting.') This certainly begs questions over what extent choice actually has in impact on most Americans if the only way that they can change health insurance is by swapping jobs.

FEOS wrote:

PF wrote:

FEOS wrote:

There are amazing increases in inefficiencies...particularly with our government.

Americans are just crappier at running countries that the people of other rich countries? If so, are Americans in the private sector also crappier, thusly explaining the huge differences in healthcare costs between the US and other countries?

That's a huge leap. The answer is no.

What causes the huge cost differentials is multi-fold: different laws, different levels of disposable income, different priorities, longer life spans...most of the cost drivers aren't medical in nature and aren't related to method of payment.

None of those things look like serious possibilities. Americans live on average for less than in rich European countries, their disposable income is on the high side but not the highest or vastly above the average. Remember that there's a literal doubling in costs between the two systems so the differences have to be huge.

FEOS wrote:

PF wrote:

FEOS wrote:

As posted in another thread re this topic: US Constitution does not allow the federal government to intervene in intrastate commerce...which is what you are getting at.

Why does the Federal government have to get involved, can the states not chose to sort out the system co-operatively themselves?

If you go to a "single-payer system", which is what you have been championing, then yes. The federal government would have to be involved. We already have 50 different single-payer options in the states, along with a single single-payer option from the feds. They are options if you have a sufficiently low income level or sufficiently complex medical problem...and "sufficiently" varies widely from state to state.

That's one of the cost drivers: varying standards and laws from state to state that limit portability. That's something the Fed could do to help reduce costs--make a standard that is portable between states. Related to that cost driver are the ridiculously low payment levels from the government, which drive up costs for everyone else due to the government's payment levels not even touching the actual cost of services rendered.

In the EU we have a wide variety of different standards and practices and lack the strong overhead control of the US federal government, instead have the realtively weaker EU parliment and it works. In a universal healthcare sytem the governemnt is forced to pay real costs. In a private system there are plenty of peverse incentives to distort costs. It's in the insurers interest to deny claims and inthe hospitals interest to over treat.

FEOS wrote:

PF wrote:

FEOS wrote:

Then explain the extravagant costs associated with malpractice insurance--a direct result of the threat posed by current tort laws. It's not the actual cost of the legal proceedings...it is the recurring cost of malpractice insurance and the recovery of those costs through increased fees for services rendered by doctors, hospitals, companies, etc. You're looking at it from the wrong perspective.

In 2002 the entire insurance industry had a $1.4 trillion dollar turnover.
http://www.forrester.com/Research/Docum … 73,00.html
In 2009 it is still likely to be well below $2 trillion. In order for tort insurance to be a leading cause of the incresed costs of the US healthcare system vs. European systems, insurance taken out against being sued within the healthcare system would have to represent something on the order of 25-40% of the entire insurance market. This is a market that includes auto insurance, home, life, health insurance, financial insurances, a vast array of business and fincancial insurance policies. Those at risk of being sued in the medical sector simply don't put out anywhere near that much money for their insurance, so the financial impact cannot be that significant.

When did I say the insurance was the primary cause? It's a contributing factor. Then you roll in the cost of unnecessary tests, visits, procedures, etc that doctors order to cover their asses from a malpractice perspective. Why? Because they are scared to death of getting sued for missing something when they provide the basic standard of care in a given circumstance. Revision of torts would reduce a significant medical cost driver...and it has nothing to do with who is paying for medical care.

Most of this evidence simply states that medical tort has direct costs in the region of 1.5% of the total healthcare budget. The other claimed costs are poorly understood and come primarily through doctors and companies going way out of their way to avoid being sued. The first thing to note about this is that even if you take the wildest estimates about the costs of the system, it's still only covers a fraction of the difference between the European systems and the US one. This becomes most evident when you factor in the fact that in Europe there's a tort system too, adding costs to their systems. The only way that tort can be a significant culprit is if tort is adding multiple times more to the costs of US healthcare than the simlar systems in Europe. None of this evidence shows that. note that in your own source it claims that tort reform will reduce overall healthcare costs by "a minuscule one-half percent."

