Goodbye to US HealthCare?

[MulaMan]

Re: Goodbye to US HealthCare?

Lasik is an example of free market health care. Went from $3,500 per eye down to $199 per eye.

Lasik was lucrative and the market is huge - 200 million Americans. Then more and more competition entered the industry, technology improved and prices went down.

The majority of American health care is NOT a free market but controled by cartels: Health Insurance Firms, American Bar Association, American Medical Association, FDA / Pharma, Congress.

Taking over health care is a good forward step from where we are today.

If you think free market health care will somehow organically happen without a government takeover or huge re-regulation, then I'd like to hear how that is possible?

Perhaps the big health insurance companies will find Jesus and do what is right? LOL.

[c1ue]

Re: Goodbye to US HealthCare?

If you think that we have a free market in health care now, what would you call the "optional" health care industry (i.e. cosmetic surgery)? Is that a super-free market?

Given that cosmetic surgery is part of general surgery - it is impossible to separate the operations of one vs. the other.

Or in other words: For every boob job, there might be a breast reconstruction due to breast cancer.

But even in a narrow field: the costs of a boob job in the US are comparable with what you might see in South Korea. The US is still higher, but not 2x or 10x.

In addition I've been looking at dental implants for someone else in my family. The costs for these 2 or 3 years ago was astronomical - with the falling economy the costs in the US are falling though still quite high.

So clearly for those medical areas which are not commonly (or at all) covered by health insurance, the market has some effect.

But then we get to the second part of the free market which purely cosmetic surgeries do not share with general medicine: a service can only be truly governed by the free market if it is electable.

Health care for health maintenance is not generally electable - and elections made generally result in health deterioration.

Choosing to get a boob job has no health effects; similarly a dental implant is not necessary to survival.

But there are many medical situations which are: childbirth, broken legs, serious disease, aging complications, injury due to accident, etc etc.

But again, the entire concept of cosmetic surgery is irrelevant.

The costs of basic medical care in other nations have demonstrably been lower with universal coverage.

Clearly it can work.

[Jim Nickerson]

Re: Goodbye to US HealthCare?

Given that cosmetic surgery is part of general surgery - it is impossible to separate the operations of one vs. the other.

Or in other words: For every boob job, there might be a breast reconstruction due to breast cancer.

But even in a narrow field: the costs of a boob job in the US are comparable with what you might see in South Korea. The US is still higher, but not 2x or 10x.

In addition I've been looking at dental implants for someone else in my family. The costs for these 2 or 3 years ago was astronomical - with the falling economy the costs in the US are falling though still quite high.

So clearly for those medical areas which are not commonly (or at all) covered by health insurance, the market has some effect.

But then we get to the second part of the free market which purely cosmetic surgeries do not share with general medicine: a service can only be truly governed by the free market if it is electable.

Health care for health maintenance is not generally electable - and elections made generally result in health deterioration.

Choosing to get a boob job has no health effects; similarly a dental implant is not necessary to survival.

But there are many medical situations which are: childbirth, broken legs, serious disease, aging complications, injury due to accident, etc etc.

But again, the entire concept of cosmetic surgery is irrelevant.

The costs of basic medical care in other nations have demonstrably been lower with universal coverage.

Clearly it can work.

I don't know that it makes any difference in your argument, but even though plastic surgeons are first trained in general surgery, the practices are vastly different and I think clearly separable. All breast reconstructions I ever heard about were done by plastic surgeons and the ones supposedly with the best outcomes were done by subspecialists (breast reconstruction) in plastic surgery.

Not all plastic surgery is cosmetic, though some things might result in people looking infinitely better, e.g. cleft lip repair, repair of defects from gun shot wounds and other traumas, and other congenital deformities.

I looked up a guy recently, on the web, whom I had known as a dentist who then went back and trained in oral surgery, then got his medical degree, general surgery training, and then plastic training. The guy had the training experience to have been a one-stop-shopping fantastic facial, maxillofacial surgeon. What was his web site mostly about? Tits. http://www.breastimplantsusa.com/cos...geon.php?dr=62

[Ghent12]

Re: Goodbye to US HealthCare?

Given that cosmetic surgery is part of general surgery - it is impossible to separate the operations of one vs. the other.

