Still, there are a lot of simple cost-reducing measures we haven’t taken yet. One of the easiest ways to improve both the cost and quality of our health care would be to ban marketing for prescription drugs. Marketing is a huge cost to drug companies, which of course gets passed along to you in the form of higher prices. Drug companies spend nearly $30 billion each year on marketing.
Not only does marketing increase costs, it’s a major public health problem. Drug marketing encourages self-diagnosis and doctor-shopping; I think we’ve all heard stories about patients who visit doctor after doctor trying to get a prescription for a certain medicine they saw on TV. Simply put, we shouldn’t be asking our doctor if a medicine is “right for us,” we should be talking to our doctor about our symptoms and letting the doctor prescribe the appropriate medicine.
I know conservatives are going to complain that this approach will “destroy the free market,” as always. They’ll argue that it will remove the incentive for drug companies to create effective new medicines. I disagree — in fact, I think it will improve drug research. After all, drug companies won’t be able to increase sales through flashy marketing; they’ll have to actually focus on creating the best medicines possible to ensure that they are prescribed.
I’m with you on the drug advertising ban. I’m no fan of bans but marketing a cure without a diagnosis seems a little shady to me and you’re right that it would end up saving people money as well as allowing their doctor to pick the right med for them.
Hats off, for a good common sense suggestion.
I agree with the idea of prohibiting medicinal advertising. Free speech doesn’t happen to include the TV airwaves - it’s a public trust and therefore can be regulated without Free speech concerns. Of course, prior to 1994?? Medicinal advertising WAS banned - and we still had pretty steep inflation, so I’m not convinced it will be a magic bullet. You didn’t say it would, but if we don’t use a national plan to negotiate drug costs down, this is the next best option and without a national plan we’ll need 100 small cuts, rather than one big change.
Yeah, it wouldn’t be a magic bullet but would help. But more money is spent in visits to Dr’s offices by “advertising professionals” (read: big boob beauties with lots of free gifts for the Dr, staff, and sometimes even the kids waiting in the patient lounge).
Oh, free market theory pretty much itself excludes advertising, once you throw that in, “let the market work” means nothing.
If you ban marketing, how would the doctor know about the drug? No marketing = no sales. But I assume you really meant to say that you want to ban TV advertising.
That’s what peer-reviewed medical and scientific journals are for. And we also need to have better conflict of interest policies at universities where those scientific studies occur.
Doctors are generally a pretty bright lot. Marketing is not necessary to drive doctors to treat their patients appropriately.
Does anyone even know what they are advertising, in those gentle blue & purple pills?
Do I order them by color?:
* Blue Monday?
* Black Friday?
How much cheaper would those drugs be without the advertising?
Ha. Exactly Mockingbird. I think we’re talking about advertising prescription medicine to people that may not need it. Marketing to doctors is something completely different (though the potential for payola there is great too).
It may not have a big impact on costs but it would at least stop giving people the mindset that they should run to the doctor every week a new ad comes out. It’s also a bit incongruous to want to ban tylenol (an otc that does relieve pain and doesn’t require a doctor’s visit) yet allow advertising for prescription meds that do. I would argue that we should have more non doctor required remedies available than less since the doctor and his behind the counter drugs are where the costs come in.
I’ll give you all an example (though it seems I’ll be preaching to the choir) but please excuse the spelling. My doctor prescribes me $140 a bottle omeprezol for heartburn/acid reflux. That’s $140 dollars that WITH my insurance. What did I only later find out? The same damn thing is available without a prescription for pennies on the dollar. Why did I have to pay $120 dollars (and half a day in a lobby) to spend 5 minutes with a guy to write me a scrip for $140 dollars (a month) worth of stuff that a pharmacist could have told me was in aisle 3 for $19 bucks for free?
I know not to go back to the doctor again for heartburn but how much more did I spend and how much more am I spending in premiums because we don’t know this stuff. The system is just set up like that now - rigged to protect and grow its own importance in our lives and if we can peel some of that craziness back by making them stop pitching solutions to people that don’t have the problem I’m all for it. Every purple pill, e.d., depression, immunization ad that runs on tv is as much to sell you a those drugs as it is to get you in to see a doctor. That wouldn’t be so bad if you and I didn’t pay for other people’s visits through premiums or taxes but we do, so why allow, encourage or protect the practice when it’s so obviously detrimental.
Again. Great commonsense, practical idea Jeff.
When the focus is on outcomes and not marketing then costs will decrease because effectiveness and cost are unrelated and Doctors, like the rest of us, are largely unaware of the outcomes of treatment with different drugs in the same class. That type of head to head research is rarely done because it is not funded by the drug companies who won’t finance their own demise. Funding for that type of research needs to be public and a public payor will support it. That is one of the primary reasons why a public payor system is necessary.
The market that should be free in pharmacology is the market of science where the winners are the most effective. Doctors understand science and will make the right choices for their patients based on science when the science is available. It isn’t now. Cost effectiveness will drive the sales of pharmaceuticals down when a payor that cares about cost effectiveness is negotiating prices with the pharmaceutical companies. At this time, insurance companies are self interested and cost effectiveness is not a primary concern of theirs. They are motivated by achieving the greatest amount of cash flow through them because money handling is the source of their income, not health care.
The 30 billion that the drug companies spend on marketing annually is equal to the entire budget of the National Institute of Health research budget. These figures provide compelling evidence that the marketing of medicine is more profitable than the science of medicine. We don’t pay for premium medical care, we pay a premium cost for profitable medical care that is of uncertain quality.
Health care shouldn’t be a “for profit” enterprise. Making money off of people’s misfortune and mis-behavior leads to dis-incentivicing healthy lifestyles. Insurance companies don’t make money from providing funds to pay for health care, just the opposite. They make money by “promising” to pay for health care then, doing everything in their power to not fulfill that promise. The first and most necessary step to making our health care system affordable and universal is to remove the Insurance industry from the equation.
Where are the patients in all of this? They are the ones who have the single biggest ability to reduce healthcare costs. Ensuring that I don’t start smoking is up to me, not my insurance company. Maintaining a healthy weight is my responsibility, not the government’s.
We don’t have a system that rewards patients financially for healthy choices. The bogeyman isn’t the health insurer, and its not even the government. The person who needs to be incented to change is the patient.