The next point is that the claimed increased costs are coming from doctors and comapnies doing unnessecary tests/safety procedures. Firstly according to your own source, this is primarily a product of poorly informed doctors and patients. The unnessecary tests result from doctors not acting in a scientific manner because they don't properly understand what they are doing. Patients also end up mis-informed and demand unnessesary tests, wasting money. Another issue is that doctors in the US system typically get paid more for doing more tests etc. This is one of the problematic issues with a for profit helathcare system, the peverse incentives. It also looks only at one side of the coin. The risk of being sued will motivate doctors and comapanies to increase checks and safety that has a possitive role in increasing patient safety. We know that companies already willfuly harm people because they think that they may still earn profits anyway (see vioxx and others). Reducing the potential penalties will only encourage this further. This all indicated that better information for both doctors and patients is the key to reducing unnessessary medcial treatment costs as well as removing the peverse incentives.

The overall picture is also NOT that tort causes large financial costs, but an over-reaction to the possibility of being sued potentially is. 97% of injuries caused by doctors do not result in a lawsuit and the amount that is claimed is spent defending agaisnt potential claims is multiple times greater than the real costs. This is a result of an over reaction, not a result of the tort system itself. Changing the tort system would therefore appear to be a poor way to solve this issue. One much more sensible way would be to follow the UK route and have doctors publicly insured and so you end up suing the government instead of the individual doctor. This should drop much of the percieved need for defensive medicine.

Overall it's hard to see how tort reform could possibly have a significant impact on the runnaway US healthcare costs, even when you restrict yourself to the sources that you chose as evidence for doing it.

FEOS wrote:

PureFodder wrote:

Apparently according to wiki 27.8% of Americans get public health coverage through the government, 59.3% get their insurance through their employer. That means that a full 87.1% of Americans have at least some restrictions in choice or no choice at all as they aren;t the ones purchasing the insurance, their employer is. To get a sensible look at the amount of choice, you'd need to look at the typical degree of freedom that employers give their employees when chosing healthcare (ie. does the employer say you have a budget of $X per year to get whatever healthcare you want or do they say 'here's the company healthcare policy, that's what you are getting.') This certainly begs questions over what extent choice actually has in impact on most Americans if the only way that they can change health insurance is by swapping jobs.

This post is enough to show that you truly do not understand how healthcare plans are provided for in this country.

There is a great variety of choices, both within individual insurance providers and among various insurance providers...even by employees of the same company. Most can choose the level of coverage they want, the type of service provision they want, the amount of deductible they want, etc.

The only ones who really can't are those who have their care provided by the government. No choice whatsoever.

but it is company dependent, therefore a lot of people won't get that choice, especially in small businesses and for the low paid workers.

FEOS wrote:

PureFodder wrote:

None of those things look like serious possibilities. Americans live on average for less than in rich European countries, their disposable income is on the high side but not the highest or vastly above the average. Remember that there's a literal doubling in costs between the two systems so the differences have to be huge.

Those things are ALL serious possibilities...particularly the legal differences and different systems of government.

So the slightly lower than average life expectancy of Americans does increase their healthcare costs considerably? As I've shown below, the legal differences are mainly misrepresented by bundling the effects of the tort system with several other effects that all act in the same way and then pretending that they don't exist. The legal systems in the Us and other EU countries are fairly similar. The political differences are significant I guess as the US government has a history of being more willing to prioritise the profits of big business over everything else in healtcare in comparison to other countries (see the mind shatteringly dumb move to legally prevent the US government from negotiating for lower drug prices.)

FEOS wrote:

PF wrote:

FEOS wrote:

If you go to a "single-payer system", which is what you have been championing, then yes. The federal government would have to be involved. We already have 50 different single-payer options in the states, along with a single single-payer option from the feds. They are options if you have a sufficiently low income level or sufficiently complex medical problem...and "sufficiently" varies widely from state to state.

That's one of the cost drivers: varying standards and laws from state to state that limit portability. That's something the Fed could do to help reduce costs--make a standard that is portable between states. Related to that cost driver are the ridiculously low payment levels from the government, which drive up costs for everyone else due to the government's payment levels not even touching the actual cost of services rendered.

