health care in France

[c1ue]

Re: health care in France

All healthcare is rationed because it is scarce in quantity.

This is true of certain specific areas like transplants, but frankly is completely untrue for everything else.

General Practice Physicians in the United States spend only 15 to 30 minutes with clients not because they want to, but because the overall system - including cost of living, health insurance payments, etc etc all militate this routine in order to earn their 'prescribed' wage. While there are specific effects, IMO they all can ultimately be traced to the health care/health insurance bureaucracy, leavened with FIRE.

I've put up numerous real life and first hand examples of the differences between health care in the US and in other nations; in no case have I seen the 'rationing' you speak of.

And note this includes a specific example in Australia where, as a foreigner, my doctor specifically had to check - by law - that there were no 'natives' being held out by my intervention.

Sure, I had to wait in the Australian hospital some time, but then again I wasn't an emergency case.

Yet for very similar full operations in Australia vs. the US, the US cost was literally 7x more expensive.

In both cases I had the best doctor around, but the US doctor got $1200 whereas the Australian doctor got AU$2999 = $2760 (3.33% of total cost in US vs. 60% of total cost in Australia)

I stayed a full night in the hospital including 2 meals in Australia; the US was 5 hours entry to boot out the door.

Lest you think the only reason the difference exists was due to state health care building/maintaining the hospital - the initial diagnosis itself showed radical differences.

In both the US doctor's office and the Australian doctor's office, I had my eye checked using a laser. The procedures were identical in both places, and both places were private.

Yet in Australia the laser scan plus initial diagnosis/consultation was a total of AU$249. The laser scan in the US was $859 by itself. In Australia, they scanned both eyes - not like anything is really used up. In the US, one eye only.

These differences can be repeated in pretty much any 1st or 2nd world nation vs. the US: France, Germany, Russia, China, Japan, etc etc.

The problems have nothing to do with ideology - they have everything to do with monopoly and bureaucracy.

[Thailandnotes]

Re: health care in France

one thing you cannot really claim is that the U.S. has a "bad" system from the perspective of actually providing care so long as you aren't priced out of what you need.

root canals, crown construction, tetanus shots, rabies shots, skin cancer treatment...the list goes on and on.

and on.

I cannot tell you how many Americans (including myself and my wife) who have been blown away by advanced treatment techniques that were experienced first hand in Thailand, but were not available in the US. Digital medical records were standard at many Thai hospitals long ago.

Whenever I see a comment suggesting the US is providing equal care, but that's it's just more expensive, I feel a duty to respond. Not only are many procedures cheaper in other countries, they are often way ahead of what you would expect in the states.

[Ghent12]

Re: health care in France

c1ue, I am having trouble understanding your contentions because you are arguing against the fundamentals of economics. Everything is scarce and therefore everything is rationed in some way. The typical or "natural" way is through the price system, but social, political, economic and other pressures can cause rationing to occur from other forms. Every single time someone wants medical treatment for anything, but does not receive it when they want it, that is an example of some rationing system in effect. Whether it be by time, decree, or price or even some other mechanism is immaterial. Health care is not infinitely available and will never be unless and until we discover some impossible Utopia. Arguing against the very definition of what is "rationing" or what is not "rationing" is fruitless and removes yourself from the constructive conversation, just as arguing against the truism that "health care itself is scarce" implies you are arguing against the very foundation of economics.

This discussion has nothing to do with the marginal cost of scanning your other eye, but with the overall forces at work here. We both seem to be in agreement as to where the problem lies; now we just need to figure out what path to follow. I, for one, see simply too many reasons to choose the consumer of health care as the principle power holder in the market arrangement to be in favor of the current system or the transitioning system (Obamacare).



Thailandnotes, I do understand that many places outside the U.S. offer better care generally both in aggregate and in specific instances. However, I still wouldn't place much weight into any contention that the fundamental treatment within the U.S. is somehow "bad" or even inadequate to those priced within the system, with few fields of practice as exceptions.

[c1ue]

Re: health care in France

I am having trouble understanding your contentions because you are arguing against the fundamentals of economics. Everything is scarce and therefore everything is rationed in some way.

Where you are going wrong is in equating a limited resource (true) with insufficient supply (untrue).

If indeed there were so few doctors, and so little equipment, and a teensy amount of available medication, then you could correctly state that scarcity exists.

There is no such thing in the United States.

Under your rationale, the Internet is scarce, because it is limited. The sun is scarce, because it is limited. For that matter, Gaia is scarce because it is only one planet.

All of these above statements are true in some academic sense, but are untrue in the real world sense.

The purpose of my first hand examples - which clearly many other iTulipers can also attest to - is that the cost of health care be it insurance or health care provision has nothing whatsoever to do with scarcity in the vast majority of the US health care 'system'.