With that said, I fully realize that every day people get a disease or are in an accident that had nothing to do with their choices. When major, that is exactly what insurance (private or otherwise) is for.
As for drug marketing, I won’t defend it. Ban it, fine. It seems a bit like the ads for cereal my kids watch on Saturday mornings during cartoon time. They can’t buy the product, but they can sure influence someone else to. If that would help solve some problem, do it.
Spurious argument is spurious.
^^No argument at all. None.
Where are the patients in all of this? They are the ones who have the single biggest ability to reduce healthcare costs. Ensuring that I don’t start smoking is up to me, not my insurance company. Maintaining a healthy weight is my responsibility, not the government’s.
That’s absolutely true, Captain Obvious but, what happens when a smoker gets lung cancer? What happens when a fellow who’s a bit on the chubby side, suffers a coronary? I know you’re not advocating turning them away so what are you really saying here? Possibly, you’re saying insurers should be able to refuse policies to people who smoke or to people who are 20% overweight. Or maybe, to people who live in a dodgy neighborhood, or to people who are genetically predisposed to heart disease. All of that would reduce costs to insurers, thereby reducing our costs. But there is a problem in all that. Insurers love to cover healthy people but the minute one has a problem then insurers toss that person to the curb as quickly as possible. They are not in the business of covering sick people. They make their money by not paying for health care. They make their money, and that
is what they are in business for, to make money, by paying out a little as they can get away with.
All I’m saying is that whenever I see those on the left post about health reform, it always comes down to who pays for CARE. Care is only part of the equation. What about health?
Patients hold the key to transforming our healthcare system, not Max Baucus or Barack Obama or United Healthgroup. Hell, when it comes to the role payers play in our healthcare system, I group United and Aetna in the same camp as Medicare. They are all part of that problem. I’m not hearing a choir and seeing a halo when I envision government payers. They are all payers and they are all enabling higher costs.
It will be great to get everyone covered. But it is equally or more important to have people eat fewer Big Macs and take a walk once in a while. It is great if people who get the new insurance start going to see their doctor, but if the patient doesn’t attempt to follow-through on doctor’s orders and improve their health, we won’t save.
The only way to instill this kind of personal responsibility for health needs is by adding more of a consumer driven element to healthcare. It doesn’t need to be the banket solution, but to not have it as a portion of the solution is flawed.
DTM,
It is true that people make choices about personal behavior that impact their need for health care and their longevity. The effects that this may have on increasing or reducing the overall cost of health care though are complex. Some choices don’t effect longevity as much as they effect morbidity and may increase cost. Others reduce longevity and increase mortality and may decrease costs. This is a separate issue from how we fund health care.
Public law and policy and private regulation already address these issues. There are “sin taxes” that help to reduce things like smoking or drinking; seat belt and passenger restraint laws that help to reduce accident mortality and morbidity; and life insurance regulations that consider risk factors like body mass index, smoking and other risky behaviors in their pricing equations. There are publicly and privately funded education campaigns that address these issues as well. This is all good. Would you would really want a payor system in health care, public or private, that dictates personal choice to the degree that you seem to be suggesting?
The market system works in government just like it works in the private sector. I view my taxes as an investment in systems that provide the services that I need. Health care, infrastructure, law enforcement, education, public transportation, national defense, civil management, and regulation of the private sector in the public interest. I willingly pay my taxes to support these services. I make investments in the private sector to get what I want; financial security, a home, private transportation and personal possessions that I feel add value to my life. I don’t want the government taking over these segments of the economy.
I don’t support the public payment of health care because I hate private enterprise. I respect private enterprise for what it can do if the incentives are appropriate. I support it because I believe it is the system that will be most focused on value. Profit in the payment system does not bring value to health care. It is greed driven, not need driven. The competition that will bring value to health care is need driven medicine that is based on science and not on marketing.
If I may,
The point I believe Dan is making (or at least the one that I’d like to make) is that people make decisions in there life and in virtually every other aspect of their lives their costs are based on those decisions. You cited life insurance and sin taxes but consider auto insurance.
With auto insurance, a guy with 4 speeding tickets, 3 wrecks and a DUI can still buy insurance and as soon as he totals his next car the insurance company will replace it for him but he is going to have higher premiums and likely a higher deductibles. His neighbor with 10 years of clean driving history is going to be given a greater choice in premium and deductible options because she isn’t viewed as great of a risk as dui guy is.
People aren’t cars and they don’t have a choice in having life the way they can choose to own a car but explain to me why the same market principals that work in keeping the insurance rates for cars down wouldn’t work in healthcare? If everyone must buy it, then there will be more money in the system and premiums would remain low. If what everyone pay is based upon their lifestyle choices than the cost of those choice will become more known to the consumer.
Sure people that are over weight, smoke and shoot heroin would need to pay higher premiums than the people that don’t but as you mentioned this is already the case with sin taxes and life insurance except now instead of insuring against the costs of people’s death or “offsetting the cost” of what the state pays in healthcare it would have a direct effect on people’s lifestyle choices. If health is what we’re concerned about and freedom and choice are what we need to protect, why would this type of system be bad?
I have good insurance. It doesn’t cover everything, but what it covers, it covers well.
When I have a procedure or service that I know will be fully covered, I automatically go to my doctor or the doctor of my choice, have it done, and don’t worry about it. The only time I’ll ever really know what it cost is when I see the EOB showing that I owe $10. Even then, it is more of an FYI than anything that means anything to me.
On those services where I will pay 50% or more, I think long and hard about if I really need it. I research alternative methods that may be less expensive. I almost always attempt to make lifestyle changes before seeking the care.
Studies on the cost of procedures that are almost fully covered by insurance vs. those that are mainly out-of-pocket bear out that the exercise I describe is done all the time by patients. As a result, costs for those services that are mainly out-of-pocket grow at a slower rate, are more transparent, and are more logical in general.
In a Universal Care model, this grassroots understanding of pricing and lifestyle doesn’t exist. It has to be determined by the government through a formulary.
I’d rather control more of how my healthcare dollar is spent, but that’s just me.
On those services where I will pay 50% or more, I think long and hard about if I really need it.