Or in other words: For every boob job, there might be a breast reconstruction due to breast cancer.

But even in a narrow field: the costs of a boob job in the US are comparable with what you might see in South Korea. The US is still higher, but not 2x or 10x.

In addition I've been looking at dental implants for someone else in my family. The costs for these 2 or 3 years ago was astronomical - with the falling economy the costs in the US are falling though still quite high.

So clearly for those medical areas which are not commonly (or at all) covered by health insurance, the market has some effect.

But then we get to the second part of the free market which purely cosmetic surgeries do not share with general medicine: a service can only be truly governed by the free market if it is electable.

Health care for health maintenance is not generally electable - and elections made generally result in health deterioration.

Choosing to get a boob job has no health effects; similarly a dental implant is not necessary to survival.

But there are many medical situations which are: childbirth, broken legs, serious disease, aging complications, injury due to accident, etc etc.

But again, the entire concept of cosmetic surgery is irrelevant.

The costs of basic medical care in other nations have demonstrably been lower with universal coverage.

Clearly it can work.

"For every boob job, there might be a breast reconstruction due to breast cancer." If if's and mights were candy and tights, we'd all have a Merry Christmas.

I have three main contentions/queries which are aimed more directly at the bill recently passed through the House than at your point, so you can take either position as you please.

1) Even conceding that universal coverage lowers costs (which you are right in that it demonstrably does), that is not the path we are on. I am more apt to believe Dennis Kucinich on this one. The lowered cost from universal coverage does, however, come with lowered quality* as well as other disadvantages.

* - quality being loosely defined as some combination of speed, access to technology, and access to specialists; all of which are demonstrably lower in most places where the cost barrier is also lower.

2) How does one explain any of the following without positively attributing it to the system as it once was and as it is now, and also how does one explain how any of the following will improve under either the bill passed by the House or under a universal coverage scheme?
a) Medical technology advancement concentration in America.
b) Life expectancy almost on par with those "civilized" countries in spite of America's obesity, gun violence, and other life-adverse characteristics.
c) The extremely rapid speed with which the majority of care is given, limited only in a few cases by the supply of things such as transplant organs.

3) Why does it cost $1.3T from American citizens to tell insurance companies that they have to accept everyone?

[grapejelly]

Re: Goodbye to US HealthCare?

to think a government monopoly lowers costs is simply criminal ignorance.

Here's why. You replace any semblance of bargaining with complete politicization. No market at all, all decisions political decisions. How much care to give is political. How much to pay, political. Everything is political. In political decisions there are many losers and few winners.

To look at what health care can be like, simply look at veterinary care. It resembles a free market very closely. Forget the fact that the standard of care is not as high. It easily could be. The difference is that willing buyers and sellers contract together and costs are like a tenth of what the same procedures cost for human beans.

If health care were completely deregulated, people could buy any insurance they wanted. With their own money. That would begin a long decline in the costs of health care.

Uninsurable people could purchase "assigned risk" type coverage, just as they do with auto insurance.

Everyone who uses health care should be spending their own money for it. The providers should be contracting with consumers directly. The role of insurance is to cover catastrophes, and to pre-negotiate rates and care for routine medical care use.

That has been largely lost because the government is the 800 pound gorilla in the room already. There is no free market for health care, but there is the possibility of one. I pay a high deductible plan I purchase with my own money. With the schemes being envisioned, government will end up controlling all of health care and my own choice will be unavailable to me, period.

This will make the issue all a political problem and the result will be rationing, lower standard of care, and ridiculous allotment of scarce resources under the Five Year Plan, which will change all the time anyway.

Take a good look at veterinary medicine for what is possible.

[c1ue]

Re: Goodbye to US HealthCare?

Take a good look at veterinary medicine for what is possible.

I think this is a case of apples and oranges.

Last I looked, there is not a medical spend level where the person is just 'put to sleep'.

Secondly animals can't talk - or sue. Animal's kids and grandkids don't cluster by the hospital bed. Animals don't have Medicare.

Thirdly veterinary care is a very very small market compared to the human health care market.

It is like saying private security guards have the same economic dynamic as national defense.