It has nothing to do with the equipment cost. It has nothing to do with how much doctors get paid (or not paid). It has nothing to do with quality of care.

Every single time someone wants medical treatment for anything, but does not receive it when they want it, that is an example of some rationing system in effect.

Again, you conflate a specific situation without taking into account the rest of the problem.

Were said health care available at prices which exist in every other 1st and 2nd world nation - the vast majority of health care would then be available and not scarce.

The only scarcity which exists in the US is one of affordability.

Thus your tunnel vision on scarcity is focused on the wrong aspect: it is not supply or demand, it is cost.

Cost is not purely a function of supply and demand in the real world.

This discussion has nothing to do with the marginal cost of scanning your other eye, but with the overall forces at work here.

This discussion has everything to do with my example.

My example shows 2 identical situations: 2 private practices in different 1st world nations, performing the same diagnostic procedure with mostly the same equipment (the equipment in the cheaper example being newer), in different countries, with vastly different cost structures the differences being far and above the standard of living differences (which are relatively quite small).

In neither example is scarcity, quality, or whatever else you can name an issue.

It is all about cost.

As to the why: so long as you fixate upon scarcity of supply justifying cost without being able to demonstrate said scarcity actually exists - as opposed to scarcity being created by affordability - you cannot focus on a realistic solution.

Having more doctors won't fix the problem, for example.

The bureaucratic and rent-seeking components of the US health care system today would cause even the theoretical infinite health care provision capability to still be ridiculously expensive.

[aaron]

Re: health care in France

When you pay 1000 dollars for the procedure, in a way you are subsidizing the 250 dollar bill in Australia. It goes the same across the world. The drugs are invented here, marketed and tested here, and then sold at a discount to other countries. The equipment as well.

The advantage? The rich in the U.S. always have access to the very best medical care. Other than that, it is not a good deal for the rest of us. But, we know who owns the government.

FIRE baby! You gotta love it!

[Thailandnotes]

Re: health care in France

Myths of Pharma R&D

"Industry executives, well supplied with facts and figures by the industry’s global press
network, awe audiences with staggering figures for the cost of a single trial, like tribal
chieftains and their scribes who recount the mythic costs of a great victory in a remote pass
where no outside witnesses saw the battle. Companies tightly control access to verifiable
facts about their risks and costs, allowing access only to supported economists at consulting
firms and universities, who develop methods for showing how large costs and risks are; and
then the public, politicians and journalists often take them at face value, accepting them as
fact. The global press network never tells audiences about the detailed reconstruction of
R&D costs for RotaTeq and Rotarix that found costs and risks were remarkably low up to
the large final trials, and that concluded the companies recovered their investments within
the first 18 months (Light et al, 2009). The companies could now sell these vaccines for
rotavirus for one-tenth their Western price and still earn profits."

http://www.pharmamyths.net/files/Bio...arch_Costs.pdf

[Munger]

Re: health care in France

This is the whole point of the economic research into health care in the past 50 years (which you purport to be familiar with yet obviously are not).

People don't "bargain shop" for a healthcare while they are having a heart attack. They don't compare and contrast hospital charges and quality when they have an aneurysm. Moreover, when people can't afford insurance and they sustain a traumatic injury, they tend to go get healthcare anyway and worry about the cost later. We, as a society, have decided that we are going to take care of an ailing patient and figure out the payments later. The costs will be shifted.

The free market does not work in healthcare. It never will. It's not a "normal good." I'm sorry.

The free market is fantastic when it works. In fields where large information asymmetry exists, it's not so great.

Libertarianism is great in theory. Of course, in theory, theory and practice are the same. In practice, they are not.

[flintlock]

Re: health care in France

This is the whole point of the economic research into health care in the past 50 years (which you purport to be familiar with yet obviously are not).

People don't "bargain shop" for a healthcare while they are having a heart attack. They don't compare and contrast hospital charges and quality when they have an aneurysm. Moreover, when people can't afford insurance and they sustain a traumatic injury, they tend to go get healthcare anyway and worry about the cost later. We, as a society, have decided that we are going to take care of an ailing patient and figure out the payments later. The costs will be shifted.

The free market does not work in healthcare. It never will. It's not a "normal good." I'm sorry.

The free market is fantastic when it works. In fields where large information asymmetry exists, it's not so great.

Libertarianism is great in theory. Of course, in theory, theory and practice are the same. In practice, they are not.

I agree. Free market is great for many things, but for healthcare it simply doesn't hold up well at every level. In terms of research of course, there has to be a carrot and stick. The absurd rate of increase in health care costs in the US is proof to me that something isn't working. It will become completely out of reach for most very soon. The current approach seems to be, " well, if it will just last until I die then I don't give a damn". Sustainability is not even considered. No way my generation will get the level of care today's retired are getting. No way. You can argue the reasons all day long but the fact remains that it has become too expensive. Too many are invested in the current system to ever let go of it and become open to other ideas.