You’re getting very close to understanding the problem. Now, for the last little bit of cognition, think about if you have no insurance. Now you’re looking at paying 100% of the costs. And lets say, that that chest pain isn’t so bad. Or that nasty cold you’ve had for 2 weeks that maybe is getting a little worse but it’s really not so bad. Or that cut that you got working at some small shop, that you probably should’ve gotten a stich or two put in but the supervisor said to just slap a bandage on it and get back to work, is maybe getting a little red and those lines running up your arm are just a little infection, not so bad. See the problem here? Has the penny started to drop? To people who live in gated communities and their biggest worry is will there be a capable caddy for tomorrows round of golf at the country club, the day to day problems of our health care system and it’s built in inequities, decisions aren’t about if it’s necessary to get treatment, it’s a matter of wanting treatment. I imagine DtM, that chest implants for you are something you want to think long and hard about but if it makes you feel better about yourself, I say go for it. Meanwhile, for those who will die for lack of proper treatment, oh well, they should’ve made better decisions.
DtM. Why wouldn’t you have insurance?
Many of the very same countries with national health care which have better metrics for life expectancy then the US have higher smoking rates. Facts belie your spurious comments.
First of all Lloyd, there is a distinct and fundamental difference between health care insurance and car insurance. People can choose to own a car. Health care is not a choice. You will sicken and die. Hopefully not for a number of years but there is no escaping the fact you will need some attention by several doctors and nurses in the future. They will strive valiently but futilely to keep you alive as long as possible. Some day, you will likely clutch your chest and go down on a knee. At that point, will you begin shopping around for an ambulance? Will you ask for the yellow pages through clenched teeth to find a good, affordable hospital? Of course not, there is not a free market for health care. Up to that point, you can make choices that will put that eventually heart attack further down your personal time line but that heart attack is inevitable. Sure, some people are over weight and some people shoot heroin but the thing that kills us all is time. By your logic then, peoples health care premiums would go up for every year we remain sucking air. Is that really what your advocating?
Yes Richard, that’s exactly what I’m advocating until the age of 60 where I think they should just lay down and die. I mean, I wouldn’t fix a clunky 60 year old car would I? (That was sarcasm, by the way.)
In any case I’m glad you agree with me that people aren’t cars but you haven’t explained why it wouldn’t drive costs down if you required everyone to have some form of health insurancem you allowed the price of that health insurance to be tied to risk and you allowed individuals and families to choose what insurer they wanted to go through. Why wouldn’t geico comepete with american family to bring you lower rates and create better packages (maybe one that didn’t require you to shop for an ambulance) like they do for auto insurance?
But that’s not even the point is it? Who does blue cross, or medica or whoever have to market their benefit plans to now? Employers, and the states right? Is an employer’s motivations or the states motivations the same as their employees’ or citizens? Do employers have a greater incentive to service or to bottom line costs? How about the state governments that regulate insurance?
Now answer this, why would a government run, non profit, managed, subsidized (whatever) system have any more incentive to service over costs than an employer or a current insurance company? Outside of an inate sense of goodness, they wouldn’t, would they.
How would any system you would propose differ from the current system where the money comes out of your paycheck and is sent to the insurer who may or may not pay the hospitals for the care you were given? Wouldn’t it be virtually identical with the government becoming the place where your money is sent instead of the insurer? Wouldn’t the government now be in the position of improving or denying service? If they must decide prior to service, what would ensure that the ambulance came in time and if they approved afterwards, what would ensure you wouldn’t have to pay out of pocket for unapproved care? How is that different from now?
What experience does the government have with insurance and healthcare? Would this be managed by congress or the executive (I’m reasonably certain no one would suggest the judiciary) and under what authority would it be. In what way would this be dramatically different from medicare or the VA hospital system other than it being the primary option for everyone?
Would congress or the executive hire a bureacracy to manage the state run insurance companies or would they authorize existing hospitals and health insurers to manage these plans under the government’s strict oversight? Wouldn’t that actually result in higher costs and worse service because you would be paying for an entirely new layer of bureacract and red tape to work through?
What market pressure would be able to be brought to improve services that would now be soley provided by the government or some gse that manages healthcare now? With the knowledge that they could prevent any competition through regulation or law, would the government or gse be more or less inclined to allow competition to their services? In cases of dispute, would the judiciary then be called on to act as HR mediator? Which laws would they use to decide legal coverage.
Show us naysayers how much you guys thought about this. We’re willing to admit the complicity in doctors, insurers, employers and states in this so feel free to blame them in your solution but off the table are “Republicans”, “Democrats”, “Liberals” and “Conservatives”. You have the burden of proof that this will be better, cheaper and faster than the current system so try to answer any of the questions above without using labels or slogans. Right now, I think your using a lot more magical thinking and emotion than reason but I’m willing to be proved wrong.
The answer to all your questions on the topic can be found by going to this link.
http://hr676.org/
I personally believe the state sound get ahead of the curve on this and implement a Minn Care system for all Minnesotans and let the rest of the country follow if they wish. In fact, by taking a state by state approach, we would have 50 different labratories to come up the best possible system for everyone. See, there’s the thing. Everyone, is the key word in all of this. Universal coverage, regardless of station or income. Health care for poor pregnant women. Health care for every child. Health care for the laid off factory worker. These people are the ones that need help. It’s not those who are worrying about it costing a bit more. Imagine every wage earner in the country, instead of paying into one of 1300 insurers, paying taxes to either state or federal for health care. Single payer is the only system that will fix all the problems.
No, that doesn’t answer any of my questions because I asked YOU to answer them. How much have YOU thought about this. Dont send me some bill that the people who will vote on it wont even read. Tell me why YOU have the burden of proof that this will be better, cheaper and faster than the current system because YOU are the one advocating the change. Explain why YOU have concluded this because your still not showing your work.
State by state is great. I couldn’t agree with you more. So why are you so in a ruch to get something done federally that would remove even that option?
“Single payer is the only system that will fix all the problems.”
You kind of had me until you said that.
Changing the payer changes the payer. That is one portion of the problem. It doesn’t address the delivery model. That is a larger chunk of the problem.
Assuming that you hadn’t said what you said about “fixing all the problems”, and I was still listening, what kind of revenue source would you suggest would pay for this?