Fourthly you still fail to illustrate why the 'government monopolies' in all of the other nations seem to work just fine.

Your straw man of wasteful governmental health care should be replaced with specific examples vs. Japan, the EU, the UK, Canada, Cuba, etc etc.

Hell even Russia has national health care - that bastion of honest government.

You continue to rail against a federal health care safety net, but ultimately all you really want is (best case) survival by tooth and claw - the poor can die early or (mainstream case) perpetuate the present system. The poor can die early but less so due to government or private charity.

I have yet to see substantive discussion on the different aspects of the health care problem and how to resolve them; the one size fits all of the American libertarian 'free market' solution is a sham and a shame.

[grapejelly]

Re: Goodbye to US HealthCare?

I think this is a case of apples and oranges.

Last I looked, there is not a medical spend level where the person is just 'put to sleep'.

Secondly animals can't talk - or sue. Animal's kids and grandkids don't cluster by the hospital bed. Animals don't have Medicare.

Thirdly veterinary care is a very very small market compared to the human health care market.

It is like saying private security guards have the same economic dynamic as national defense.

None of this is an argument. There isn't any valid rebuttal here. Animals can't talk? That is an intelligent rebuttal?

I said, the standard of care is not as high. But that is a detail, really. Overall, the same procedures are a fraction of the cost that they are with human healthcare.

I am not saying we want to treat humans like animals. i am saying that we should examine this parallel system and see what works and why it works. And the reason it works is that consumers and providers make a free bargain with each other.

Fourthly you still fail to illustrate why the 'government monopolies' in all of the other nations seem to work just fine.

Your straw man of wasteful governmental health care should be replaced with specific examples vs. Japan, the EU, the UK, Canada, Cuba, etc etc.

Hell even Russia has national health care - that bastion of honest government.

So what. They can have their fascist government. I don't want it.

You continue to rail against a federal health care safety net, but ultimately all you really want is (best case) survival by tooth and claw - the poor can die early or (mainstream case) perpetuate the present system. The poor can die early but less so due to government or private charity.

I have yet to see substantive discussion on the different aspects of the health care problem and how to resolve them; the one size fits all of the American libertarian 'free market' solution is a sham and a shame.

All I really want is to be able to contract with providers in a free market.

[c1ue]

Re: Goodbye to US HealthCare?

None of this is an argument. There isn't any valid rebuttal here. Animals can't talk? That is an intelligent rebuttal?

I said, the standard of care is not as high. But that is a detail, really. Overall, the same procedures are a fraction of the cost that they are with human healthcare.

Animals can't talk and equally related - can't vote. This is not a trivial point.

As for standard of care not being as high - if the human standard of care was equal to that of animals, then we wouldn't be having the present problem. Therefore it also is quite a relevant difference.

None of this is an argument. There isn't any valid rebuttal here. Animals can't talk? That is an intelligent rebuttal?

I said, the standard of care is not as high. But that is a detail, really. Overall, the same procedures are a fraction of the cost that they are with human healthcare.

So the United Kingdom is a fascist government? And Canada is a fascist government? Interesting. I guess anywhere but the US or pure anarchy like in many parts of Africa is fascist.

Again, failure to even look at the details vs. sliding down the well worn path of ideology.

All I really want is to be able to contract with providers in a free market.

In case you didn't see what fliped posted in #59 - every single 'fascist' health care system outside of the US has free market providers. In some cases, the majority of the population uses free market providers despite the availability of a government system.

"I knows what I knows, don't bother me with facts"

[Ghent12]

Re: Goodbye to US HealthCare?

So the United Kingdom is a fascist government?

I'm not going to wade into the rest of that post, but I will answer this question. Yes.

Now please join me in recognizing that the FIRE economy is the primary cause of our health care woes, not the lack of universal (lower quality) coverage.

[c1ue]

Re: Goodbye to US HealthCare?

1) Even conceding that universal coverage lowers costs (which you are right in that it demonstrably does), that is not the path we are on. I am more apt to believe Dennis Kucinich on this one. The lowered cost from universal coverage does, however, come with lowered quality* as well as other disadvantages.

* - quality being loosely defined as some combination of speed, access to technology, and access to specialists; all of which are demonstrably lower in most places where the cost barrier is also lower.