[drumminj]

Re: health care in France

People don't "bargain shop" for a healthcare while they are having a heart attack. They don't compare and contrast hospital charges and quality when they have an aneurysm.

Your statement is correct. However, they would/should/could bargain shop for insurance if there were a true free market there. Sadly, employer-provided healthcare is favored by the government.

Do people shop around for auto insurance? Absolutely. Do they shop around for health insurance? Quite often, if their employer doesn't offer a policy. And even with insurance, folks still shop around for price on certain things (that insurance won't cover, or won't cover 100%).

I agree with you that for an immediate need, folks won't/can't shop around. That's true of anything - repairing a punctured tire or health care. However, the further removed the individual is from the actual cost, the less incentivized they are to actually care about the cost or look for a better price...

[c1ue]

Re: health care in France

However, they would/should/could bargain shop for insurance if there were a true free market there.

Have you ever tried to bargain shop for anything remotely covered by health insurance? It is literally almost impossible to get a quote on what something will cost.

When I got my operation in the US, the doctor literally had no idea. His estimate was more than 200% too low.

The hospital financial planner I spoke to right before the operation (read: the money collector) also did not know. Her estimate provided to me was 40% too low.

My friends who have asked around, have literally had to make a half dozen calls and threats before a number is produced.

All of this goes beyond simple "not my job" division into outright obfuscation.

[Thailandnotes]

Re: health care in France

My wife fainted in LAX five years ago. Was required by airport authorities to go to a local emergency room. Two years later, I was getting notices from collection agencies demanding 1,000 dollars. "I have a ten percent co-pay for emergency transportation," I explained. "1,000 dollars is ten percent," they responded. The 2.5 miles, no treatment in ambulance had "cost" 10,000 dollars.

I agree with Clue. Shopping for "health insurance" is absurd. I've just done it. You might as well be reading the fine print on a medicine bottle and trying to understand the user agreement on a sofware download. The only way to shop is to interview a bunch of people who have that insurance and listen to their experiences.

[drumminj]

Re: health care in France

Have you ever tried to bargain shop for anything remotely covered by health insurance? It is literally almost impossible to get a quote on what something will cost.

Yes, I have. Sometimes it's really difficult - I agree with you. I've found some providers (urgent care facilities) that have been good about knowing the costs up front, and for giving discounts for paying cash/at time of service. While in between jobs at times I had to seek out treatment and didn't pay for COBRA (though implicitly covered if I wished to be). I paid cash and new the costs up front. But this was for minor treatments.

I've also had the opposite experience where I've tried to get an up-front cost for a simple blood test, and could not get an answer. "Whatever the lab charges" was the best I could get. Pretty sad.

Given that, how about regulation/legislation that requires providers to be able to answer that question prior to service. Then let people/the market decide. MUCH simpler solution that government-provided health care.

[c1ue]

Re: health care in France

Given that, how about regulation/legislation that requires providers to be able to answer that question prior to service. Then let people/the market decide. MUCH simpler solution that government-provided health care.

Such a regulation is one way.

Another way might be for a hopefully independent government agency to publish cost estimates of most common procedures/medications based on government health care spending (i.e. what the federal employees + federal health insurance programs pay). This pool is large enough and effectively independent from the existing private health insurance system that said information is probably useful.

A development partner of mine has put together an app for one of the medical services companies; the app tells users (company only, unfortunately) what the cost of a given medication is at any given pharmacy based on the company's own internal records.

[Thailandnotes]

Re: health care in France

Have you ever tried to bargain shop for anything remotely covered by health insurance? It is literally almost impossible to get a quote on what something will cost.

In better Thai hospitals where most middle class Thais and almost all foreigners go, there are three things that strike you...

1.) Procedures are often on sale. Banners, posters, and email notices tell you that such and such hospital now has a deal on dental xrays and teeth cleaning or cataract surgery or complete physicals. It's not limited to the mundane. I knew a runner who flew from India when back surgery went on sale. Thailand is openly promoting medical tourism. (Not sure how I feel about it or what it will do to costs for the average citizen, but bargaining/shopping are clearly keeping prices competitive for now.)

2.) Doctors, pharmacies, lab-work, and insurance reps are all under the same roof. Combine that with digital medical records and high speed internet, and you get efficiency that can make you weep.

3.) Because things are working well, general morale (of workers and patients) is very high.

[aaron]

Re: health care in France

It is not just that... It is also the FDA. And the university research. And the test populations... The whole apparatus.

I figured it went without saying, but yes FIRE's cut is large... It does not matter how it all works. FIRE will be paid. It just so happens that Americans are footing the bill for the rest of the world for both FIRE's cut and the original research.