The payer is all of us. Every wage earner in the country paying into a fund instead of employers or individuals paying into insurance companies. Nothing else need change. Hospitals and doctors will not become owned by the federal government. Bureaucrats will not be making health care decisions. Hospitals and doctors will see a much easier system of getting paid though and every citizen will recieve much better care. Preventative care will become the norm for everyone instead of just those with enough money. See my post from 12:39 for more details.
Fair enough, I’m open to new ideas.
I could have my arm twisted to try this at the state level as I believe you suggested above. I’d want it to be a state pilot that lasted for 3 years. At the outset, there would be desired metrics in place that we would all agree on. A nonpartisan, small panel of healthcare experts would monitor the program vs. those metrics. If those metrics hadn’t shown significant improvement over the current system after 3 years, the program would be eliminated altogether.
I’m not afraid of a good government program. I’m afraid of a bad government program that becomes permanent.
http://www.muhcc.org/
There’s the link for the Minnesota plan. HR 676 is the legislation being put forth at the national level. Write your congressmen and senators with your ideas and support.
I would not support this at the federal level, but would consider it at the state level. I believe in federalism, and I’d like to see 50 different good ideas come up that we can compare against each other as someone above suggested.
Plus, I think the inertia of failed policy is harder to correct at the federal level than at the state level. I wouldn’t trust our federal government to be nimble in fixing and critical in ending a program if need be.
But I would consider support a state initiative if it ever comes up.
I would just add that my expectation of going with a state plan like this would not be that it would solve all problems; it would be that we could cover everyone in our state and begin to make a dent in costs.
There would still be major overhaul needed with our delivery system, and I think a stronger component of consumer-directed health in this plan would be part of that.
Anyone who thinks that simply changing the payer will fix the multitude of problems in our system is kidding themselves. It may fix the coverage problem. It could be one of several components in our cost issue. But let’s have realistic expectations about what it will and won’t do.
So I take it you didn’t read the bill. Okay, I understand that it takes effort sometimes to understand an issue and ignorance is much easier then knowledge.
Tell me why YOU have the burden of proof that this will be better, cheaper and faster than the current system because YOU are the one advocating the change.
First of all, from personal experience I know this will be a better system because there will be universal coverage. Having recently attended a funeral for a friend who died of cancer. Not one of those celebrity, exotic cancers where the patient wages a heroic battle against a strain that has a 99.99% kill rate. Nope, this was your everyday, run of the mill colon cancer. While it’s nothing to sneeze at, the kill rate is in the low teens if caught early. There’s the rub. Our friend didn’t have insurance. She knew something was wrong but because of the costs, she decided she could tough it out. She didn’t go easy. Pain and suffering for months while doctors tried to play catch up. If she had insurance, it’s possible the outcome would’ve been the same, but I can’t help thinking that if she had gone to a doctor two years earlier, I’d still have my friend.
Cheaper,, I don’t know about that, maybe, but let’s just try for equal to what we’re paying now. The following is taken from the web site — Physicians for a National Health Program
http://www.pnhp.org/facts/what_is_single_payer.php
Let me site just a few passages:
All Americans would receive comprehensive medical benefits under single payer. Coverage would include all medically necessary services, including rehabilitative, long-term, and home care; mental health care, prescription drugs, and medical supplies; and preventive and public health measures.
I would add Dental to that.
Hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the government to cover operating expenses—a “global budget.” A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc.
The program would be federally financed and administered by a single public insurer at the state or regional level. Premiums, copayments, and deductibles would be eliminated. Employers would pay a 7.0 percent payroll tax and employees would pay 2.0 percent, essentially converting premium payments to a health care payroll tax. 90 to 95 percent of people would pay less overall for health care. Financing includes a $2 per pack cigarette tax.
And employers would be paying much much less, and not subject to the uncertainty of what next years increase will be to their health plan.
Medical endorsements include PNHP (9,000), the American Public Health Association (30,000), American Association of Community Psychiatrists, Massachusetts Academy of Family Practice, American Medical Women’s Association (13,500), Alameda-Contra Costa Medical Society, American Medical Student’s Association, D.C. Medical Society, National Medical Association (6,500), American College of Physicians (Illinois Chapter), Long Island Dermatological Society, Islamic Medical Association, American Nurses Association, the Nurses’ Network for a National Health Program, and the D.C. chapter of the American Medical Association.
This is just one proposal. There are several different flavors of this particular ice cream but the bottom line is removal of the insurance industry from the equation. The idea that you can treat health care like a commodity or apply free market rules is a complete fallicy, foisted upon us by the insurance industry and their bought and paid for legislators.
That’s great Richard. You just substituted some website’s copy for your own personal thought. While I’m terribly impressed with your depth of google skills and your patience in being the only one in your district to have read HR 676 (including your representative) you’ve failed to address any of the legitimate concerns about a single payer sytem. I know of anyone on the this site you will best represent a cogent and reasoned argument so if you would please, do me the favor of answering the following concerns we may be able to come to some agreement. (We do ultimately want agreement, dont we?)
“…you haven’t explained why it wouldn’t drive costs down if you required everyone to have some form of health insurance and you allowed the price of that health insurance to be tied to risk and also allowed individuals and families to choose what insurer they wanted to go through. Why wouldn’t geico compete with american family to bring you lower rates and create better packages (maybe one that didn’t require you to shop for an ambulance) or one that provided routine screening and preventetive care like they do for auto insurance?
But that’s not even the point is it? Who does blue cross, or medica or whoever have to market their benefit plans to now? Employers, and the states right? Is an employer’s motivations or the states motivations the same as their employees’ or citizens? Do employers have a greater incentive to service or to bottom line costs? How about the state governments that regulate insurance?
Now answer this, why would a government run, non profit, managed, subsidized (whatever) system have any more incentive to service over costs than an employer or a current insurance company? Outside of an inate sense of goodness, they wouldn’t, would they.
How would any system you would propose differ from the current system where the money comes out of your paycheck and is sent to the insurer who may or may not pay the hospitals for the care you were given? Wouldn’t it be virtually identical with the government becoming the place where your money is sent instead of the insurer? Wouldn’t the government now be in the position of improving or denying service? If they must decide prior to service, what would ensure that the ambulance came in time and if they approved afterwards, what would ensure you wouldn’t have to pay out of pocket for unapproved care? How is that different from now?