2) How does one explain any of the following without positively attributing it to the system as it once was and as it is now, and also how does one explain how any of the following will improve under either the bill passed by the House or under a universal coverage scheme?
a) Medical technology advancement concentration in America.
b) Life expectancy almost on par with those "civilized" countries in spite of America's obesity, gun violence, and other life-adverse characteristics.
c) The extremely rapid speed with which the majority of care is given, limited only in a few cases by the supply of things such as transplant organs.

[/quote]

Please provide some backing for this statement. I don't necessarily disagree with it depending on precisely what the definition of these categories is; for example I'd point out that systemic speed of service is actually not nearly as good as it seems if ER wait times are included. One of the many tricks used is to only count how the 'paying' patients are treated.

Similarly on technology: certainly there is a place for new technology - but rarely does new technology offer across the board benefits.

I'd also point out that medical technology development is a complete misdirection. Medical technology which only benefits the wealthy is nice, but meaningless. Medical technology which cannot be offered to the majority of those in need of it is equally pointless.

In fact it would be very interesting to see the demographic cross section of those who receive transplants in the US vs. other nations. I'd not be overly surprised if income/asset level was a pronounced factor.

3) Why does it cost $1.3T from American citizens to tell insurance companies that they have to accept everyone?

For one thing, health insurance itself is at least part of the problem. If there is 1 health insurance company employee per 2 doctors; if the health insurance industry is averaging 30%+ of overall spending then clearly money is not being effectively utilized.

As for American citizens - I am still amused that somehow paying $1.3T in taxes is bad when these same American citizens pay $275B+ a year to the top 14 health insurance companies (2008) PLUS $506B a year into Medicare (2008 estimated) PLUS additional co-payments and what not.

http://money.cnn.com/magazines/fortu...223/index.html

http://www.kff.org/medicare/upload/7305_03.pdf

The question isn't how much money is going to be spent - it is and will continue to be spent.

The question is what is the value received for it.

I'm not going to wade into the rest of that post, but I will answer this question. Yes.

If the UK is a fascist government - so is the United States.

And if so, I fail to see what the complaint is about. Mussolini/Hitler will do what they will and there's nothing you can do to stop it.

[grapejelly]

Re: Goodbye to US HealthCare?

The US certainly has a fascist government. There is a bit of a free market but it is not what it was and quickly disappearing. Government is 45% of GDP and fast approaching 55% with this health care issue which I am sure will eventually make it into law, probably sooner rather than later.

The veterinary health care system is a complete model of what could be the human system. Costs for humans will be higher because of higher standard of care but otherwise it is pretty analogous. And it shows you that you can get reasonably priced health care, just as you can get reasonably priced computers, where there is a free market.

Making the market even less free is no answer. It simply means a monopoly provider, everything becoming political instead of market based, and higher costs through rationing.

[Ghent12]

Re: Goodbye to US HealthCare?

Please provide some backing for this statement. I don't necessarily disagree with it depending on precisely what the definition of these categories is; for example I'd point out that systemic speed of service is actually not nearly as good as it seems if ER wait times are included. One of the many tricks used is to only count how the 'paying' patients are treated.

I lack the chart-finding capabilities of many of the members of this forum, but my own experience, many anecdotals, and things I have read seem to confirm these observations. For one thing, I cannot confirm or deny that any tricks are used in those statistics.

Similarly on technology: certainly there is a place for new technology - but rarely does new technology offer across the board benefits.

I'd also point out that medical technology development is a complete misdirection. Medical technology which only benefits the wealthy is nice, but meaningless. Medical technology which cannot be offered to the majority of those in need of it is equally pointless.

In fact it would be very interesting to see the demographic cross section of those who receive transplants in the US vs. other nations. I'd not be overly surprised if income/asset level was a pronounced factor.

Your contention is wrong for three reasons.
1) New technology almost invariably starts off expensive and limited in access. These issues are lessened over time.

2) Specialist technology is absolutely required for rare and unique ailments. Who are you to say that a new treatment for a rare form of cancer is "pointless?"

3) Once a technology is developed, its pursuit or integration can be scaled to meet the need for it. X-ray machines are everywhere, but portable 3-D lasers not so much.