In the EU we have a wide variety of different standards and practices and lack the strong overhead control of the US federal government, instead have the realtively weaker EU parliment and it works. In a universal healthcare sytem the governemnt is forced to pay real costs. In a private system there are plenty of peverse incentives to distort costs. It's in the insurers interest to deny claims and inthe hospitals interest to over treat.

The EU is not like the US. Nor is one country's NHS necessarily portable to other EU countries.

In our current government-provided healthcare system, the government pays nowhere near the real costs--what makes you think it would be different if expanded to cover the entire country? For example, there was a recent charge for treatment for my son. The doctor billed $90 (fairly excessive, to be sure, considering the treatment)...the government paid him $8. Nowhere near "reasonable" for the treatment. That's why many providers do not accept government-provided insurance but DO accept private insurance: the government doesn't pay anywhere near a "reasonable" amount for services rendered. Private insurance pays less than the billed rate, but far more than the government will pay.

The entire US system pays too much. If almost the entire system is government run then the government will by definition be paying the correct costs. That's how it works everywhere else.

FEOS wrote:

PF wrote:

FEOS wrote:

When did I say the insurance was the primary cause? It's a contributing factor. Then you roll in the cost of unnecessary tests, visits, procedures, etc that doctors order to cover their asses from a malpractice perspective. Why? Because they are scared to death of getting sued for missing something when they provide the basic standard of care in a given circumstance. Revision of torts would reduce a significant medical cost driver...and it has nothing to do with who is paying for medical care.

Most of this evidence simply states that medical tort has direct costs in the region of 1.5% of the total healthcare budget. The other claimed costs are poorly understood and come primarily through doctors and companies going way out of their way to avoid being sued. The first thing to note about this is that even if you take the wildest estimates about the costs of the system, it's still only covers a fraction of the difference between the European systems and the US one. This becomes most evident when you factor in the fact that in Europe there's a tort system too, adding costs to their systems. The only way that tort can be a significant culprit is if tort is adding multiple times more to the costs of US healthcare than the simlar systems in Europe. None of this evidence shows that. note that in your own source it claims that tort reform will reduce overall healthcare costs by "a minuscule one-half percent."

And again, you overlook the indirect costs of unreformed tort: overtreatment and the costs associated with it. You keep focusing on the payouts in court rather than all the other costs associated with our current malpractice laws because ignoring the actual costs allows you to keep making the argument.

No, I explained how the indirect costs were just the result of the tort system but of a multitude of other factors that tort reform will not address. Only looking at tort reform will only solve a small amount of this problem.

FEOS wrote:

PF wrote:

The next point is that the claimed increased costs are coming from doctors and comapnies doing unnessecary tests/safety procedures. Firstly according to your own source, this is primarily a product of poorly informed doctors and patients. The unnessecary tests result from doctors not acting in a scientific manner because they don't properly understand what they are doing. Patients also end up mis-informed and demand unnessesary tests, wasting money. Another issue is that doctors in the US system typically get paid more for doing more tests etc. This is one of the problematic issues with a for profit helathcare system, the peverse incentives. It also looks only at one side of the coin. The risk of being sued will motivate doctors and comapanies to increase checks and safety that has a possitive role in increasing patient safety. We know that companies already willfuly harm people because they think that they may still earn profits anyway (see vioxx and others). Reducing the potential penalties will only encourage this further. This all indicated that better information for both doctors and patients is the key to reducing unnessessary medcial treatment costs as well as removing the peverse incentives.

None of which obviates the need for malpractice tort reform. None of which removes the sword of Damocles from over the heads of the doctors.

What it explains is that defensive medicine is actually a combination of a wide range of factors, from doctors on fee-for-service pay structures, to poorly informed doctors making poor decisions. These all contribute in the same way as any effects of defensive medicine from being sued. In order to get the savings from reducing unnessecary treatments, you'd have to address all of these factors. The tort system only causes a fraction of this overall costs, and reform of the system is only realistically going to reduce even the part that is being caused by the tort modestly as doctors are still going to be sued and still going to carry out defensive medicine with the typical tort reform policies such as capping non-economic damages. Also this has the obvious problem of making healthcare more dangerous as risks from reckless and dangerous behaviour from doctors and healthcare companies are reduced.