What experience does the government have with insurance and healthcare? Would this be managed by congress or the executive (I’m reasonably certain no one would suggest the judiciary) and under what authority would it be. In what way would this be dramatically different from medicare or the VA hospital system other than it being the primary option for everyone?
Would congress or the executive hire a bureacracy to manage the state run insurance companies or would they authorize existing hospitals and health insurers to manage these plans under the government’s strict oversight? Wouldn’t that actually result in higher costs and worse service because you would be paying for an entirely new layer of bureacract and red tape to work through?
What market pressure would be able to be brought to improve services that would now be soley provided by the government or some gse that manages healthcare now? With the knowledge that they could prevent any competition through regulation or law, would the government or gse be more or less inclined to allow competition to their services? In cases of dispute, would the judiciary then be called on to act as HR mediator? Which laws would they use to decide legal coverage.”
I really would like to know if you have an answer to any of these questions. Do you?
That’s a lot of questions Lloyd and it’s apparent now you either lack the skill or ambition to answer them for yourself so I will do my best to illuminate you.
you haven’t explained why it wouldn’t drive costs down if you required everyone to have some form of health insurance and you allowed the price of that health insurance to be tied to risk and also allowed individuals and families to choose what insurer they wanted to go through.
Administrative costs would go down by an estimated 30%. That’s not just from the web site, that’s confirmed by a hospital CFO who is a personal friend of mine, says that figure is accurate. Hospitals and doctors have to wade through a maze of policies and insurers for billing information about what’s covered and how much, then the payment is delayed, then claims have to be resubmitted, then the balance has to be billed to the insured, then and so on and so on. That’s just administrative costs. Another major cost savings would come in from the universal coverage for preventative care versus emergency care. It’s much cheaper to treat a cold then pneumonia. The uninsured typically do not go to the doctor as soon as they ought. They wait until their situation becomes intolerable then go to the emergency room. Now the costs of treatment are often many times what they would be had the patient gotten the problem dealt with at an earlier time. And since the patient is uninsured or under-insured, the hospital bears the burden for that treatment. Those costs get passed along to the insured driving up costs for insurance, driving more people off the rolls of the insured. It’s the death spiral our health care system is trapped in.
As far as the “tied to risk” part of this. The system you are seemingly advocating would empower the insurance companies to raise rates based, not only on personal choices, but on econmic status, geographic location, geneticss and any number of factors tied to some actuary table. In essence providing these companies the ability to cover only those that the company wished to cover. Thereby driving more people off of the rolls. Thereby accelerating the death spiral. Get this concept into your head somehow. For the insurance companies, there is no risk. It’s not a gamble. Everyone will sicken and die. There is no free market model. It’s like air. If you get it, you will live longer.
Why wouldn’t geico compete with american family to bring you lower rates and create better packages (maybe one that didn’t require you to shop for an ambulance) or one that provided routine screening and preventetive care like they do for auto insurance?
The short answer is because they don’t have to. It’s a captive market. I don’t get to choose which provider my employer uses. I only get to choose which employer I work for. When employers are competing for workers, they have to “sweeten the pot” with better health care plans. In today’s working environment, not so much. I have never shopped for insurance at that level so I’m not sure how it works but I’m going to go out on a limb here and guess that the market is largely rigged and the costs don’t vary much more then 10 or 15% for similar coverage. Now you throw in executive percs, kickbacks and any number of other quasi-legal tactics and you get medical coverage for your employees. Which they have to pay a good amount of their paycheck for the priviledge of having. Which they had no say, at all, in purchasing. This begs the question, then, how much more competitive would our nation be, if employers were no longer responsible for providing health care insurance?
Who does blue cross, or medica or whoever have to market their benefit plans to now? Employers, and the states right? Is an employer’s motivations or the states motivations the same as their employees’ or citizens? Do employers have a greater incentive to service or to bottom line costs? How about the state governments that regulate insurance?
I answered the bulk of that in the preceding paragraph but again, this begs a question. How much is the insurance industry spending on marketing and advertising? Would executive compensation be tied to the success of those marketing efforts? Is that how Bill McQuire got his billion dollar salary?
why would a government run, non profit, managed, subsidized (whatever) system have any more incentive to service over costs than an employer or a current insurance company?
This is an easy question. Because we own it. It’s ours. It makes us more competitive. It’s the moral thing to do.
How would any system you would propose differ from the current system where the money comes out of your paycheck and is sent to the insurer who may or may not pay the hospitals for the care you were given?
None of the money coming out of my paycheck would go to an executve making 4000 times what I make. None of the money coming out of my paycheck would go to pay for some advertising campaign. None of the money coming out of my paycheck would pay for a multimillion dollar junket in the Cayman Islands.
If they must decide prior to service, what would ensure that the ambulance came in time and if they approved afterwards, what would ensure you wouldn’t have to pay out of pocket for unapproved care?
You really think the profit motive drives that? Again, we will own this. We will decide. Government is not some separate entity. We are government.
In what way would this be dramatically different from medicare or the VA hospital system other than it being the primary option for everyone?
I am not sure it would be dramatically different. Why would it have to be? It would differ in scope but there are a number of different systems out there that could fall under the umbrella of Universal single payer we could look at as models. Frances system is regarded as one of the best. Sweden and Norway have slightly different but very highly regarded health care systems.
As for the rest of your questions, those are details which will be worked out, then reworked. I hope this helped your understanding. You will have to do the rest of your research yourself and toward that, I would recommend reading Kip Sullivan. He has written extensively on this topic and has the most common sense approach in my opinion.
I’m familiar with Kip Sullivan’s opinions. He is knowledgeable, but he seems more hellbent on covincing everyone to go with single payer than discussing varying points of view with an open mind. He also seems to assume that Medicare is a model worth following in much of his work, a deeply flawed assumption.
I’m much more a fan of Zeke Emmanuel. He leans left, but has much more of an obective researcher slant to his work. He includes elements in his plan that he didn’t expect to at the outset, but his analysis indicated that is was the right thing to do so he did.
The minute the Obama administration adopted Emanuel’s plan, you’d be SCREAMING nepotism.