For one thing, health insurance itself is at least part of the problem. If there is 1 health insurance company employee per 2 doctors; if the health insurance industry is averaging 30%+ of overall spending then clearly money is not being effectively utilized.

As for American citizens - I am still amused that somehow paying $1.3T in taxes is bad when these same American citizens pay $275B+ a year to the top 14 health insurance companies (2008) PLUS $506B a year into Medicare (2008 estimated) PLUS additional co-payments and what not.

You are amused by it? How can that be? Why should anyone not be upset at paying $275B+ a year to the top 14 health insurance companies PLUS $506B a year into Medicare PLUS additional co-payments PLUS $1.3T setting up a government option?

http://money.cnn.com/magazines/fortu...223/index.html

http://www.kff.org/medicare/upload/7305_03.pdf

The question isn't how much money is going to be spent - it is and will continue to be spent.

The question is what is the value received for it.

You ask one good question indeed. What will be the value received, if and when any of the 45% of doctors go through with their threat to leave their practice when the health care bill passes the Senate?

Also, how come the question of quantity is invalid? This amount is much, much more--the amount being paid now gets reduced some via MediCare cuts, but increased a net amount overall via the bill.

If the UK is a fascist government - so is the United States.

And if so, I fail to see what the complaint is about. Mussolini/Hitler will do what they will and there's nothing you can do to stop it.

Well most of us still have the ability to speak publicly against legislative proposals.

[fallout]

Re: Goodbye to US HealthCare?

The problem with US health care is cost. It costs too much relative to what it costs in other OECD countries and it costs too much relative to income. A cost problem is in essence a price problem. Prices serve as signals. Since healthcare is a marketplace- quite distorted, but a marketplace- the price is telling us that there is a supply-demand imbalance. There is either too much demand, too little supply, or both.

Like good market fundamentalists, let's look at both sides:

Supply

(1) Doctors: the medical mafia has made it very difficult and expensive to become a doctor in the US, all in the name of patient safety, of course. I am not saying that it should be easy, BTW, but compared to other OECD countries, where doctors are more or less a middle class-level occupation, here, in most locations, doctors are not. Part of the supply constraint is the number of years of schooling required (upwards of 10 years post high school; often 15 with fellowships for certain specialties) and another part is the cost of education. Also, the present system places heavy emphasis on better-paying specialized medical subfields, rather than general/family care, where the need is much greater. When software engineers make too much in the US, somehow the H-1B quotas get adjusted and the supply of engineers in increased. Doctors, obviously, are luckier and smarter in restricting entry into their fields.

Does the Pelosi bill address doctor shortage? No. In part, they "promise" to cut reimbursements. Like that's going to happen.

(2) Coverage availability: A huge problem now is the incredibly high cost of individual policies. There are a number of reasons for this, such as negative selection, state-level insurance market regulation, monopoly law exemptions, absolute lack of transparency in pricing and others. There really isn't a functioning market for individual policies, as far as I can judge. We recently changed car insurance policies. It took minutes. While the parallel is far from perfect, there is something to learn there.

Does the Pelosi bill address the dysfunctions of the individual policy market? Only partially, and will create more problems than it solves. At least, they recognize that it is a problem and they are attempting to take steps towards a more transparent marketplace.

(3) Employer-link: I mentioned "unintended consequences" above. A big part of the problem is that most employed get coverage via employers, and this started as an unintended consequence back in the 1940's when the government started limiting compensation to control war-time inflation. This is a very, very perverse aspect of the existing HC system. It forces employers to get in the business of buying healthcare, medicines, flexible spending accounts, dental, fitness programs and other what I would call "non-essential" business activities. In addition, employers pay for a part or all of the insurance, on top of payroll taxes. This makes American businesses waste resources on non-business activities, and makes hiring in the US expensive.

Does the Pelosi bill try to move away from employer mandates? No, it makes them worse by taxing businesses that do not offer it. I am going to make the prediction that within 3-5 years employers will be choosing to pay the 8% payroll tax penalty and not bother with the whole thing. If an employer can fire 60% of their benefits department, save on insurance costs and get away with an 8% payroll tax, I think the decision will be a no-brainer. Either that, or a wholesale move to hiring "contractors" or "temps" in lieu of "employees": why even bother with payroll taxes at all? Or some other "who could have known" side effect.