FEOS wrote:

PF wrote:

The overall picture is also NOT that tort causes large financial costs, but an over-reaction to the possibility of being sued potentially is. 97% of injuries caused by doctors do not result in a lawsuit and the amount that is claimed is spent defending agaisnt potential claims is multiple times greater than the real costs. This is a result of an over reaction, not a result of the tort system itself. Changing the tort system would therefore appear to be a poor way to solve this issue. One much more sensible way would be to follow the UK route and have doctors publicly insured and so you end up suing the government instead of the individual doctor. This should drop much of the percieved need for defensive medicine.

If you could be completely ruined by someone's claims (whether founded or not), I'm sure you wouldn't call your reaction to mitigate that threat "over-reaction". Pretty easy to throw that assessment around when you aren't one affected by it, isn't it?

Tort reform isn't the ONLY solution...but it must be part of any solution, otherwise, there is still a massive, unnecessary cost out there.

But that ignores the possitive aspects of the tort system, discouraging dangerous behaviour by workers and comapnies inthe healthcare system.

FEOS wrote:

PF wrote:

Overall it's hard to see how tort reform could possibly have a significant impact on the runnaway US healthcare costs, even when you restrict yourself to the sources that you chose as evidence for doing it.

$230B a year. Nuff said.

If that value is based on the debunked work by Daniel Kessler and Mark McClellan then yes, nuff said. (it turns out that when their methodology is applied to a wider range of conditions the correlation entirely breaks down as shown by the CBO investigation that showed tort reform is expected to cut costs by somewhere near 1% which is less than the rate at which healthcare costs grow each year, while ignoring the benefits of the system.)

FEOS, there's one thing I noticed about your post here that I found interesting.  Part of it involves the thing you mentioned about 20% of the population with chronic diseases and/or those with longer than average lifespans.

If that high of a percentage of the population really is that much more expensive to care for, then doesn't that make socialization a more practical approach?  If you already know beforehand that a percentage that significant is going to drive up costs, then you want an insurance pool as large as possible to deal with it.  The only way that is possible is through a nationwide socialized system.  Otherwise, you have smaller pools per company that have to regularly choose to either raise everyone's rates significantly to account for this, or they can simply deny coverage to these people.

Last edited by Turquoise (2009-08-23 09:33:43)

FEOS wrote:

PureFodder wrote:

but it is company dependent, therefore a lot of people won't get that choice, especially in small businesses and for the low paid workers.

As I stated before, there are multiple options available from single providers...even for the smallest businesses.

So a government run helathcare that offered several choices of levels of care and costs would replicate (and in some cases increase) the choice seen in the current system?

FEOS wrote:

PureFodder wrote:

So the slightly lower than average life expectancy of Americans does increase their healthcare costs considerably?

You've made the mistake of assuming that all healthcare expenses are shared equally by all people. They aren't. 80% of healthcare expenses are spent on 20% of the population...that would include those who live longer than the actuary tables foresee. Which throws your ham-fisted usage of average life expectancy as a valid cost-related statistic out the window.

http://www.projo.com/opinion/contributo … 89889.html

The Agency for Healthcare Research and Quality says that 20 percent of the population incurs 80 percent of total health-care expenses.

http://www.ahrq.gov/research/ria19/expendria.htm

However, actual spending is distributed unevenly across individuals, different segments of the population, specific diseases, and payers. For example, analysis of health care spending shows that:

    * Five percent of the population accounts for almost half (49 percent) of total health care expenses.
    * The 15 most expensive health conditions account for 44 percent of total health care expenses.
    * Patients with multiple chronic conditions cost up to seven times as much as patients with only one chronic condition.

and is this any different in the US than anywhere else?

FEOS wrote:

PureFodder wrote:

As I've shown below, the legal differences are mainly misrepresented by bundling the effects of the tort system with several other effects that all act in the same way and then pretending that they don't exist. The legal systems in the Us and other EU countries are fairly similar.

Pretending tort reform wouldn't address much of the behavior-driven costs is just as much of a misrepresentation. I didn't bundle up the effects of overall tort--only the medical-related torts (primarily malpractice). It helps your argument to make the assumption that I did bundle up all torts, but since I didn't, all it does is show that you don't bother to actually read or understand contrary arguments to your own. You argue to argue, not to learn.