You really have no idea that you just recited the very points that I was making earlier, as though disagreed with them. I’m not laughing at you because I genuinely want to learn how someone of your political persuasion would answer some of these questions. I have a hard time understanding how you people make these big leaps in faith you the ability to ask these basic philosophical questions is wonderful.
So we agree that requiring everyone to buy health insurance will drive down costs. We also agree that employers dont care whether the plans they buy for you are any good, they care how much they cost. We also agree that insurance companies really only market to employers so what they market is more about the bottom line than it is how good their service is.
I personally believe that employers use their benefits packages to screw employees out of just compensation and that insurance companies love not having to answer to the people they insure. I believe that medica and blue cross should have to start marketing their services to individuals the way that geico and american family do for auto insurance. I believe that the state has created a virtual monopoly by making only a handful of benefits providers eligible to provide benefits to employers and this monopoly of service has inflated the price of healthcare to the point that there are areas that can’t even afford the doctors, let a lone the insurance that will pay them.
I’ve asked you to consider that a single payer system would not address any of the above issues in the way you believe it will. In a single payer system the virtual monopoly is replaced with an actual monopoly. You’ve refused to address the very real fear that should at any time the ONLY payer refuses to pay, if at any time, the ONLY provider refuses to provide, most people will have no recourse at all.
Your entire support for single payer rests on one single assertion of faith:
Q: “why would a government run, non profit, managed, subsidized (whatever) system have any more incentive to service over costs than an employer or a current insurance company?”
A. “This is an easy question. Because we own it. It’s ours.”
Just like it’s our Army? Did you support the war in Iraq? It was your Army so you must have had a say in that, right?
Whether you realize it or not, you’re advocating the creation of a government run monopoly on healthcare where altruism is what keeps the system accountable to those it serves. I advocate a system that’s accountable to the people and if the people feel they are underserved a profit motive exists for some one else to serve them.
So we agree that requiring everyone to buy health insurance will drive down costs.
No, I maintain removing the insurance industry from the equation is the only practical solution.
We also agree that insurance companies really only market to employers so what they market is more about the bottom line than it is how good their service is.
I assume your talking about the insurance companies bottom line which is to say, maximizing profits. That means paying out as little as possible. That means providing as little service as they can get away with.
You’ve refused to address the very real fear that should at any time the ONLY payer refuses to pay, if at any time, the ONLY provider refuses to provide, most people will have no recourse at all.
This fear you bring up can be addressed by looking at the rest of the first world nations, all that have some sort of single payer, government sponsored, health care system. Do you hear any news concerning wide spread movements in any of these nations to adopt a US style system?
Just like it’s our Army? Did you support the war in Iraq? It was your Army so you must have had a say in that, right?
You have just earned the title of “King of the non sequitor”. But let me try and address this ridiculous non point. Yes, I support the Army and it’s existence. What I don’t support is how that Army was used by an ex-blow head, dry drunk war criminal. That is in in the process of being addressed.
“I assume your talking about the insurance companies bottom line which is to say, maximizing profits. That means paying out as little as possible. That means providing as little service as they can get away with. ”
Yes, that’s precisely what I mean. The insurance company’s customers are not those that they insure. If the people that carried that insurance were actually there customers, is it at least conceivable that the insurance companies would need to address do something more than provide as little service as possible? Is it not at least conceivable that they would have to be responsive to their customers needs because if they weren’t there customer could switch to another plan?
Do you actually believe the government will never be faced with a situation where the cost of services are a concern? Do you honestly believe that there will never be rationing in a single payer system? Do you not think service will at somepoint be limited to people with the approved diet and excercise? Honestly? You bring up other countries’ systems but why is it that the united states is the premier destination for care and training if the systems are as advanced as you say. I wont deny that they have great health benefits in some other countries but those other countries aren’t even the size of california and california has driven itself in the ground trying to emulate those countries - and it hasn’t been for lack of money or taxes or smart people like you saying “trust me, I know this will work”.
I’ve really enjoyed this discussion and I’m greatful for your efforts but I’m still not quite sure why you think trading one monopoly for another is going to actually improve the healthcare and lower costs. It will certainly provide a certain level of coverage for all but that level will be subject to the very same pressures it is now but we’ll no longer have the option of opting out. Unless it is to go to another country or boutique clinic as they do today in Europe - the rich and powerful will always have the best - the rest will get what they give us.
Lloyd,
The cost of services will always be a concern for any payor. It is a question of value and right now we are now getting value in health care that is commensurate with cost. That is primarily because increasing cost increases profit which is the focus of the industry right now. Outcomes of care are not generally tracked because it is not profitable to do so. That was the original point of this post. Pharmaceutical companiies market profitable drugs directly to consumers without comparisons related to cost effectiveness. Sometimes the same drug company will have a related or even identical drug on the market that is cheaper and in every other way equivalent in effectiveness. A good example is pain medications. Acetaminophen is generic. Tramadol is generic. Both are cheap. Ultracet is a combination of the two. It is not generic and not cheap. Ultracet is marketed heavily. Acetaminophen and Tramodol are not. It is more profitable to market the fancy new name.
There are thousands of examples like this and yet the practice continues. Marketing of pharmacueticals is profit based, not science based. The same situation exists in the device business. Names are sold, not outcomes.
Do I honestly believe there will never be rationing in a single payor system? I never say never but it is unlikely that effective treatments will be rationed. I do believe that you may have to pay for your own coffee enemas and that an MRI won’t be available just because you want one. The best healthcare is the least expensive care in the long run and a single payor non profit system will take the long view.
The Mayo Clinic and a few other well integrated institutions may be premier destinations for health care but people throughout the world get by well on what they have. Better than us in many instances. And the notion that all of the best technology is developed in the US is erroneous. Some of the finest drugs and technology come out of Europe. It is more profitable for some of the international companies to do business here however. It is also common for foreign investors to buy into our highly profitable delivery systems, like Surgery Centers, Imaging Centers, etc where we market profitable procedures and the expense of integrated health care.
Perhaps the rich, like Michael Jackson, will always have access to the care they want but a single payor system is likely to provide all of the highest quality care that you and I may need.
You worry that trading one monopoly for another won’t improve things? We don’t have a monopoly now. We won’t have a monopoly with single payor. Care is delivered by many competing sources and drugs and equipment are, and will continue to be as well. When payment is tied to outcomes and not profit, competition will reduce cost and improve quality.