I should also point out that the worst side effect of the employer-linked coverage is that it makes it difficult for start-ups to attract people. We all lose in aggregate when this happens but too few people care about what "might" have been. If Sergey Brin needed kidney dialysis, do you think he could have dedicated all his time to starting Google?

Demand

(1) Users of free HC goods and services: "poor", illegals, elderly
Most of our representatives are both innumerate and economically illiterate. Some even have troubles filing tax returns. They fail to understand that the demand for free goods is near unlimited.

As a result, here in the city hospitals, you have a huge population that pays nothing for their hospital stays, and as a result, they treat it like a full-service hotel: non-stop demands, frequent visits, you name it. Homeless people simulating sickness to stay in for a couple of days, eat and take a shower. Nursing homes refusing to pick up patients if they have another test in two days. Families collecting the social security check from grandma refusing to let her die. Caribbean tourists visiting family trying to get in for a kidney transplant. Illegal aliens giving birth to their "anchor" babies. Drug addicts faking illness to get morphine and a good night's sleep. "Poor" trying to get themselves checked in so that they get 2 week supply of meds without a copay. These are all actual cases. ALL PAID FOR BY THE TAXPAYERS/FUTURE TAXPAYERS AT $5,000/DAY.

Does the Pelosi bill address these huge generators of losses for the system? Absolutely not. Even the simplest thing, such as mandatory minimum copays, are not in. Never mind some other solutions, like, gasp, rationing. The bill even bans illegals from buying insurance, even if they want to, thus guaranteeing that the taxpayers get the tab.

(2) Heavy users of HC goods and services: the obese, the smokers, the drug users, people with genetic conditions

Another way to reduce demand would be to discourage behaviors that are likely to result in increased health care demand. The way I would approach it, the government will not pay for anyone's care if they are obese (based on BMI or body fat %), smokers or drug users. And, on top, the system should assume that one does not qualify, unless proven otherwise, with annual eligibility checks.

Does the Pelosi bill do anything to reduce future demand by discriminating against the obese, the smokers and the drug users? No.

One exception to this group are people born unlucky with genetic disorders. I would have no problem with a portion of my healthcare dollar going to those truly, genetically unlucky people. However, smoking, obesity and drug use are a matter of choice by and large (with the exception of metabolic disorders affecting obesity), and have to be actively discouraged, something the bill does not do at all.

(3) Federal programs matching state spending
Another large factor in the "demand" side of the equation is that for many of the state-level run programs, the Federal government provides matching funding. Obviously, this creates huge incentives for states to maximize spending on everything, and, as a result, costs skyrocket.

Does the Pelosi bill change these incentives to reduce demand? No.

Again, unlike most HC problems, the solution here is relatively simple. Move away from matching, and go to zero-based budgeting: every year the budget resets at 0, and every dollar has to be rejustified.

(4) Tort reform
Talk to any doctor, particularly anyone doing invasive procedures of any kind, and you are likely to hear horror stories about malpractice lawsuits. The lottery-ticket tort system (the cesspool home of slime like John Edwards, and a major donor to the DNC and the President) encourages frivolous lawsuits and outsized jury awards. Since most jury verdicts are unpredictable, doctors and their insurance companies often choose to settle, thus feeding the scum.
The current system has two perverse consequences, one is an increase in insurance costs (which can run tens of thousands of dollars or more per year). The second, and much more costly but difficult to quantify, is that doctors overorder medical tests for unlikely conditions both in in-patient and out-patient setting, and have patients overstay in hospitals while waiting for all of those to come through. This is a huge money drain in the entire system.

Does the Pelosi bill address tort reform as means to reduce demand? No.

The solution is relatively simple: limit the maximum award in any malpractice suit to $50-100k, and refer all alleged cases to the State medical boards for review. As a result, in a true malpractice case (which is something a jury in my view absolutely cannot decide as most Americans in my view lack basic science skills), the doctor would lose his license.