As the effects all have the same general effect of increasing unneccessary procedures, the burden of proving that tort as opposed to the other effects os what is driving this cost.

FEOS wrote:

PureFodder wrote:

The political differences are significant I guess as the US government has a history of being more willing to prioritise the profits of big business over everything else in healtcare in comparison to other countries (see the mind shatteringly dumb move to legally prevent the US government from negotiating for lower drug prices.)

There's no doubt that that legal action was stupid. But considering the prices the government will pay under Medicare/Medicaid, I can understand the drug companies wanting no part of it...nobody willingly operates at a loss.

Or to have their profits lowered by reasonable market forces (remember that drug companies operate predominantly within the government granted monopoly markets of the patent system).

FEOS wrote:

PureFodder wrote:

The entire US system pays too much. If almost the entire system is government run then the government will by definition be paying the correct costs. That's how it works everywhere else.

No, the entire US system doesn't pay too much. And even if it did when averaging in the underpayment by the government, that bundling misrepresents the entirety of the situation. What we have is a government-run program (similar to what is being offered up as a possible single-payer alternative) that doesn't pay anywhere close to the actual costs, much less cover even a minimal profit margin for the businesses involved. That deficit is then taken up by the private industries effectively subsidizing the government by paying reasonable charges. Again, the reason why many physicians do not accept government programs or government provided insurance--nobody wants to operate at a loss.

If the entire system is run by the government, then the entire system will cease to operate because the government doesn't pay enough to keep the system sustained. In order for that to happen, ALL medical-related industry would have to be run by the government, not just delivery of care. There is simply no way that will happen.

And yet every other country manages to keep their costs well below those seen in the US with a fairly wide range of different levels of involvement of the private sector. The private sector in those countries willfully participates in it showing that they obviously aren't getting totally screwed as there's nothing stopping them from just doing somewthing else.

FEOS wrote:

PureFodder wrote:

No, I explained how the indirect costs were just the result of the tort system but of a multitude of other factors that tort reform will not address. Only looking at tort reform will only solve a small amount of this problem.

No, you didn't. You ignored the actual costs associated with overtreatment and other actions performed by doctors explicitly because of the fear of malpractice claims. Add in the actual costs of insurance to those who provide care and it stops becoming a trivial situation. You conveniently lump all torts in to the situation instead of looking at the actual impact of medical-related torts. The studies are there. I can't make you stop ignoring them simply because they aren't in line with your views.

PureFodder wrote:

What it explains is that defensive medicine is actually a combination of a wide range of factors, from doctors on fee-for-service pay structures, to poorly informed doctors making poor decisions.

There was nothing in the source I provided that said poor decisions by doctors was the primary reason--only that it could be a contributing factor. The bottomline is that when doctors were interviewed, the primary reason given for the prescription of extra tests was to cover their asses in a malpractice environment.

PureFodder wrote:

These all contribute in the same way as any effects of defensive medicine from being sued. In order to get the savings from reducing unnessecary treatments, you'd have to address all of these factors. The tort system only causes a fraction of this overall costs, and reform of the system is only realistically going to reduce even the part that is being caused by the tort modestly as doctors are still going to be sued and still going to carry out defensive medicine with the typical tort reform policies such as capping non-economic damages. Also this has the obvious problem of making healthcare more dangerous as risks from reckless and dangerous behaviour from doctors and healthcare companies are reduced.

The tort system is the primary driver of the unnecessary costs, as stated in the source provided and related by the doctors being interviewed. And, as has been provided in other sources, the tort system as currently enacted has not accomplished it's stated intent as more innocent doctors are punished than those who are actually guilty of malpractice. The two situations feed on each other.

PureFodder wrote:

FEOS wrote:

Tort reform isn't the ONLY solution...but it must be part of any solution, otherwise, there is still a massive, unnecessary cost out there.

But that ignores the possitive aspects of the tort system, discouraging dangerous behaviour by workers and comapnies inthe healthcare system.

No, it certainly does not. Your argument ignores the findings of the study, which I pointed out above.

PureFodder wrote:

FEOS wrote:

$230B a year. Nuff said.