You worry about not being able to “opt out” of a public payment plan”. It is unlikely that you would want to but nonetheless, the nearly universal fear right now is that you can be “opted out” of a private plan at the whim of the payor, with the loss of a job, with the development of an illness, etc. This is one of the most liberating features of a public plan. You are free to make job choices, moves, reproductive decisions etc without the fear of losing your health care coverage.
Ron -
One clarifying question — will the public plan impose any restrictions whatsoever on the deliver of care? For example, if, as a doctor, I realized that patients covered by the public plan were causing my practice to operate at a loss, could I stop seeing them? Or would I be mandated to accept them?
DantheMan,
I do not believe that a public option that included a broad risk pool would need to reimburse at a rate less than what the private plans pay now.
I saw a patient in the clinic today. He was a young Canadian man in his late 20’s. He suffered a herniated disc in a work comp injury. His injury was denied by the work comp insurance carrier and he was forced to get an attorney to fight it. He was fired by his employer because of this injury. This does not relieve the work comp carrier of the ultimate responsibility of paying for his care but that won’t be known for a couple of years because it will ultimately be decided by an administrative law judge. It does send the message though to other employees to think twice before filing a work comp claim. In the mean time, he was bankrupted by the loss of his job so his care is being paid for by the taxpayer through Medicaid. This is an example of how an insurer can deny treatment and place the ultimate risk on the taxpayer. Many people don’t have the energy to fight this and just give in.
If this man’s injury did not threaten his employer or if there was not an adversarial relationship between the insurance carrier and the patient he would be back to light duty by now and back to full employment in a month or two. Because of the delays related to the insurance companies denial and because his employer fired him; preusumably to send a shot across the bow to other employees who might file a claim, society will pay the costs of his care and his unnecessarily protracted time off work. Several years from now some of the lost income and the cost of the care may be recouped by the patient and the taxpayer when this case is heard by an administrative law judge, but only after the lawyers on both sides get their share. This is an extremely inefficient and costly way to practice medicine.
Another interesting point is that he has weakness and numbness in his leg that may be permanent now but may well have been prevented if he had not been forced to wait over a month for treatment by an employer and an insurance company that denied treatment to prevent short term cost and thereby probably contributed to long term nerve damage. This is why it is unlikely that a single payor system would deny or underpay for proper treatment because the loss of productivity and the loss of function by the worker is more costly in the long run than the cost of surgery and rehab.
Finally, as I mentioned, he grew up in Canada. He just wants to get back to work and is completely baffled about how an illness put him into financial despair. He said that he is one of five kids and that he does not recall a single time in his childhood that his family had a concern about health care. He said that in the few years that he has lived here he hasn’t needed health care so he never gave it a thought here until he herniated that disc. Now one relatively simple medical problem has lead to this. I asked him which system he preferred and he just laughed.
I am sorry if this sounds concocted. This all happened today.
Again, thanks for this dialog. Especially your last post where the tone was very cordial. I think when we don’t look at others with opposing viewpoints as enemies we can actually get a better grasp of the big picture. You’ve helped me immensely with your responses and I hope I’ve been able to provide some insight into the conservative mind as well.
As I’ve stated, I’m not sold on the single payer system and I think it’s going to be a terribly hard sell to get it implemented in the forseeable future. There is always the chance but we will likely just be given another porky bandaid plan that will allow everyone in washington to go home and say they did something.
My question is whether you would support anything short of a single payer system. Be it the success of the left’s efforts to educate us all on the greed and corruption of major corporations or my own ability to reason it out on my own, I’m convinced that the current system is “rigged” against the people that need it. I get it. I’m on board for cutting the bastards down to size. (We really do agree on that, don’t we?)
With that said, I realize that those bastards (as greedy as they are) already have the knowledge and infrastructure to deliver healthcare to everyone and even with a full government take over (which no reasonable person is really advocating) they are still going to be involved because of it. Sure they may have more rules to make them accountable to the taxpayer or something but they really aren’t going to change who they are or what they are. Their money has secured them power and their power will protect their money.
Would a fair compromise to a single payer plan not be to remove all the protections that these major companies enjoy? At one point, you almost seemed to agree that the collusion between employers and insurers has more to do with rising costs and lousy service than most anything else. Would it not be a fair compromise to provide tax deductions to families that buy their own insurance and tax credits to those that can’t afford them. The same federal witholding standards could make this easier and it would spur a whole host of new industries designed to deliver care. (Kind of like green jobs for healthcare.) I don’t like the idea of providing tax credits or stipends because there is a tremendous opportunity for fraud and abuse but the fact remains that stuff happens and we you cant remove a safety net for the jumpers without also removing it for the fallers.
Furthermore, if as you suggested earlier, this was done at a state level where the blend of deduction and credit was closer to the people, wouldn’t it be more responsive to the needs of the people it was intended to serve than if it were run federally?
I ask this because I know I’m not gonna get a system where everybody takes care of themselves and they leave me the hell alone. I dont even want a system like and even if I did, that isn’t what are government was designed to do. I’m wondering, if the event that you aren’t able to get would you want (cradle grave coverage under a centrally managed single payer system) would you be willing to ever meet somewhere in the middle - and where would that middle be?
“My question is whether you would support anything short of a single payer system”.
I would say that I would not advise something less than a single payor system but I would support a public option that competed directly with private insurance if that is what it takes to convince people that profit driven insurance is more costly. I believe that this is a back door approach and it will prolong the inevitable because it will soon be obvious that this is the most cost effective solution.
Conservatives wonder where the money will come from. I am an administrator in a business that pays 100% of the costs of it’s employees health care. For twenty employees that is $320,000 in premiums and HSA contributions plus short and long term disability insurance, FICA, and workers comp insurance. That is an enormous pool of money for such a small number of relatively healthy employees and their families. In addition to that cost, our business and my employees pay taxes that support the current government contribution to health care payments. I haven’t taken the time to determine what the total sum that my business and my employees ultimately contribute but you can see that it is substantial. That is where the money would come from. Since, as a nation, we pay over 16% of GDP for health care, the money is already there. The problem isn’t where the money will come from but how the money is spent.