(5) Prescription drugs
There are a few problems here. On one side, drugs are incredibly expensive to develop, and the people who develop them must earn a proper risk-adjusted return on capital for doing so.
Then there is the other side. The US taxpayer and paying HC consumers have been paying for the development of drugs that the rest of the world gets at much lower prices. This is not a system that can last for too long as the free riders have to be cut off. Second, the US is the only OECD country, to my knowledge, that allows direct-to-consumer (DTC) drug ads. This generates demand for certain brands even when generics are available. "Ask your doctor if the purple pill is right for you" has a cost and it is coming out of your pocket.

Does the Pelosi bill address the problems with prescription drug costs? No.

There are a few things that can be done: ban consumer advertising, ensure flat or reasonable pricing across regions, and so on. Obviously, it would take too much thinking on Congress's side.

(6) Demographics
There isn't anything the bill can do per se, but it would have been the perfect occasion to start with future cost reductions via various mechanisms as it is clear that the problems we have now are only going to get worse in the future. To paraphrase a famous management thinker, demographics is the future that has already happened. And it is not pretty, in my view. Ideally, this would be a wider national discussion on aging, and how what was promised simply will not be there. There will be substantial reductions in benefits in the future, whether you like it or not, and these reductions will be in healthcare, pensions and social security, again whether you like it or not.

Does the Pelosi bill address the coming demographic upheavals in the healthcare system? No.

(7) Fraud
Finally, it is not a secret that there are substantial fraud operations going on with the various programs. Every major bust there is simply staggering in scope, but what is also staggering are the incentives for people not to work and to hide assets to qualify for the "free" programs, a small-time "beat the system" operators.

Does the Pelosi bill address fraud at the large and individual levels? No.

This is my market-based look on the bill. I am sure there are a lot more aspects of it, but I have given up thinking any more about it as there is no way I can change anything. I rate this bill at FAIL as it fails to address the underlying problems with the current system. It simply raises taxes while doing nothing for a "true" reform even though the bill is marketed to the clueless populace as "reform." It is not.

Mind you, the bill is completely unconstitutional as it mandates purchases of services from private parties, regardless of want. There is plenty written about the tax increases it will bring about, going to jail if you do not have insurance (what sort of a Orwellian country is this becoming?) and so on. In aggregate, Congress took upon to reform the status quo, and made a bad situation into a complete disaster.

The unintended consequences of this monstrosity will surely surprise everyone. Here are a few suggestions. Remember that black swans are black swans for a reason. My view as clear as anyone's on what will happen. I am only sure it will be something that will "surprise" the consensus.

(1) Disappearance of employer-based insurance as employers accept the "fine" as a cost of doing business
(2) Republican majority in Congress in 2010 based on the healthcare reform-crappy economy combo
(3) Controversial aspects of the bill get voted down in the next 2-4 years
(4) Since the bill does nothing to address supply and demand, HC costs continue to outpace general inflation, much to the politicians' surprise
(5) Attempts at cost-fixing in healthcare lead to rationing
(6) Rationing leads to a two-class health care system: one for the "rich" and one for the "masses". The "rich" pay cash to providers who do not want to deal with insurance companies or the government.
(7) The cash-only providers are banned because it is not egalitarian. End result: Royal Caribbean retrofits a few cruise ships into healthcare centers/hospitals, parks them in international waters near the big coastal cities and operates heli/ferry services lifting cash customers for treatment.
(8) Proliferation of self-medication and outsourcing of medical services
(9) The whole B/S reduces the supply of doctors, dropping the physician to population ratios to near third-world levels within 30 years
(10) Canada and Indian reservations become medical tourism hotspots for regulatory arbitrage purposes
(11) Introduction of end-of-life care vouchers to control costs. Since most costs are incurred in the last 3 months of a patient's life, when faced with a serious condition, a patient can choose to use "the" voucher. If the patient survives, she no longer has a voucher the next time around. Black market develops for identities and vouchers.
(12) No one goes to jail for failing to purchase insurance, despite what the bill says
(13) The bill thrown out as unconstitutional within four years, starting with a state judge decision in "flyover land" where there is still some common sense and respect for the constitution left
(14) New pharmaceuticals nearly disappear as producers cannot afford R&D; most pharmaceutical production moves abroad
(15) Major national politician runs on a platform consisting entirely of rounding up the illegal aliens and shipping "them" South in box cars
(16) NYT- if not bankrupt by then- runs stories of young people who died while waiting for treatment while some "old, rich" white guy got it quickly
(17) Legalization of a market for organ and tissue donors for cash payers; everyone else dies while waiting for a transplant (this already exists in some niches, like eggs, embryos and gestational carriers)
(18) Patients are asked to pay for linens, food and medicine out of pocket during hospital stays (not a rare practice in many places around the world)
(19) ER doctors demand cash pay to see patients (again, not rare in many places)
(20) Increased rates in hospital-caused deaths as cost-cuts endanger basic safety.