If that value is based on the debunked work by Daniel Kessler and Mark McClellan then yes, nuff said. (it turns out that when their methodology is applied to a wider range of conditions the correlation entirely breaks down as shown by the CBO investigation that showed tort reform is expected to cut costs by somewhere near 1% which is less than the rate at which healthcare costs grow each year, while ignoring the benefits of the system.)

That number is from the JEC, not Kessler and McClellan. Go back and actually READ the sources you try to debunk. Better yet...just go back and READ the posts previous to this one, particularly the ones citing the JEC studies.

JEC wrote:

In an authoritative study on defensive medicine,
Stanford University researchers Daniel Kessler and Mark McClellan found that expanded
malpractice liability significantly increased medical expenditures. Specifically, they found “that
malpractice reforms that directly reduce provider liability pressure lead to reductions of 5 to 9
percent in medical expenditures without substantial effects on mortality or medical
complications.”56 Based on national health expenditure data, Kessler and McClellan’s estimates
imply that medical liability reforms could have reduced defensive medicine expenditures by
between $69 billion and $124 billion in 2001, or between 3.2 and 5.8 times the amount of
malpractice premiums.57 Importantly, the practice of defensive medicine does not produce
measurable health benefits.58

......

Reform of the medical liability system would generate savings in a number of areas.
Kessler and McClellan’s research indicates that medical liability reforms, such as those
discussed here, would reduce health care spending by 5 percent to 9 percent, without an
appreciable impact on health outcomes. Assuming the reforms are fully implemented after three
years (i.e., by 2006), the gross savings would range from $99 billion to $178 billion.

So their source IS exactly the report that I was talking about, maybe if you had read the JEC report you would have seen it as the fact that they base it on the Kessler and McClellan work is utterly transparent as they repeatedly state that.

nlsme1 wrote:

FEOS wrote:

Turquoise wrote:

FEOS, there's one thing I noticed about your post here that I found interesting.  Part of it involves the thing you mentioned about 20% of the population with chronic diseases and/or those with longer than average lifespans.

If that high of a percentage of the population really is that much more expensive to care for, then doesn't that make socialization a more practical approach?  If you already know beforehand that a percentage that significant is going to drive up costs, then you want an insurance pool as large as possible to deal with it.  The only way that is possible is through a nationwide socialized system.  Otherwise, you have smaller pools per company that have to regularly choose to either raise everyone's rates significantly to account for this, or they can simply deny coverage to these people.

Keep in mind that the majority of those people already qualify for Medicare or Medicaid. They are already on a socialized system, by and large, which is fine for them.

Having experienced both sides of the issue, I choose privatized healthcare every single time.

But there are more then 2 sides here. I doubt you have dealt with our healthcare industry as an under/uninsured patient.

No kidding.

nlsme1 wrote:

FEOS wrote:

Turquoise wrote:

FEOS, there's one thing I noticed about your post here that I found interesting.  Part of it involves the thing you mentioned about 20% of the population with chronic diseases and/or those with longer than average lifespans.

If that high of a percentage of the population really is that much more expensive to care for, then doesn't that make socialization a more practical approach?  If you already know beforehand that a percentage that significant is going to drive up costs, then you want an insurance pool as large as possible to deal with it.  The only way that is possible is through a nationwide socialized system.  Otherwise, you have smaller pools per company that have to regularly choose to either raise everyone's rates significantly to account for this, or they can simply deny coverage to these people.

Keep in mind that the majority of those people already qualify for Medicare or Medicaid. They are already on a socialized system, by and large, which is fine for them.

Having experienced both sides of the issue, I choose privatized healthcare every single time.

But there are more then 2 sides here. I doubt you have dealt with our healthcare industry as an under/uninsured patient.

I have dealt with doctors not accepting the insurance I have. Does that count as under/uninsured? You can't get the doctor you would prefer because they don't accept the insurance you have. The fact that the insurance I do have is provided either by a contractor executing the government's health care plan (TriCare) or government-run directly (Medicaid).

And there was the time I was uninsured and had eye problems, had to see an ophthalmologist repeatedly without any insurance, get medications without any insurance...

So...yeah. I have experience. Thanks.