If you read my comments to DTM earlier, you can see that in the case of workers comp, much of the waste is in denial of treatment, delay of care, unnecessary litigation, and lost productivity. That is only one small segment of the problem. The original post here about direct marketing by pharmaceutical companies points out another area where marketing trumps reason and science and increses the cost of care without commensurate benefit. With the private insurers, the most costly problem is that they pass risk to the government programs and allow the costs of uninsured care and inadequately reimbursed public care to be cost shifted in the Hospitals and passed on to the employer based programs and private policies. They allow this because it forces more money to be funneled through them and their income is derived from that flow of money. The more that comes in and the less that goes out the more they profit. That is why they have shown little interest to date in tracking the outcomes of care and why they tend to favor payment for costly intervention rather than cost effective prevention. This cost is an enormous hidden tax on all of us.
If your interest lies in quarterly profits derived from the health care industry as it exists today then you would want to maintain the status quo. If you are fiscally conservative and believe that universal access to health care is a long term benefit to society and the costs of the system should be commensurate with the value derived from it then you would ultimately support a single payor system. Based on the experience of all of the other industrialized economies and even some of the less industrialized ones, it is clear that we can offer universal coverage with better outcomes for much less than the cost of the current system. If we are content to continue to spend over 16% GDP then we can be the envy of the world and make everybody happy in the long run.
The compromises that I think are sensible and desirable are that the Doctors, manufacturers of devices and drugs, and hospitals should all remain privately held and should compete amongst themselves based on quality and cost. I would also have the pools of money used to pay for health care managed individually by the States so that there continues to be competition for quality on the payment end. I believe that it would be unwise to allow such an enormous pool of money to be managed by a single entity like the Federal Government. It is always a risk to put such power in the hands of a small central group. Federal mandates regarding the scope of care and the standardization of payment processes and reciprocal agreements between the States would be good but one big pool of money wouldn’t.
Over 70% of Americans want serious reform in this system. You really have to ask yourself who benefits from the current system. It is obviously not the majority of Americans.
A wonderfully thoughtful response Ron. I agree that the money to do this is already there and the problem we face is just getting that money spent wisely but we’ll just have to agree to disagree that a government is equipped to handle that challenge. I struggle to think of an area where a government (at least our government) has had success in spending money wisely. We don’t need to refight this battle but while there may not be a profit motive for government there is still the profit motive for the many friends of government and they are pretty much the same one running things now.
It would be interesting to see how well a public option competed with a private one. I would fully support such a plan if we could ensure a fair fight between the two but I’m not sure how such a thing could be done. Would you support an apples to apples, no holds barred cage match that pitted my private systems reforms against your public system reforms? (We could never do this but what’s the harm in theorizing, right?)
Here are the rules I’d propose to make this a fair fight.
1.) IF an employer pays for their employees healthcare that healthcare is taxed at the normal income tax rate. (Meaning Employers would have to declare exactly how much they pay out in health benefits per employee. In this way the level and cost of service becomes a negotiating point for both parties and the state is provided additional money for the under-priveledged’s vouchers.)
2.) IF an employer does choose to pay for healthcare, while their employees will have that healthcare taxed as income, they would be able to deduct the cost of that healthcare (along with the entire wage paid to said employee) from their quarterly tax bill.
3.) IF an employee chooses not to take the company plan (in which case employers should be expected to pay out the sum that would be spent on their health insurance, or if no company plan is offered employers would still be required to help facilitate withholdings that could be directed to the plan of the employee’s choice.
4.) Any out of pocket money spent on healthcare (copays, hospital visits, monthly premiums would be tax deductible.
5.) Employees would be able to choose between any insurance carrier in the country including any state’s public plan.
6.) Both private and public plans must be funded in the same way (on premiums) though those premiums may be paid by needs based state vouchers.
7.) The federal government can not interfere by creating a plan of its own or attempting to regulate any state’s private or public plans.
8.) States can not use their powers of regulation to impede the private plans and any regulation on said plans would apply to the public plans as well.
In the Right Corner we have the For Profit Private Plans that market directly to the consumer and are no longer able to hide their costs or their profits. They must stand on their own and face the pressures of competition from by consumers that are no longer in a captive market because they can shop outside of their state.
In the Left Corner we have the Not For Profit Public Plans that also market directly to the consumer and must compete with the private plans as well as other state’s plans (should they wish to offer them). They cannot dip into the public coffers to more service at a lower rate because that would be breaking the rules set above.
The contest is to see who can best provide the service, education and care necessary for a healthy populace at the most affordable price. The winner will be the consumer.
Sound like fun Ron? Frankly I wouldn’t care who won the battle. If the public plans were required to be self sufficient, I might even find myself rooting for (and buying from) them. I just want a fair fight and I want apples to apples benchmarks. If they can assure us of that I;d buy in. Unfortunately all our reasonable discussions are for nought because Washington is about ready to decide all this for us. Oh well. It was a fun mental excercise.
“Oh well. It was a fun mental excercise”.
Not really Lloyd, it is a lot of work and not much fun at all to argue endlessly for something as fundamentally right and necessary as universal health care only to be stymied by public apathy and the enormous lobbying ability of the corporations that control this issue.
You can cop out and think that you are letting “Washington” decide this but it is the electorate that ultimately allows the industry to maintain this control and the electorate is us.
I don’t do this for fun Lloyd. I also don’t believe that I am powerless. I believe that it is the voters who ultimately share accountablility for what we get from Washington or any other seat of state or local government. Discussion is necessary for citizens to to develop informed opinions. That discussion was preempted by a massive disinformation campaign in the 1990’s and it may well happen again. when you defer to Washington you diminish your own role in all of this. If you feel strongly, take a stand. You are clearly questioning the position the republican party has taken on this issue in the past but you stop short of committing to an alternative. If you think that a public option is a viable alternative say it. I don’t need any contests. I already told you I think that single payor is superior but a public option competing on an even playing field would be acceptable. That is unequivocal and irrespective of what any group of politicians in Washington might do.
I personally don’t think a public option is a viable alternative but even though I’m unconvinced I think proponents of universal health have made a compelling enough argument to try a public option in order to prove such a system would work. I’m not willing to yield to socialized medicine and you aren’t willing to yield to a laissez faire system supplemented by hardship vouchers. I just offered the above as a compromise solution that could help settle the matter of which system would work best on a national level.