[c1ue]

Re: Goodbye to US HealthCare?

Your contention is wrong for three reasons.
1) New technology almost invariably starts off expensive and limited in access. These issues are lessened over time.

2) Specialist technology is absolutely required for rare and unique ailments. Who are you to say that a new treatment for a rare form of cancer is "pointless?"

3) Once a technology is developed, its pursuit or integration can be scaled to meet the need for it. X-ray machines are everywhere, but portable 3-D lasers not so much.

Really? So you're saying heart transplants will be cheap in the future?

What about cancer treatments, are they getting cheaper?

How much cheaper are anti-AIDS treatments getting?

What about any in-hospital procedure period, are these getting cheaper?

The real world doesn't seem to be conforming to your idealistic vision.

X-ray machines are 100 years old; Roentgen first stumbled on it and the first X-ray device was in 1903. It has taken nearly 100 years for X-rays to become ubiquitous.

For that matter, CAT scans were invented in 1975. Does this mean they'll become cheap in 2075?

How about some examples from the past 3 decades?

You are amused by it? How can that be? Why should anyone not be upset at paying $275B+ a year to the top 14 health insurance companies PLUS $506B a year into Medicare PLUS additional co-payments PLUS $1.3T setting up a government option?

I'm amused because you seem to think that the $1.3T is on top of the existing payments. The reality is that it will not be; if this were not so then the health care industry wouldn't be spending $1M/day to fight it.

The entire point which you still don't seem to understand is that health care spending is something which everyone at every age spends.

The point of a national health care system is that you at least get a minimum level of health care. If you choose to spend more for a higher level of care - that option is perfectly open to you.

Every other nation anywhere near the US' level of prosperity has this choice. And these nations all spend far less per capita and as a percentage of per capital income than the US by a huge margin.

The assertion that health care in the US is better is not borne out by any demographic data whatsoever.

Is it better for those with tons of money? Yes.

But in general health care ANYWHERE is better for those with tons of money.

The point is that the results achieved in the US - mediocre at best - do not justify the spending level. The existing system is not working and will continue to not work.

To complain that there is an additional tax is stupid.

The choice is ultimately between perpetuating a broken system where costs are growing 3x or more faster than income and putting in an alternate system which has proven to be able to both provide both a minimum acceptable level of care as well as drive overall systemic costs down.

The reality is that medical costs even outside the socialized sphere in other nations are also lower.

Arguments about technology, about doctors, etc etc are also similarly stupid.

New technology that is useful makes money ANYWHERE and under ANY system.

Doctors who presently migrate to the US to make more money equally can migrate to other nations or not; I very much doubt that most of them will switch to being bankers or ditch diggers assuming these individuals truly are motivated to professionally practice as opposed to become wealthy. If on the other hand they're just reaping profits - it is debatable how beneficial having such practitioners are to begin with.

[MulaMan]

Re: Goodbye to US HealthCare?

To say that the American system doesn't work well because it isn't completely a free market is a copout.

The loop works as follows: The present system doesn't work - it isn't fully free. A fully free system isn't possible because it is corrupt.

Wrong!

The argument is most people actually BELIEVE our current system is a free-market and so a public option must be worse - socialist.

In order to break the cartel the government MUST take control of health insurance and create / force some free-market competition THROUGH a public option.

It is impossible to get from Today to a Free-Market health care WITHOUT going through the goverment (the people) - massive re-regulation.

Same with financial services and banking.

A Free-Market DOES NOT mean a 100% un-regulated market, a free-market is regulated by definition. Nature does NOT organically create free-markets.